DME owners and managers often cite quality improvement (QI) and/or performance improvement (PI) as one of the most difficult concepts to understand and one of the most difficult programs to implement within their businesses. And industry consultants and surveyors find the so-called QI Standards some of the most frequently cited standards for deficiencies and recommendations, and one of the areas in which they spend the most consultative time educating companies.
Let’s break down the requirements into the most basic format and try to understand the standards both conceptually and also from a practical point of view. What does your program need to do to meet the standards? And -perhaps more importantly: how can your company craft a program that brings actual value to your organization.
QM 1 is the primary standard that describes the requirements. It states that your company will implement a QI program designed to “monitor and record the quality of its services and programs and measure the outcomes of consumer services, billing practices, and adverse events”. The program must collect and study data for various performance measures.
Breaking that standard down into practicality, it requires that your company considers certain performance measures and report on those measures. Besides simply reporting on those measures, the idea is that your company studies these measures as a means of improvement and adjusts protocols, programs, policies, and procedures based on the results of these measures and the outcome of the data collection that goes into studying them.
The measures are referred to as “indicators” because they indicate areas that are doing well and areas that need or would benefit from improvement.
The required measures are:
Customer Satisfaction Surveys: Generally, these take the form of a customer satisfaction survey which is solicited from customers to rate their experience with the company and also a compiled list of customer complaints. At traditional DME organizations, this is usually accomplished by giving new or existing customers a customer satisfaction survey form to fill out and send back with their experience rated. Keep in mind for nontraditional medical equipment companies, the “customer” might be a Hospice or another business instead of an end user customer/patient.
Financial Performance Targets: This usually takes the form of some tracking mechanism to measure billing/coding errors and/or the measurement of percentage of collections. Tracking these helps a company understand how quickly they receive their monies (income) and in some cases, points out inefficiencies in the process which slow collections and thus slow income and the bottom line.
Business Activities & Service Issues: Companies typically track issues relating to staff performance here (review personnel files for competency assessments and performance evaluations, for example). The key is that the indicator should be related to customer care, access to services/equipment, etc.
Timeliness of Response: This is almost always a measure of how quickly your company responds to problems or concerns received from customers. It can also be something as simple as tracking how fast your team fulfills orders and gets deliveries out to the customer. Understanding how responsive your company is with order fulfillment is the crucial first step to being able to make yourself MORE responsive or quicker.
Tracking of Adverse and/or Sentinel Events: Malfunctioning equipment or inappropriate service that results in major injuries, accidents, hospitalizations, and death are rare in our industry, but they do happen. This indicator is simply the tracking of those events, along with notes and documentation about follow up. There are specific rules about timeframe of responses and also notifying entities such as licensing boards and your accreditation organization when these do occur.
Each of these measures should be measured continuously. Companies form committees (depending on how big the organization is) that include representatives from various departments and even branches if the organization has multiple locations. The committee is tasked with monitoring these indicators, measuring them, and reporting the data to staff and leadership. Reports of the results are normally documented at least quarterly. Trending over time is very important. The point is to understand how your company performs with these measures so you can spot areas that need improvement. At the end of the year, an overview and summary of these quarterly reports should be documented.
Most important of all: remember that the goal is to improve. In addition to compiling these measures and all the associated data, the summary should document how changes are made within the company based on the findings of the measurement of these indicators. For instance, you send a customer satisfaction survey out to customers. If the results point out a consistent complaint or problem, you discuss how to improve that problem. Document the improvement as well as the problem. The goal here should always be to improve.
Quality improvement is the very essence of accreditation. The most successful companies are the ones that embrace the idea of quality improvement and use the program to make real improvements within their organization.