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PART III
New Directions: Organization- and System-Focused Quality Improvement



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Medicare: New Directions in Quality Assurance PART III New Directions: Organization- and System-Focused Quality Improvement

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Medicare: New Directions in Quality Assurance This page in the original is blank.

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Medicare: New Directions in Quality Assurance New Directions: Organization- and System-Focused Quality Improvement Introduction Loring W. Wood This part of the conference proceedings examines the complex of methodologies subsumed under the generic heading of quality improvement, that issue so evocatively referred to earlier as not yet having ''run for sheriff'' (Schroeder, 1991). The theme of quality improvement, which is a transplant from industry, is a fact of everyday life in my own corporate environment. It incorporates organization-wide commitment to a customer focus through continuous improvement of all of the processes in the organization, to improving the average, and to moving the curve. Quality improvement appears in one form or another in several parts of the Institute of Medicine's committee report. The second recommendation in the committee report states that Congress should adopt three goals for the quality assurance activities of the Medicare program. In an early draft of the report, the first of these three goals was given as ". . . improve the quality of health care for Medicare enrollees. . .". This implied moving quality from point A to point B over some unit of time. We added a single word to that—the word "continuously" at the beginning of the sentence—changing the entire meaning of this recommendation in the final report. Quality improvement is one of a wide variety of methods of managing quality within and across organizations that we envision will be tested during our proposed 10-year strategy. In our committee discussions, professionalism was a central theme. One of the features of our strategy is that professionalism be allowed to grow in local organizations, institutions, and systems. Through the collection of information about the performance of those systems and of the physician as a component of those systems, a variety of methods of quality assurance and quality improvement can be evaluated. What really works will be the end point that will drive those evaluations.

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Medicare: New Directions in Quality Assurance The next two papers explore this idea of quality improvement from two perspectives. James Mortimer, a member of the IOM study committee, is President of the Midwest Business Group on Health (MBGH). Organized initially in 1980, the coalition now has about 180 member employers and spans a nine-state region. The MBGH is one of the major business coalitions in the country today and one of the few that is actively exploring quality-of-care issues on behalf of its members. Mr. Mortimer's paper explains the basis of the committee report, but with overtones of his extensive background in value-managed purchasing of health care services. Chip Caldwell, President and Chief Executive Officer of the Hospital Corporation of America's West Paces Ferry Hospital in Atlanta, Georgia, represents a supplier of health services in one of the long-standing and successful programs of quality improvement in a hospital system. In November 1987, West Paces Ferry began implementing a quality improvement program under the Deming management method. Today the quality improvement program hosts six clinical teams, eight cross-functional quality improvement teams, and more than 20 functional teams. Drawing on this experience, Mr. Caldwell offers a "real-life" example of the directions in which a commitment to continuous quality improvement may take a health care institution. REFERENCES Schroeder, S.A. The Institute of Medicine Report. Pp. 7-14 in Medicare: New Directions in Quality Assurance. Donaldson, M.S., Harris-Wehling, J., and Lohr, K.N., eds. Washington, D.C.: National Academy Press, 1991.