Many healthcare organizations don’t hold quality and cost gains because they don’t make improvement the backbone of their organization. Rather, they approach improvement as a series of initiatives. Ronald D. Snee, a fellow with the American Society for Quality states, “Many organizations focus on sustaining the gains only after improvement has been achieved. Intuitively, that may seem the correct sequence, but it is in fact backwards. The time to focus on sustaining improvement gains is well before the initiative is launched.” Here are 3 critical organizational steps that can help sustain those gains.

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© 2014 Health Catalyst
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How to Sustain Healthcare Quality
Improvement in 3 Critical Steps
By Cherbon VanEtten

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Improving Care Quality
Finding ways to improve care
quality while reducing costs is
essential in today’s healthcare
environment.
Many organizations focus on
sustaining the gains only after
improvement has been
achieved. Intuitively, that may
seem the correct sequence,
but it is in fact backwards. The
time to focus on sustaining
improvement gains is well
before the initiative is
launched.”
- RONALD D. SNEE, Ph.D.
American Society for Quality Fellow

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The Three-system Approach to
Healthcare Transformation
All three of these systems work together, but the deployment
system is essential to sustaining quality gains.

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Driving Sustainable Healthcare
Transformation
Without structure and processes in place to sustain quality
initiative, stakeholders tend to disengage. Many factors
are involved in this loss of momentum and focus, but the
most important are:
Teams are temporarily assigned to the project
A lack of clear accountability and decision pathways
Limited or no access to analytic resources
The inability to create broad buy-in for the change

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Aligning Organizational Resources
Establishing permanent teams, clearly designating
accountability, including analytic and clinical resources,
and involving every level of the organization ensures
broad understanding and support for the change.
1: The Clinical Implementation Team (CIT)
2: The Clinical Workgroup
3: Hospital Senior Executive Leadership

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Aligning Organizational Resources
Once a clinical work process
(for example, pregnancy) has
been prioritized for improvement,
the clinical implementation team
is assembled.
The team includes individuals
who represent every major step
in the care process (for example,
fertility; prenatal; L&D;
postpartum).
Each CIT member represents a
group of peers who fill the same
role in the workflow.
The Clinical Implementation Team (CIT)

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Aligning Organizational Resources
The workgroup is comprised of the CIT
leadership triad and content, analytic, and
technical experts.
This small, smart group does the legwork for
the larger team by assembling and
analyzing data and drafting tools like order
sets, treatment protocols, and value stream
maps.
Additionally, the workgroup has primary
accountability for studying the impact of the
improvement effort and bringing forward that
information to the CIT.
The Clinical Workgroup

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Aligning Organizational Resources
Understanding of a need for a
different approach and being willing
to make the necessary cultural
changes must start at the top.
It is difficult to surmount the
challenge of involving clinicians on
the frontlines of care in the process
of improvement if executives aren’t
completely on board with the
approach.
Hospital Senior Executive Leadership

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Aligning Organizational Resources
In practice, the deployment structure for sustaining clinical
improvements looks like this:

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The Clinical Implementation Team
is Permanent and Accountable
These teams do not disband at the initiative launch, nor
do they stop collaborating six months in; they are tasked
with and accountable for continuing to monitor and
maintain the improved process. Ongoing accountability
lies with the clinical implementation team.

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Sustaining Clinical Improvements
is Difficult but Possible
The structure presented here is a straightforward, proven method for
successfully rolling out and sustaining clinical improvement. All you
need is executive support, the right analytics technology, and a single
workgroup.
An experienced analytics vendor can provide guidance and tools so
you can learn how to structure yourself to become an improvement
organization.

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Other Clinical Quality Improvement Resources
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Cherbon VanEtten Director of Education, Health Catalyst Ms. VanEtten has 16 years of
health care experience in information technology and healthcare analytics. Prior to joining
Health Catalyst, she worked for MultiCare Health System as a Senior Project Manager
Professional (PMP) where she led numerous enterprise wide strategic initiatives –
including the implementation of a healthcare data warehouse and quality improvement programs.
She developed tools and methodologies to calculate ROI and total cost of ownership for IT
investments – including EHR and EDW systems. Ms. VanEtten was responsible for leading a multi-
disciplinary clinical team in developing content for computerized physician order entry (CPOE),
physician note templates and interdisciplinary plans of care. She earned her under graduate degree
in Psychology from the University of Washington and graduate degree in Biomedical Informatics
from Oregon Health and Science University.