Challenging Quality Improvement in healthcare

By Megan Paulson Explore Big Sky Staff Writer

On his way to a remote river expedition in Western China, Jason Moore and his group treated a Tibetan man suffering from life threatening injuries after a motorcycle accident. Using the tools at hand, Moore tied off the man’s femoral artery with an NRS boating strap and a t-shirt, and splinted his leg with an umbrella.

After an arduous 18-hour drive to the closest hospital in Xining, doctors reported Moore had saved the man’s life.

Moore works on the trauma and critical care team at one of the nation’s busiest Level 3 trauma centers. A PhD epidemiologist and physician assistant, he is Co-Director of the Intensive Care Unit at Vail Valley Medical Center in Vail, Colo.

Through his experience, Moore has learned self-reliance and a non-traditional view.

“It’s not money, power, intelligence or respect that is the most important thing in life. [It’s] perspective,” he said. “Perspective on any given situation is what allows us to see with clarity and overcome.”

With this background, he’s aiming to change the progression of Western medicine.

In healthcare, Moore says, a “top-down” approach typically applies generalized theories system-wide, something that’s not ideal because not all mandatory compliance measures are appropriate for all institutions and patient populations.

And while Moore believes research helps create a proactive approach to healthcare, that doesn’t mean he’s waiting for the next big paper to show medical professionals how to progress quality of care.

Instead, he believes institutions and individuals should actively explore how they care for people in their own communities and look into new areas and ways to improve. This is known in the medical field as Quality Improvement, a system Moore has been working to improve through his own research and applications at Vail Valley Medical Center.

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A July 2013 analytical survey from the Managed Care Information Center, a national healthcare consulting group, discussed quality as the secondary consideration in most cases, only moving to the front when it impacts either profits or public relations.

“This is not OK with me,” Moore said. “It is the responsibility of healthcare leaders to create systems that provide efficient and effective patient care.”

He maintains that the focus for healthcare must be on patient outcomes and containing costs through increased efficiency.

“It makes more sense to provide basic parameters for patient outcomes and allow institutions to focus more time on efficiency and system-specific issues, rather than allocating all of their dwindling resources on meeting often-irrelevant compliance mandates.”

Two nationally respected healthcare institutes support this theory.

The National Institutes of Health and the Agency for Healthcare Research and Quality both increasingly point to the combination of scientific and practical research as a means to successfully advance healthcare practice.

“It is time for hospitals to get creative, utilize relevant data, and not focus so much on a process for quality,” Moore said. “Create the culture, and the process will evolve to meet the demands of the system.”

But that approach has not been the industry standard.

The Institute of Medicine has its own approach to Quality Improvement – or QI – consisting of what it describes as “systematic and continuous actions that lead to measurable improvement in healthcare services and the health status of targeted patient groups.”

An independent, influential nonprofit that advises decision makers and the public, the IOM considers quality by looking at how an organization operates, defining healthcare performance by looking at the group’s efficiency, outcomes of care and patient satisfaction.

But to actually improve results and quality of care, Moore says a system needs to remain adaptable and change when needed. He believes successful QI programs incorporate a strong focus on four key principles: an institution’s systems and processes, patients, teamwork and data analysis.

According to Moore, it’s often hard to nail down the right questions to ask when addressing a QI initiative. He starts with the following:

– What is the actual problem?
– What are the factors, and how much do they affect the problem?

“Often the opinion of what the actual problem is varies among healthcare leaders,” Moore said. “Until this can be addressed, sustainable solutions will remain elusive, allowing quality to suffer and costs to rise.”

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Once the factors contributing to a problem are identified and weighted, then Moore says it’s possible to address them and implement a feasible action plan and determine how to best allocate resources.

His approach to QI has been successfully implemented at the medical center in Vail, where it determines the factors contributing to delayed surgical start times and creates a refined staffing model for patient care. Additionally, Moore has published research in peer-reviewed journals, and the August 2013 issue of the acclaimed Journal of Trauma and Acute Care Surgery, analyzing how snowfall and mechanism of injury affect injury severity among skiers and snowboarders from local resorts, to allow for better allocation of hospital resources like ICU beds on a real-time basis.

“Incorporating clinical experience, relevant research, data analysis and most importantly, making it easy for people to do the right thing, will lead to sustainable change in QI,” Moore said.

S. Jason Moore PhD, PA, is an Epidemiologist, the head of Quality Improvement, and Co-Director of the ICU, Vail Valley Medical Center in Vail, CO. To learn more about QI initiatives or for speaking engagements, visit sjasonmoore.com.