The quality assurance program at SHS has evolved from a traditional case review program to a comprehensive quality improvement program, report those involved in the process.

"Frankly, when physicians are asked by the CALS (Consolidated Accreditation Licensing Survey) team [ see related story] about the steps taken to improve quality, they should be able to answer with confidence that they are involved in a comprehensive quality program that has resulted in demonstrated improvement in patient care," says Cindy Day, director of the Department of Clinical Quality Support Services (CQSS).

Components of the quality improvement program include interdisciplinary teams consisting of physicians, other caregivers, administrators and nurses. The role of the latter has expanded from the traditional care review function.

Peter Gregory, chief medical officer, said that "practicing physicians are beginning to embrace the current concept of quality improvement because its express purpose is to make the complicated process of medical care better. I like it personally because it brings doctors, nurses and others together to solve a problem that is central to their common core values."

"In the past, we were concerned with the care of individual patients and taking disciplinary action, but now we look beyond that to collect information or systems issues to correct or improve," noted Catherine Crawford-Swent, a registered nurse and a clinical quality manager. Her role has emerged from that of care review to the new broader role, and she is specifically assigned to assisting the medicine, neuroscience and functional restoration services in quality improvement activities.

Crawford-Swent noted that objective standards are used to measure outcome.

"For example, when we decrease length of stay in the ICU for a group of patients, we track how often these patients are readmitted to the ICU.

"Best of all, that information is shared among physicians. If one physician's patients return to the ICU more frequently than the patients of his or her colleagues, it's a good opportunity for the physician to ask, 'Why?' And we'll have enough information to find out whether the explanation relates to the doctor's practice, the patient mix or some other factor.

"The positive thing about the new program is that physicians have access to information. They can compare their results against colleagues. Individual case review continues to be important for quality and education reasons. However, looking at systems issues and looking at populations of patients, rather than individuals, brings a new dimension to the effort. And the focus is now on overall quality improvement," she said.

Crawford-Swent noted that much of the current process is based on management improvement techniques, such as Juran, a data-intensive method of total quality management.

"We've been using these techniques throughout the institution for nonclinical and administrative issues, and now we've found a way to use these same models and techniques to monitor and improve care," Crawford-Swent said.

Day said that the quality improvement program is one of several efforts along similar lines. For example, the clinical pathways program, was a first step in implementing the new system and continues today, she said.