The Top 6 Examples of Quality Improvement in

Healthcare
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Hospital systems across the country face a number of pressing problems: clinical
variation, preventable medical errors, hospital acquired infections, delays in patient
discharge, and dwindling cash flow. While health systems need to consistently innovate in
order to tackle these problems, many quality improvement projects fail to deliver on ROI.

While there are many different definitions of quality improvement, the Health Resources
and Services Administration (HRSA) defines it as “systematic and continuous actions that
lead to measurable improvement in health care services and the health status of targeted
patient groups.” In addition to a practical definition, health systems need a roadmap to
help guide successful quality improvement projects forward.

Health Catalyst has focused on helping health systems identify, prioritize, and succeed in
tackling quality improvement projects since 2008. With the right evidence, analytics, and
methods, providers and improvement teams can transform healthcare, improving the
quality of care delivered to the patients they serve and the bottom line. Health Catalyst
offers a roadmap to use best practice, adoption, and analytics together to drive outcomes
improvement. This article provides examples of quality improvement in healthcare that
may help others in their journey.

Clinical Examples of Quality Improvement in Healthcare

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Healthcare systems working to improve clinical quality face the difficult challenge of
aligning changes across the organization. But health systems can learn from successful
clinical quality improvement projects and implementing key principles of their success.
Below are three successful clinical examples of quality improvement in healthcare
covering a wide range of issues facing many health systems today.

1. Pharmacist-led Medication Therapy Management Reduces Total

Cost of Care
The first example is a recent project to improve patient outcomes and reduce cost
where Allina Health leveraged their analytics system to demonstrate the impact of their
pharmacist-led medication therapy management (MTM) in reducing the total cost of care.

In order to reduce medication-related adverse events the health system initially

considered expanding the involvement of pharmacists performing medication therapy
management (MTM) to a group of Medicaid patients covered by a shared-risk contract.
Before making this decision and developing a comprehensive business plan, the health
system wanted to better demonstrate the unique impact pharmacists were making on
patient outcomes. The health system leveraged its analytics platform and Health Catalyst
professional services to perform a comprehensive analysis. The analysis showed the
following results:

$2,085 mean total cost of care reduction per patient in the six-month period after
the first pharmacist MTM encounter; over $590,000 extrapolated out over 283
MTM patients.
12% reduction in hospital admissions per 1,000 members and a 10% reduction in
emergency department visits per 1,000 members.
Statistically significant decreases in average medication count.

The analysis demonstrated the unique, positive impact pharmacist medication therapy
management program is making on patient outcomes in the six-month period following
the pharmacist MTM. This program is effectively reducing the total cost of care.

2. Optimizing Sepsis Care Improves Early Recognition and

Outcomes
The second example of a clinical quality improvement project deals with an issue well-
known to hospital systems. Sepsis is a major driver of mortality in the U.S.–
it’s estimated that up to half of all hospital deaths are linked to the infection. Identifying
sepsis early can be challenging, as the patient’s physical response presents as a syndrome
of non-specific symptoms, which delays recognition, diagnosis, and treatment–all of
which increases mortality rates.

Mission Health, North Carolina’s sixth largest health system, had previously implemented
evidence-based sepsis care bundles. However, their processes for identifying patients with
sepsis and initiation of care was fragmented and varied widely across the system,

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negatively impacting outcomes. By using a comprehensive data-driven approach to
facilitate early sepsis identification and standardize the treatment of sepsis, including the
addition of evidence-based alerts, Mission Health gained insights into sepsis performance
to drive improvements. Using this comprehensive approach for early recognition and
treatment, they achieved substantial improvements in sepsis outcomes, including the
following:

1% relative reduction in mortality for patients with severe sepsis and septic shock.
9% relative difference in mortality for patients that received the evidence-based
protocols compared to those who did not—the evidence-based protocols
substantially reduce mortality.
4% relative reduction in emergency department (ED) length of stay (LOS) for
patients with severe sepsis and septic shock.
Four percent relative reduction in ICU LOS for patients with severe sepsis and septic
shock admitted from the ED.

The health system will continue to use this proven plan to improve sepsis outcomes and
enhance care for patients with sepsis and they are laying the groundwork to move the
early identification screening tools to the outpatient setting, including urgent care centers
and physician offices.

3. Boosting Readiness and Change Competencies Key to

Successfully Reducing Clinical Variation
This example of clinical quality improvement in healthcare comes from UnityPoint
Health, a healthcare system serving Iowa, western Illinois, and southern Wisconsin.
System leaders recognized the importance of reducing clinical variation and the need to
have strong physician champions and robust analytics to effectively support improvement
efforts. However, they also realized that without understanding organizational strengths
and weaknesses related to adopting change and improving outcomes, they would struggle
to successfully implement initiatives that delivered the desired benefits and sustained
improvements over time.

By consistently integrating information from a readiness assessment, an opportunity

analysis, and expert resources, the health system was able to establish a prioritization and
implementation approach to outcomes improvement that produced the following results:

Variable costs were reduced by more than $1.75 million based on the deployment of
interventions in sepsis alerts, order sets, and other clinical decision support tools.
Reductions in length of stay have allowed patients to return home earlier and spend
more than 1,000 additional nights in their homes.
Millions of clicks have been reduced for clinicians based on deployment of new
sepsis screening tools.
36% increase in sepsis screenings completed in the emergency department (ED).
Sepsis order set utilization in the ED has increased by more than 185 percent.

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The health system plans to continue identifying large improvement opportunities aligned
with its strategic planning cycle and the priorities identified by clinical and operational
leadership.

Financial and Operational Examples of Quality Improvement in

Healthcare
Financial challenges are increasingly threatening the future of healthcare organizations.
In order to thrive in an increasingly complex environment, financial and operational
improvement projects are more important than ever. But, health systems need to tackle
the right projects at the right time for their organization. Below are three excellent
financial and operational examples of quality improvement in healthcare.

4. New Generation Activity-Based Costing Accelerates Timeliness

of Decision Support
The first example comes from UPMC, an academic medical center affiliated with the
University of Pittsburgh. Health system leaders recognized that the common denominator
to addressing threats to sustainability is to fully understand and effectively manage costs.
To address this, they implemented activity-based costing (ABC), facilitated by the Health
Catalyst CORUS® Suite, to deliver detailed and actionable cost data across the analytics
environment, and support service line reporting, contract modeling, and clinical process
improvement. They used this capability to effectively drive cost savings and improve
clinical outcomes in many of its service lines, including Surgical Services, Women’s
Health, Orthopedics, and Cardiovascular.

Through its analytics platform and best-of-breed, ABC models, UPMC is improving
quality and safety, reducing costs, and increasing value across service lines. An efficient
accounting closing process delivers timely and accurate information to guide decisions
and operational adjustments. Taking these steps led to the following improvements:

Three-day reduction in time to close.

Monthly preliminary results are typically reviewed within one business day,
affording more time for validation and analysis.
Executives receive financial data up to three days sooner.
Reduction of 3.5 FTEs needed to complete the monthly close.
Reduced 60 human touchpoints and opportunity for error.
Multiple months of data can now be run simultaneously.
Provided support for new data-driven governance structure.

5. Systematic, Data-Driven Approach Lowers Length of Stay and

Improves Care Coordination
The second example comes from Memorial Hospital at Gulfport. The hospital was faced
with declining revenue due to changes in Medicare and Medicaid reimbursements.
Hospital leaders knew additional methods of providing more efficient and cost-effective

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quality care were needed to maintain long-term success. Improving and reducing length
of stay (LOS) improves financial, operational, and clinical outcomes by decreasing the
costs of care for a patient. It can also improve outcomes by minimizing the risk of
hospital-acquired conditions.

Hospital leaders embraced the challenge of reducing LOS to lower costs and lessen risk
for its patients. By adopting a systematic, data-driven, and multi-pronged approach,
Memorial has achieved significant results in one year, including:

$2 million in cost savings, the result of decreased LOS and decreased utilization of
supplies and medications.
47-day percentage point reduction in LOS.
Improved care coordination and physician engagement have successfully reduced
LOS.
The 30-day readmission rate has remained stable.
Three percent increase in the number of discharges occurring on the weekend.

6. Clinical and Financial Partnership Reduces Denials and Write-

Offs by More than $3 Million
The last example of financial and operational quality improvement projects comes
from The University of Kansas Health System. Despite previous initiatives, The University
of Kansas Health System’s claim denial rate of 25% was higher than best practice (five
percent). System leaders realized that, in order to provide its patients with world-class
financial and clinical outcomes, it would need to engage differently with its clinical
partners.

To effectively reduce revenue cycle and implement effective change, the health system
needed to proactively identify issues that occurred early in the revenue cycle process. To
rethink its denials process, it simultaneously increased organizational commitment,
refined its improvement task force structure, developed new data capabilities to inform
the work, and built collaborative partnerships between clinicians and the finance team. As
a result of its renewed efforts, process re-design, stakeholder engagement, and improved
analytics, The University of Kansas Health System achieved impressive savings in just
eight months, including:

$3 million in recurring benefit, the direct result of denials reduction.

$4 million annualized recurring benefit.
Successfully partnered with clinical leadership to transition ongoing denial
reduction efforts to operational leaders.

The Quality Improvement Journey

Healthcare systems working to improve care, reduce expenses, and improve the patient
experience face many challenges, including the need to align changes across many levels
of an organization. But the process of identifying, prioritizing, and implementing these
changes can be improved with the right tools and, process, and people. Once these three

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things are in alignment, health systems can tackle clinical, financial, and operational
quality improvement projects like the examples covered here and make incredible strides
in the clinical, financial, and operational health of the organization.

Everyone involved in improvement projects from doctors and nurses, to data analysts and
administrators are busy with other projects. Quality Improvement projects typically mean
additional work everyone involved. However, health systems have the ability to improve
care, patient experience, and save lives through quality improvement projects that reduce
clinical variation, preventable medical errors, hospital acquired infections, delays in
patient discharge, and improve the bottom line.

Additional Reading

Would you like to learn more about this topic? Here are some articles we suggest:

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Additional Reading

Would you like to learn more about this topic? Here are some articles we suggest:

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