209130 Governing body: Role in implementing a successful quality improvement program in a large scale public organization

Monday, November 9, 2009

Consuelo Dungca, EdD, RN , Quality Management and Clinical Affairs, NYC Health & Hospitals Corporation, New York, NY
Juliet G. Gaengan, RN, MSA , NYC Health and Hospitals Corporation, New York, NY
Sue Lee, MPA, RN , Quality Management, New York City Health and Hospitals Corporation, New York, NY
NYC Health and Hospitals Corporation is a public benefit corporation w/11 acute and 4 long term care facilities, 6 diagnostic and treatment centers, over 80 satellite clinics, a home health care agency and managed care organization. It provides services to largely disadvantaged, indigent, diverse population, new immigrant's w/variety of chronic conditions but little attention to preventive care. Scientific and evidence-based studies show Quality Improvement (QI) processes made significant impact on health promotion and chronic disease prevention.

HHC's mission is to provide comprehensive, quality health services, regardless of ability to pay, in a humane and respectful manner. In keeping w/this mission, the Corporate Quality Assurance Committee (QAC) of the Board of Directors was faced w/daunting challenges to implement system-wide robust sustained QI program to address chronic conditions, e.g., congestive heart failure (CHF), diabetes, depression; and processes, e.g. cancer and HIV screening. QAC charged its corporate office and facilities to arrive at best practice guidelines by standardizing QI measurement methodologies and reporting. Measures on conditions and process monitored and reported to QAC:

CHF: LVF assessment BP/Lipid control

discharge ACE/ARB prescription

discharge instruction

smoking cessation counseling

Diabetes: A1c monitoring (good/bad control)

Depression assessment

Cancer Screening: Breast/colon

HIV Screening: New + linked to care

Implementation of these measures resulted in improved systems, processes and patient outcomes being screened and provided appropriate treatment.

QI approach on chronic conditions management entails high level commitment from Governing Body, Administration and “hands-on” staff. Chronic conditions prevention will ultimately result in improved care but also improved health and cost.

Learning Objectives:
1. identify strategies in implementing a well-sustained system-wide QI program 2. identify QI indicators impacting on health promotion and disease prevention of disadvantaged population. 3. describe QI process in implementing best practice guidelines.

Keywords: Quality Improvement, Chronic Diseases

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I manage the Corporate Quality Management Program of HHC
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.