by Dr. Suzanne Berman
We all went into pediatrics with the expectation that we would deliver the best care possible to our patients and families. We enter the office and multiple exam rooms every day with the full intention of doing so. But, high-quality care doesn’t just depend on meeting the requests and needs of the patients in front of us. It requires that we find ways to engage the families who do not reach out to make an appointment, and to look beyond the chief complaint of the patient in the exam room. Great quality care requires humble acceptance of our current performance, information we trust to benchmark ourselves against, and a willingness to commit to a culture of continuous quality improvement.
We work really hard every day to give good care. So, when we look at objective reports of our quality metric performance, our initial response is often “That can’t be my data. I know that I’m much better at providing immunizations to my patients than that!” After the initial shock and denial, we need to take a deep breath and dig deeper for two reasons: to develop confidence in the accuracy of the data and to be able to listen to the information that the data is trying to tell us.
Let’s take immunization, for example. You know that you strongly recommend and order vaccines at well visits. But do you know what happens to those patients who never come in for well visits on time? Did you miss the opportunity to give that third rotavirus vaccine because the patient didn’t come in for their six-month well visit until they were eight months of age? If so, you have permanently lost the ability to meet the “Every Child By Two” quality metric for that child since they are too old to receive that rotavirus vaccine. What about the child who cannot receive the vaccine at their well visit because they are ill? You schedule the shot for two weeks later, but what happens if they cancel or don’t show?
You can only understand your true performance and trust the data if you have the tools to do a root cause analysis. Good EMR software not only gives you a performance percentage, but also allows you to identify those patients who are dragging your performance down. You can then review their charts to find out why. It’s through this deeper analysis of actionable data that you can begin to form ideas as to what’s happening in your practice. Maybe as a group practice, you have agreed to deliver “strong recommendations for HPV vaccination” at the 11-year old check-up. The truth is, you aren’t in the exam room with your partners to hear what they say. Can you analyze the data in a way that determines missed opportunities for HPV vaccination and stratify it by provider? Is there someone in your practice who could benefit from additional coaching?
Ultimately, whether our patients actually do receive high-quality care depends on what we do after we humbly accept our current performance and trust the information. True quality performance requires a culture of continuous improvement, an office quality champion, and the entire practice team. While pediatricians can work on improving the care for those patients in front of us, we will not be the people running recalls, following up on no-shows, making sure the front desk isn’t sabotaging our messaging (e.g., check-in person telling families that they didn’t give the HPV vaccine to their teens because they don’t think it’s really necessary.) Quality improvement is a team sport. It takes buy-in and creative ideas from all staff members.
Your families deserve high-quality care. You want to deliver that care. Put your practice in a position to succeed, and once you are a quality rock star, outperforming the practices around you, keep working to sustain and improve upon this status.
Office Practicum is a leading provider of pediatric-specific solutions. Our EHR, PM system, and billing services help pediatric practices improve clinical and financial outcomes. Contact us today to learn more.