Creating a Business Case for Quality Improvement Research focuses on issues related to improving the science supporting health care quality and eliminating communication barriers that prevent advances in the field. In 2007, the Institute of Medicine convened a workshop designed to identify the economic and business disciplines that encourage sustained efforts to improve the quality of health care. Workshop presenters and participants included representatives from academia, government and industry.

A business case for quality improvement depends heavily on the progress made in the following areas: systems change and leadership, data transparency, funding, enhanced training programs and ongoing dialogue between industry officials, patients and their families. They identified a major barrier to these efforts as the nationwide institutional reluctance to invest in quality improvement and documentation of outcomes, due largely to limited resources and competing priorities as to how these resources are spent in the industry. Too often priorities are placed on creating highly-visible technology-driven programs, with less emphasis in meeting the needs and expectations of the patients. In Creating a Business Case for Quality Improvement Research, a diverse group of stakeholders identifies and assesses these and other challenges to attain a better understanding of how to create a high-value health care system for the general population.

CREATING A BUSINESS CASE FOR QUALITY IMPROVEMENT RESEARCH

EXPERT VIEWS, WORKSHOP SUMMARYBy Samantha Chao

NATIONAL ACADEMIES PRESS

Copyright © 2008 National Academy of Sciences
All right reserved.
ISBN: 978-0-309-11652-7

Contents

OVERVIEW..........................................................11 THE BUSINESS CASE FOR QUALITY IMPROVEMENT.......................5Managed Care......................................................6Department of Veterans Affairs....................................7Systems...........................................................11Integrated Health Care System.....................................13Nursing Perspective...............................................17Discussion........................................................192 THE ROLE OF FEDERAL FUNDERS.....................................24Agency for Healthcare Research and Quality........................25National Institutes of Health.....................................27Discussion........................................................283 RESEARCH AS A DRIVING FORCE FOR CHANGE..........................32Overview..........................................................33Examples of Quality Improvement Research..........................34Department of Veterans Affairs Initiatives........................37Discussion........................................................394 BREAKOUT GROUPS.................................................40Value Proposition.................................................40Intraorganizational Quality Improvement Gains.....................41Industrywide Quality Improvement..................................425 COMMUNICATING A VALUE PROPOSITION...............................44Integrating the Business Language.................................44The Need for Research.............................................45Other Audiences and Areas.........................................46REFERENCES........................................................48APPENDIXESA Workshop Agenda.................................................49B Workshop Participants...........................................53

Chapter One

Overview

The Institute of Medicine (IOM) convened the workshop "Creating a Business Case for Quality Improvement and Quality Improvement Research" on October 15, 2007, in Washington, DC, to develop a better understanding of the economic and business disciplines that encourage sustained efforts to improve the quality of health care.

Throughout the country, institutional reluctance to invest in quality improvement and documentation of outcomes of quality improvement interventions remains a barrier to moving ahead, said Thomas Boat, co-chair of the Forum on the Science of Health Care Quality Improvement and Implementation. This reluctance stems from limited resources and, more importantly, competing priorities as to how these resources are spent within health care. For example, priorities tend to be placed on creating highly visible technology-driven programs, with less emphasis on meeting the needs and expectations of patients. Articulating a business case is at the crux of the issue of how rapidly quality improvement and quality improvement research will advance, Boat said.

The United States health care system is currently being threatened because it is not performing optimally, said Scott Hamlin, leader of the planning committee for the workshop. In every other industry, quality has been recognized as a necessity for value. We must understand what it is about health care that causes skepticism about whether the health care market can recognize quality and the rewards it brings so that we can capitalize on opportunities to strengthen the health care system.

During this workshop, experts were asked to discuss the business case from the perspectives of those actually making the business case, policy makers, and researchers. The planning committee's statement of task for developing the workshop agenda was "to provide the forum with insight into the economic, public policy, and business disciplines that create a sustainable value proposition for aggressively pursuing quality improvement in the health care system and thereby stimulating meaningful research in this field."

In summary, speakers indicated that a business case for quality improvement can indeed be made. Many examples of business cases from a variety of settings were provided, while recognizing that robust research is at the core of the business case for quality improvement. A strong research base and data depicting the impact of quality improvement are necessary to create a business case for quality improvement.

Throughout the workshop, common themes emerged. Making the right thing to do through systems change and leadership were recognized as necessary to improve quality of care delivery. Data and data transparency are also important for making health care more patient-centric. Speakers addressed funding as a key component of quality improvement and research on quality improvement due to the need to support the incorporation of health care innovations into practice. During the workshop, it was also noted that training must be enhanced to make research on quality improvement more robust. Finally, speakers discussed how the quality improvement and research communities must become better communicators and include chief executive officers and chief financial officers, as well as patients and their families, in the ongoing dialogue to improve health care.

The following chapters describe and summarize workshop presentations and discussions. Therefore, the content is limited to the views presented and discussed during the workshop itself and is not intended to be a comprehensive assessment of the business case for health care quality improvement. The broader scope of issues pertaining to this subject area is recognized but could not be addressed in this summary. Appendix A is the workshop agenda, and Appendix B lists workshop participants.

The forum is used by the IOM to convene representatives from academia, government, and industry. In bringing together this broad group of stakeholders with diverse views, the forum provides a neutral setting where issues related to improving the science supporting health care quality improvement and implementation can be discussed. Through their discussions, forum members attain a better understanding of what the needs are and begin crossing the communication barriers that prevent advances in the field.

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