By: Dr. Andrea Lum, Chair, Medical Advisory Committee & Director, Quality of Medical Care, London Health Sciences Centre
Physicians are arguably one of the most influential members of the health-care team when it comes to quality improvement, and by their very nature, physicians use data to guide decision making every day. Quality improvement in hospitals cannot be achieved without the engagement and support of physicians and so London Health Sciences Centre (LHSC) engaged physicians in choosing common quality indicators that could be measured across all hospital departments and which reflect the physician contribution to quality.
"You can't improve if you don't know what you don't know," says Dr. Andrea Lum, Chair, Medical Advisory Committee and Director, Quality of Medical Care, LHSC. "By measuring common safety indicators we can set a baseline of our performance and work to find solutions in areas that require improvement." The process of defining indicators involved key physicians who are engaged in quality improvement. The indicators were affirmed with a focus group of departmental physician leaders then endorsed by all physician leaders
The five quality indicators physicians chose were:
- Medication reconciliation on admission
- Medication reconciliation on discharge
- Length of stay (inpatient)
- Completion of discharge summary within 48 hours of discharge
- Recording of resuscitation status within 24 hours of admission
These indicators form part of the LHSC's balanced scorecard, a standardized approach for performance monitoring and reporting. Physician leaders were first provided results that reflected hospital portfolios; then they were provided with individual departmental performance, using standardized targets and performance corridors, with a red-yellow-green coding system to visually display performance. Next, physician leaders were provided with data that was similarly displayed (red-yellow-green) for each indicator, including individual physician performance.
When provided common data measured across all departments, physician leaders were able to innovate with department specific solutions for improvement.
Physician leaders were then asked, on a quarterly basis, to complete a short analysis and action plan for their department. After four quarters, significant improvement was made in a number of clinical areas:
- 46% improvement in discharge summaries within 48 Hours in Medicine (University Hospital)
- 35% improvement in discharge summaries within 48 Hours in Medicine (Victoria Hospital)
- 27% improvement in admission medication reconciliation in Mental Health Care
- 24% improvement in resuscitation status recorded in Women's Care
- 23% improvement in resuscitation status recorded in Clinical Neurological Sciences
- 19% improvement in discharge medication reconciliation in Women's Care
Sharing and comparing agreed upon data indicators through physician engagement can support significant improvement in the quality of care provided to patients. This work would not have been possible without the expertise and support of our Quality and Patient Safety Team at LHSC.
Pictured: From left, Dr. Paul Woods, President and CEO LHSC, and Dr. Andrea Lum, Chair, Medical Advisory Committee and Director, Quality of Medical Care, LHSC, review the performance of physician chosen quality indicators.