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

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.