NQI Senior Advisor John Perry outlines the reasons and approach to the development of NQI’s integrated quality/wellness criteria for health care.

Taken from a speech at the Unleashing Innovation in Health Systems -Alberta’s Symposium on Health - on May 4. 2005.

Operational to strategic focus
In the business world, and now in the public sector, we have seen a move to strategic approaches on quality, that’s the essence of the quality revolution. The focus has evolved from one of Inspection & correction (control), to detection (measures) with a focus on safety & assurance, to prevention & total quality. Today the focus is on integrated management system and how an organization is led & managed. We have seen a positive shift from an operational focus to a strategic focus, which is why we have seen commendable improvements in quality in many sectors.

Quality focus lowers system cost
Quality costs – prevention, inspection and failure cost together make up 20 to 40% of operating costs. Boosting prevention costs lowers inspection and correction, improves quality and lowers overall operating costs. This saves a great deal of money, but a system of quality has to be in place.

Adoption healthy workplace frameworks
To assist their thinking, many health care organizations use the generic Canadian Healthy Workplace Criteria, used to adjudicate the Canada Awards for Excellence Health Workplace Awards.

Health care organizations across the nation are working to apply effective healthy workplace practices because they have a challenge. Health workers are 1.5 times more likely to miss work because of illness or disability. Rate of long-term disability claims in health care organizations caused by mental and emotional distress is increasing, and research shows that this will keep going. Studies & data show that billions are spent annually in health care on direct and indirect costs of employee injuries, illnesses, absenteeism and lost productivity caused by stress and lack of support.

There is a need for more in depth training for managers on managing healthy workplace elements covering safety and environmental factors, healthy lifestyle practices and social and supportive work environment, a comprehensive approach, including mental health.

Principles
Principles of excellence are often centered on leadership involvement; focus on internal community, patient/clients and care teams, cooperation, teamwork & continuous learning, improvement and innovation. Principles are good, but what are needed are behaviors that reinforce principles. In health care, quality frameworks and healthy workplace initiatives often fall into separate buckets driven by committees and unconnected initiatives. I believe theses initiatives must be together as one, so we can look through the lens of the right questions.

Organizational Quality/Wellness Criteria
The Drivers of an integrated approach to quality and employee wellness are leadership, planning and programs, patient/client focus, people engagement, process management and supplier/partner focus, leading to sustained organizational performance; driving how the organization is managed. This is a natural evolution; to sustain continuous improvement through quality we must look at how we manage a healthy workplace. This integration is the cornerstone of excellence. The issue is not measurement alone; the issue is the management of quality and wellness.

Progressive Implementation
A culture-building system is needed that reinforces quality and employee wellness. This can only be achieved by breaking the journey into manageable parts, a roadmap for progressive implementation. NQI, assisted by health care professionals, with special thanks to Trillium Health Centre and Toronto East General Hospital and the Annapolis Valley Health Center in Nova Scotia, has been testing and developing a progressive implementation criteria/roadmap with external validation and recognition of achievement. These are called the NQI Organizational Quality & Wellness Criteria for the Health Care Sector. This roadmap consists of four levels of implementation.

Level One – Start up:
This level establishes a clear commitment to the principles of excellence and to continuous improvement. Other key focus points are support of the vision, mission, values and quality/wellness policies, ingraining of well-being in decision-making, and analysis of baseline indicators to review current state and review progress.

Level two – Foundation:
This level builds on Level One, with a key focus on the identification of patient/client needs, building a strategic approach to quality assurance, setting improvement goals, clarifying work procedures and key processes for system stability and consistency, wide appreciation of interdependency, and more consistency in recruitment, selection and performance management.

Level Three – Transition:
Building on Level Two, the key focus is on preventative approaches and practices, achievement in meeting goals, culture of quality/wellness becoming a way of life, positive recognition and work training in place, and health and well-being programs and services promoted and reinforced.

Level Four – Sustained Performance:
Building on other levels, the key focus is on overall trends, impacts on target population, and achievement of being a role model for excellence in health care and a leader in innovation, effectiveness and performance.

Strategic focus
We need to pay more attention to strategic quality issues and workplace health, my contention that excellence means both, that may be innovative, but its time for innovation. A strategic focus on quality and employee wellness means a common conceptual base is cascaded through the line structure, not by email but by real communications. It means people at all levels can connect the dots on improvement initiatives, moving from program driven to culture building. It means a consistency of purpose, to learn from each other and sustain a vision for excellence. This all helps sustain alignment on patient centered focused services. A quality environment and a healthy workplace are integral in providing patient centered services, and key in maintaining a cost-efficient system. An integrated approach leads to optimization of quality and wellness. It’s important for health care organizations to be employers of choice; so young people choose to enter the system to replace an aging workforce. They will only do this if they see the sector as a strong and healthy place to work. The NQI Organizational Quality and Wellness Criteria for the Health care Sector will serve to enhance and reinforce all other initiatives, such as accreditation and assurance systems, risk management and others, by giving strategic perspective to such initiatives, and linkage to development of a culture for overall organizational wellness. It is my hope that Canada can be a role model country in health care quality and healthy workplace issues; we can do it if we have the commitment; we now have the roadmap.

Note: Criteria Overview and Criteria/Guide/Assessment Workbook for each of the four levels of implementation, is available from NQI in June 2005.