Guidance to Develop Better Quality Improvement Activities: Insight From AAAHC Surveyor Gayle Lowe
Gayle Lowe, RN, AAAHC surveyor, offers insight on how ASCs can develop better quality improvement activities that not only help meet the AAAHC requirements but offer substantial benefits to ASCs.
Gayle Lowe: Quality improvement activities — found in chapter 5 in the AAAHC Accreditation Handbook for Ambulatory Health Care — are one of the top areas where centers had the most difficulty in getting full compliance. It's not that it's any more difficult in 2010 than it has been any other year, but it's understanding the 10 elements, up from seven elements this year, that are required for your QI activity and making sure that those are in there and that the subject matter is pertinent to your particular activity.
ASCs struggle in part because of a lack of committing enough time to understand what's required. Usually the QI activities are performed by one of the nurses or one of the staff members who were not trained on QI activities. As a result, they really don't have an understanding of what's required and they typically do not take the time to really read what the elements are. They never understand how a good QI activity can actually improve processes, cost effectiveness, patient outcomes or administrative issues in their center and actually make a difference as to how their center is run — they don't have this basic understanding. They see QI as a task that has to be done for accreditation but they don't see this as a worthwhile activity for their particular surgery center.
Since QI is outside of most ASCs' staff member's comfort zone — they are trained to be clinical, they're not trained to think in abstract methods, the QI tools are foreign to them, terminology is foreign — they shy away from it. They need to dedicate some time and obtain input and feedback from all of the stakeholders in order to have something that is going to be worthwhile.
If the owners of the centers — the physicians — really understood that the QI activities could make a financial difference as well as a quality outcome for their patient satisfaction, I think they would invest more in training the staff overseeing it. This is an area that does not often have very good physician buy-in.
The ASCs that are doing it right — the centers which has invested time and effort in the education of a nurse or staff member who is going to lead QI, who then gets the buy-in from the rest of the staff and from the MEC/governing body, they see the benefit of QI other than just gaining compliance with the standards. We actually have seen better outcomes when we've seen some level of education outside of the center in QI.
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