AUTHOR(s): Bergman, Rhonda TITLE(s): Beyond dollar signs: folding quality into the corporate culture. (continuous quality improvement system in health care industry) Summary: Continuous quality improvement (CQI) is a way for health care organizations to improve cost control through systematic improvement of patient care quality. The CQI system saved $38.5 million for EHS Health Care in 1993. Other health care organizations that have realized cost savings from improved patient care include Northwest Hospital in Seattle, WA, and AMI Piedmont Medical Center in Rock Hill, SC. Hospitals & Health Networks p60(1) August 20 1994 v68 n16 DESCRIPTORS: Healthcare industry_Management Medical care, Cost of_Management Medical protocols_Management Quality efforts saved EHS Health Care $38.5 million last year, but saving money is not the only goal the Oak Brook, IL-based system strives to achieve through continuous quality improvement. The EHS approach calls for educating employees on CQI in order to make the philosophy part of its corporate culture. For CQI to succeed, experts say it must become a part of an organization's living culture. The quality of patient care systematically goes up under CQI--and that's how cost savings occur, says M. Daniel Sloan, a Seattle-based quality consultant and author. CQI also helps motivate employees, because it brings enthusiasm and, a sense of accomplishment to the organization. EHS has plenty of company nationwide in its quest to fold quality into the corporate culture: * AMI Piedmont Medical Center, Rock Hill, SC, takes its quality improvement initiatives outside its walls to make improvements in the county it serves. * Saint Alexis Hospital Medical Center, Cleveland, teamed up with two local hospitals in a CQI program. * Northwest Hospital, Seattle, even gave each of its employees a $250 bonus after it was able to reduce its net operating costs by $4.5 million over an 18-month period without any layoffs. Health system's CQI approach EHS, which consists of five owned hospitals and one affiliated hospital, and offers home health, outpatient, mental health and other services, began using CQI tools three years ago. Last year the system undertook 335 clinical and administrative CQI projects. Of those, 133 were completed; the rest are ongoing. To increase employees' knowledge and understanding of CQI, EHS has, since 1991, held a systemwide annual quality fair. The one-day fall event largely serves as an internal seminar, but others (including legislators and employers who have contracts with EHS) have been invited to attend. The fair also recognizes the efforts of the CQI teams across the system. During breakout sessions, each CQI team has an opportunity to provide more information on the purpose of its project, its evaluation methodology and implementation strategy, and the results to date. Last year's topics included, for example, decreasing readmissions for adult asthma, clinical benchmarking of open-heart surgery and management of community-acquired pneumonia. "It's one thing to publish a list of projects that people have done; it's another for people to actually see the projects and get the chance to talk to those who worked on them," says Cheryl Brewster, EHS vice president of quality management. Through the fair, employees bring back ideas; some of which they have applied to their own organization, according to Ben Grigaliunas, senior vice president of human resources and administration. For example, a one-day-stay program for low-risk obstetrical patients that was developed by two EHS hospitals was later applied to others in the system. Such efforts helped EHS win the 1994 Commitment to Quality Award, the San Francisco-based Healthcare Forum's version of the Malcolm Baldrige National Quality Award. Taking it to the community At AMI Piedmont Medical Center, total quality management and CQI principles have been used for nearly two years by all departments. But for the past few months, Piedmont's efforts have been extended to the community in an effort to improve responses to emergencies. Work is done by a team that includes representatives of the hospital, the hospital-owned emergency medical services, the county's emergency operations center and the volunteer rescue squad. Using quality improvement tools, the team examines how emergencies are being handled and looks for ways to improve methods. In Cleveland, Saint Alexis is one of three Ohio hospitals participating in a two-year project funded by a foundation grant and overseen by an organization that helps businesses improve quality and productivity. Saint Alexis Hospital, Geauga Hospital in Chardon and Marymount Hospital in Garfield Heights hold joint meetings to share ideas on how CQI has been implemented in their organizations. Saint Alexis has used CQI tools for about three years, and every department is involved to some extent. Patrick Horine, manager of training and CQI at the hospital, says that the initiatives brought about changes in management style, resulting in more accountability. "The managers came on board as a team," Horine says. "It's really been quite positive in terms of improving employee morale."