Quality Improvement Takes More Than a Scorecard

Quality metrics can identify an opportunity for improvement, but data alone doesn’t change patient care. Physicians need actionable feedback, clinical context, and operational support to turn those insights into action.

Before an emergency physician can send a patient home, a test result may need to come back. How long that takes depends on several people, including nurses and technicians.

Mike Lipscomb, MD, ApolloMD’s Chief Quality and Patient Safety Officer wants goals for patient care to account for that shared work. Because he still works clinical shifts, he knows that meeting a goal takes both a physician’s effort and support from colleagues.

“Give me reasonable metrics that I can follow,” he says. “Give me the tools to do it.”

Laura Springer, ApolloMD’s Vice President of Patient Safety and Quality, helps physicians see patterns they might not notice from one patient to the next. Her team prepares monthly reports on choices such as when to prescribe antibiotics or order scans.

For Healthcare Quality Week, Oct. 18-24, Lipscomb and Springer share how clinicians can use those insights, get help with local needs, and work across teams to improve patient care.

Give Each Team the Help It Needs

Lipscomb says good care starts with skilled physicians, nurse practitioners, and physician assistants. Teams also need appropriate staffing and a medical director who knows the department and works closely with hospital colleagues.

Each hospital has different needs. An emergency department may need more staff at 11 p.m. or different shift times to cover its busiest hours. Another may need help getting patients to tests sooner, he says.

When performance points to an operational barrier, physicians need a way to address it.

ApolloMD’s operations teams work with local clinical leaders on needs such as staffing, scheduling, and other challenges that can affect patient care. That support lets physicians focus on their patients while others solve the operational problems. Lipscomb describes the message to physicians this way: “You continue to take great care of your patients.” The operations team handles the rest.

ApolloMD’s physician leaders still care for patients, too, Lipscomb says. Continuing to practice gives them firsthand knowledge of the work they ask colleagues to do, including new requirements for patient records and changing expectations for care.

Make Monthly Feedback Useful

Physicians receive reports about September’s patients in October, Springer says. They can see how their results compare with averages for their local practice and across ApolloMD practices.

Lipscomb says that feedback often gives physicians enough information to make a change. A medical director can help them look more closely at specific cases and talk through their questions.

Lipscomb and Springer describe three ways to use the reports:

• Look for a pattern. Review a group of cases, such as patients who received antibiotics.
• Talk through the choices. Discuss what each patient needed, why the physician chose a treatment, and what the patient notes show.
• Check the next report. See what changed after trying a different approach.

Lipscomb offers an example: A physician’s report shows frequent antibiotic prescribing for bronchitis. A medical director might review those cases with the physician, discuss the clinical reasoning behind each choice, and compare the approach with national treatment guidelines.

The details help determine what kind of support would be useful, Springer says. Medical directors can look at whether a pattern involves one physician or the whole team, then discuss the cases and any questions about treatment or documentation.

Work Together Across Departments

When a patient needs to stay in the hospital, the emergency team works with the physicians who will assume the patient’s care, Lipscomb says, allowing the emergency team room for new patients. The next team needs enough information to plan treatment.

Medical directors can help both teams decide which tests to complete in the emergency department and which can wait until after admission, he says.

When ApolloMD manages both emergency and hospital medicine teams, Lipscomb says, shared leadership makes communication easier. Medical directors can agree on next steps with each other and hospital colleagues. Those conversations give both teams a chance to explain what they need to care for patients while keeping admissions moving.

Quality improvement, Lipscomb says, often depends on that kind of collaboration. A delay or performance challenge may cross departments, requiring teams to solve challenges together rather than looking at one clinician or metric in isolation.

Use AI to See More of the Picture

A physician’s notes often hold details that a search by diagnosis code can miss. Lipscomb sees that gap as one reason to explore artificial intelligence (AI). Used with appropriate privacy safeguards and human review, AI could help quality teams find more relevant cases and ask sharper questions about care.

“AI can pick up things that traditional programming can’t,” he says.

He offers a hypothetical example involving bronchitis. A search for one diagnosis code might find only some of the cases. AI could also find records where other details show that the patient had bronchitis.

Reviewing those additional cases could give the team a more complete picture of antibiotic prescribing, Lipscomb says.

ApolloMD is exploring how AI could support quality review. Lipscomb stresses two requirements for that work: physicians and quality staff verify every finding, and patient information stays protected under the same privacy and security standards that govern all clinical data.

Springer also sees promise in finding patterns that current reports may miss. She says that work is still developing.

For physicians, the potential benefit is feedback that draws on more of the care they provide. A broader review could help them understand when they choose a treatment, how often they use it, and where a closer look would be useful.

Recognize Good Work

Lipscomb wants feedback to recognize good work and respect physicians’ judgment. Springer sees their interest in improving when they ask about cases, discuss their results, and look for ways to do better.

“Positive feedback works way better than negative feedback,” Lipscomb says.

That approach gives physicians a role in deciding what happens next. They can explain a treatment choice, ask for help with staffing, or work with another team on a delay. Lipscomb wants leaders to listen and help them act.

Quality improvement works best when physicians aren’t simply told where performance falls short. They need to understand the data, have the opportunity to explain the clinical decisions behind it and know they have support when change requires more than an individual physician can accomplish

“Deep down, we all want to do a good job,” he says.

Giving clinicians the information, support, and partnership to do that job better is where meaningful quality improvement begins.