Jay Lechtman, Vice President, Strategy & Innovation, Healthcare

When an adverse event occurs, the immediate priority is to deal with the situation at hand. Move beyond those immediate and reactive issues and the improvement-minded naturally begin to think about causal and contributory factors and their related corrective actions. These typically fall into two key areas: human and system factors.

Human Factors

Driven by regulatory and accreditation attention in some areas – along with a genuine desire to continually improve – healthcare organizations are focusing increasing attention on evaluating the quality and safety performance of their clinical providers.

Traditionally, this evaluation has largely been limited to physicians and peer review, reflecting the status of physicians and the specifics of state-based protections for the sensitive information involved in the process. Now, peer review has a more expansive definition that often includes nurses, pharmacists, and even specialized clinicians like dieticians. Peer review has also expanded from a process used primarily for gaining, expanding, or renewing hospital privileges – or as a potential response to physician involvement in a patient safety event – to one that is increasingly integrated into a continuum of provider-quality monitoring, evaluation, and outlier identification.

For more than a decade in the United States, The Joint Commission (TJC) has mandated that accredited hospitals engage in a formal physician monitoring process, called Ongoing Professional Practice Evaluation (OPPE), with peer review forming one option for dealing with circumstances that suggest additional, more intensive evaluation. This Focused Professional Practice Evaluation (FPPE) can be triggered by the outcomes of the ongoing evaluation or as before during the privileging process. It also can be triggered as the result of a physician-involved adverse event, a patient complaint, or other identified potential deviation from accepted standards.

An Expanded View

A number of healthcare provider organizations have been looking to integrate the ongoing and focused evaluation of provider quality. It doesn’t make sense to them to segregate the same processes just because they may be used for different purposes. It’s better to have a single source of provide quality data, with as many inputs and outputs as are needed for all of the ways the data is collected and consumed.

But what to call it?

The terms OPPE and FPPE are too limiting (not to mention awkward to repeat frequently). Providers not accredited by TJC also create and manage quality scorecards for more than just physicians.

And the term Quality Management is already used by The Centers for Medicare and Medicaid Services (CMS) and other organizations to describe the range of Clinical Quality Measures on which healthcare provider organizations must report. Add Provider to Quality Management, however, and you have a concept that describes the current process while also encompassing its various forms as it continues to evolve.

Provider Quality Management covers all the ways that healthcare should look to monitor, evaluate, maintain, and improve the clinical quality of its clinical staff, regardless of area or scope of their practice.

For more on managing risks in the healthcare industry, check out our e-book, Rx for Risk: ERM in the Healthcare Industry.