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  • Quality Improvement Article
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The business case for quality improvement

Abstract

Value in healthcare can be defined as providing the optimal outcome per health dollar spent. Improving the value of healthcare for patients and healthcare organizations requires an understanding and evaluation of the costs and benefits. Investing in quality improvement (QI) work can bring about financial results for healthcare organizations over time, have beneficial organizational effects, and improve outcomes for patients. This article continues a series of QI educational papers in the Journal of Perinatology, and reviews financial and economic measures used to create the business case for QI. Ultimately, the business case for QI is better defined as a business strategy for success.

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References

  1. Institute of Medicine (US). Committee on Quality of Health Care in America. Crossing the quality chasm: a new health system for the 21st century. Washington, DC: National Academies Press; 2001.

  2. Berwick DM. A user’s manual for the IOM’s ‘Quality Chasm’ report. Health Aff. 2002;21:80–90.

    Article  Google Scholar 

  3. Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Aff. 2008;27:759–69.

    Article  Google Scholar 

  4. Porter ME, Teisberg EO. Redefining health care: creating value-based competition on results. Boston, MA: Harvard Business School Press; 2006.

    Google Scholar 

  5. Porter ME. What is value in health care? N Engl J Med. 2010;363:2477–81.

    Article  CAS  PubMed  Google Scholar 

  6. Kohn LT, Corrigan J, Donaldson MS. To err is human: building a safer health system. Washington, DC: National Academy Press; 2000.

    Google Scholar 

  7. Brooks RH. The end of the quality improvement movement: long live improving value. JAMA. 2010;304:1831–2.

    Article  Google Scholar 

  8. Øvretveit J. Does improving quality save money? A review of evidence of which improvements to quality reduce costs to health service providers. London: The Health Foundation; 2009.

    Google Scholar 

  9. Porter ME. A strategy for health care reform-toward a value-based system. N Engl J Med. 2009;361:109–12.

    Article  CAS  PubMed  Google Scholar 

  10. Swanson JR, Pearlman SA. Roadmap to a successful quality improvement project. J Perinatol. 2017;37:112–5.

    Article  CAS  PubMed  Google Scholar 

  11. Katakam L, Suresh GK. Identifying a quality improvement project. J Perinatol. 2017;37:1161–5.

    Article  PubMed  Google Scholar 

  12. Picarillo AP. Introduction to quality improvement tools for the clinician. J Perinatol. 2018;38:929–35.

    Article  PubMed  Google Scholar 

  13. Coughlin K, Posencheg MA. Quality improvement methods—part II. J Perinatol. 2019;39:1000–7.

    Article  PubMed  Google Scholar 

  14. Gupta M, Kaplan HC. Measurement for quality improvement: using data to drive change. J Perinatol. 2020. https://doi.org/10.1038/s41372-019-0572-x.

  15. Boehler R, Hardesty D, Gonzales E, Kasnetz K. The business case for quality. Health Financ Manag. 2009;63:62–6.

    Google Scholar 

  16. Homer C, Child Health Business Case Working Group. Exploring the business case for improving the quality of health care for children. Health Aff. 2004;23:159–66.

    Article  Google Scholar 

  17. Shah A, Course S. Building the business case for quality improvement: a framework for evaluating return on investment. Future Health J. 2018;5:132–7.

    Article  Google Scholar 

  18. Leatherman S, Berwick D, Iles D, Lewin LS, Davidoff F, Nolan T, et al. The business case for quality: case studies and an analysis. Health Aff. 2003;22:17–30.

    Article  Google Scholar 

  19. Crawley-Stout LA, Ward KA, See CH, Randolph G. Lessons learned from measuring return on investment in public health quality improvement initiatives. J Public Health Manag Pr. 2016;22:E28–37.

    Article  Google Scholar 

  20. Fisher D, Cochran KM, Provost LP, Patterson J, Bristol T, Metzguer K, et al. Reducing central line-associated bloodstream infections in North Carolina NICUs. Pediatrics. 2013;132:e1664–71.

    Article  PubMed  Google Scholar 

  21. Severens JL. Value for money of changing healthcare services? Economic evaluation of quality improvement. Qual Saf Health Care. 2003;12:366–71.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Thompson C, Pulleyblank R, Parrott S, Essex H. The cost-effectiveness of quality improvement projects: a conceptual framework, checklist and online tool for considering the costs and consequences of implementation-based quality improvement. J Eval Clin Pract. 2016;22:26–30.

    Article  PubMed  Google Scholar 

  23. Steele C, Czerwin A, Bixby C. Breast milk bar code scanning results in time savings and staff efficiency. J Acad Nutr Diet. 2015;115:23–6.

    Article  PubMed  Google Scholar 

  24. Oza-Frank R, Kachoria R, Dail J, Green J, Walls K, McClead RE Jr. A quality improvement project to decrease human milk errors in the NICU. Pediatrics. 2017;139:2.

    Article  Google Scholar 

  25. Agency for Healthcare Research and Quality. Toolkit for using the AHRQ quality indicators. 2017. https://www.ahrq.gov/patient-safety/settings/hospital/resource/qitool/index.html.

  26. Robert Wood Johnson Foundation. Welcome to the ROI forecasting calculator. 2007. https://www.rwjf.org/en/library/research/2007/01/welcome-to-the-roi-forecasting-calculator.html.

  27. Center for Health Care Strategies. Welcome to the ROI forecasting calculator. 2007. http://www.chcsroi.org/.

  28. Center for Health Care Strategies. The medicaid return on investment template. 2007. https://www.chcs.org/resource/the-medicaid-return-on-investment-template/.

  29. Brousselle A, Benmarhnia T, Benhadj L. What are the benefits and risks of using return on investment to defend public health programs? Prev Med Rep. 2016;3:135–8.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Rogowski JA, Horbar JD, Plsek PE, Baker LS, Deterding J, Edwards WH, et al. Economic implications of neonatal intensive care unit collaborative quality improvement. Pediatrics. 2001;107:23–9.

    Article  CAS  PubMed  Google Scholar 

  31. McIntosh E, Donaldson C, Ryan M. Recent advances in the methods of cost-benefit analysis in healthcare. Matching the art to the science. Pharmacoeconomics. 1999;15:357–67.

    Article  CAS  PubMed  Google Scholar 

  32. The American Board of Pediatrics. Newborn screening for critical congenital heart disease performance improvement module. 2020. https://cont-certification.abp.org/moc/moc-dashboard/moc-activities/quality-improvement/online-improvement-activities/activity-details/4046.

  33. Hoffman JI. It is time for routine neonatal screening by pulse oximetry. Neonatology. 2011;99:1–9.

    Article  PubMed  Google Scholar 

  34. Carias C, Chesson HW, Grosse SD, Li R, Meltzer MI, Miller GF, et al. Recommendations of the second panel on cost effectiveness in health and medicine: a reference, not a rule book. Am J Prev Med. 2018;54:600–2.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Huang L, Roberts CT, Manley BJ, Owen LS, Davis PG, Dalziel KM. Cost-effectiveness analysis of nasal continuous positive airway pressure versus nasal high flow therapy as primary support for infants born preterm. J Pediatr. 2018;196:58–64.e52.

    Article  PubMed  Google Scholar 

  36. Yieh L, Dukhovny D, Zhou CG, Gievers L, Caughey AB. Cost effectiveness of neonatal resuscitation at 22 weeks of gestation. Obstet Gynecol. 2019;133:1199–207.

    Article  PubMed  Google Scholar 

  37. Sanchez-Luna M, Burgos-Pol R, Oyaguez I, Figueras-Aloy J, Sanchez-Solis M, Martinon-Torres F, et al. Cost-utility analysis of palivizumab for respiratory syncytial virus infection prophylaxis in preterm infants: update based on the clinical evidence in Spain. BMC Infect Dis. 2017;17:687.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Dukhovny D, Zupancic JAF. Economic evaluation with clinical trials in neonatology. NeoReviews. 2011;12:e69–75.

    Article  Google Scholar 

  39. Weinstein MC, Siegel JE, Gold MR, Kamlet MS, Russell LB. Recommendations of the panel on cost-effectiveness in health and medicine. JAMA. 1996;276:1253–8.

    Article  CAS  PubMed  Google Scholar 

  40. Dukhovny D, Pursley DM, Kirpalani HM, Horbar JH, Zupancic JA. Evidence, quality, and waste: solving the value equation in neonatology. Pediatrics. 2016;137:e20150312.

    Article  PubMed  Google Scholar 

  41. Ho T, Zupancic JAF, Pursley DM, Dukhovny D. Improving value in neonatal intensive care. Clin Perinatol. 2017;44:617–25.

    Article  PubMed  Google Scholar 

  42. Swensen SJ, Dilling JA, Mc Carty PM, Bolton JW, Harper CM Jr. The business case for health-care quality improvement. J Patient Saf. 2013;9:44–52.

    Article  PubMed  Google Scholar 

  43. In: Donaldson MS (ed). Statement on quality of care. Washington, DC: National Academies Press; 1998.

  44. Goudie A, Dynan L, Brady PW, Rettiganti M. Attributable cost and length of stay for central line-associated bloodstream infections. Pediatrics. 2014;133:e1525–32.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Padula WV, Lee KKH, Pronovost PJ. Using economic evaluation to illustrate value of care for improving patient safety and quality: choosing the right method. J Patient Saf. 2017. https://doi.org/10.1097/PTS.0000000000000410. [Epub ahead of print].

  46. Gross PA, Ferguson JP, DeMauro P, Hogstrom H, Garrett R, Cima L, et al. The business case for quality at a university teaching hospital. Jt Comm J Qual Patient Saf. 2007;33:163–70.

    PubMed  Google Scholar 

  47. Adirim T, Meade K, Mistry K. AAP COUNCIL ON QUALITY IMPROVEMENT AND PATIENT SAFETY. A New Era in Quality Measurement: The Development and Application of Quality Measures. Pediatrics. 2017;139:e20163442.

  48. Weeks WB, Resar R. Does reducing length of stay make a business case? Jt Comm J Qual Patient Saf. 2008;34:627–8.

    PubMed  Google Scholar 

  49. Conway PH. Value-driven health care: implications for hospitals and hospitalists. J Hosp Med. 2009;4:507–11.

    Article  PubMed  Google Scholar 

  50. Main EK. New perinatal quality measures from the National Quality Forum, the Joint Commission and The Leapfrog Group. Curr Opin Obstet Gynecol. 2009;21:532–40.

    Article  PubMed  Google Scholar 

  51. The Leapfrog Group. The Leapfrog Group: who we are. 2019. https://www.leapfroggroup.org.

  52. The Leapfrog Group. The leapfrog hospital survey scoring algorithms: scoring details for sections 2-10 of the 2019 Leapfrog Hospital Survey. Washington DC: The Leapfrog Group; 2019.

  53. U.S. News & World Report. U.S. News & World Report Hospital Rankings & Ratings. 2019. https://health.usnews.com/best-hospitals.

  54. Olmsted MG, Powell R, Murphy J, Bell D, Stanley M, Sanchez R. Methodology: U.S. News & World Report best children’s hospitals 2019-20. Durham, North Carolina: RTI International; 2019.

    Google Scholar 

  55. Kaplan RS, Anderson SR. Time-driven activity-based costing: a simpler and more powerful path to higher profits. Boston: Harvard Business School Press; 2007.

    Google Scholar 

  56. Kaplan RS, Porter ME. How to solve the cost crisis in health care. Harv Bus Rev. 2011;89:46–52.

    PubMed  Google Scholar 

  57. Keel G, Savage C, Rafiq M, Mazzocato P. Time-driven activity-based costing in health care: a systematic review of the literature. Health Policy. 2017;121:755–63.

    Article  PubMed  Google Scholar 

  58. Popat K, Gracia KA, Guzman AB, Feeley TW. Using time-driven activity-based costing to model the costs of various process-improvement strategies in acute pain management. J Health Manag. 2018;63:e76–85.

    Google Scholar 

  59. Scoville R, Little K. Comparing lean and quality improvement. Cambridge, Massachusetts: Institute for Healthcare Improvement; 2014.

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HRF and SDD created the outline, wrote the draft, and approved the final version of the paper.

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Correspondence to Scott Davis Duncan.

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Fischer, H.R., Duncan, S.D. The business case for quality improvement. J Perinatol 40, 972–979 (2020). https://doi.org/10.1038/s41372-020-0660-y

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