How to Prioritize Your Quality Improvement Projects
Quality
Improvement Project Prioritization Guidelines for Use and Scoring
This document is designed to help you select those
quality improvement projects of most value to your department/division and the Loyola
University Health System. The accompanying spreadsheet entitled Quality
Improvement Project Prioritization is used to score each potential project and thereby
permit a reasonably objective comparison of the improvement opportunities available to
you.
Using the guidelines below, assign a score from 1 to 5 to
each of the 18 Criteria divided into five major Categories on the spreadsheet. Next,
calculate an average score for each Category. For example, if the three criteria under
Mission/Strategy were scored 3, 3, and 4, add the scores together and divide by the number
of criteria (3+3+4 / 3 = 3.3). When all categories have been scored, simply add the scores
together; the maximum score for any project is 25.
Please note that this scoring tool is designed to guide
not dictate your quality improvement activity. If a given project scores very high but
you have a very good rationale for not pursuing it, do not feel obliged to proceed. In
this regard, if a project does not receive a high score in the Mission/Strategy category
it should probably not be pursued.
If you have any questions regarding use of this tool, please
contact the Center for Clinical Effectiveness (216-3290) for assistance.
1. LUHS Mission /Strategy
A. Mission - extent to which the project supports our
mission as described below:
Loyola University Health System strives to be
among the best fully-integrated health systems in the country by providing individually
focused, cost-effective care with uncompromising quality in both medical outcomes and
service. For our patients, staff, and communities, we want to be a friendly accessible
organization.
Consistent with our belief in God’s presence in
all our work, we are committed to treatment of disease and to the maintenance of physical,
emotional, and spiritual well being. Loyola University Health System will continue its
leadership in expanding knowledge through medical research and educating health care
providers for tomorrow.
B. Strategic Plan - extent to which the project
supports the goals of our current strategic plan as described below:
Goal 1: Position Loyola University Health System as the preferred
choice for health care based upon its comprehensive, cost-effective, high quality
services.
Supporting strategies:
- Expand the Loyola University Health System and network services to
attain a "critical mass" of aligned providers
- Develop a marketing strategy that focuses on core markets and
products
- Design and pursue a full continuum of care
- Enhance an integrated approach to care management
- Enhance and promote the "Centers of Excellence"
Goal 2: Expand primary care and ambulatory care sites and services
throughout the region, particularly in the western suburbs.
Supporting strategies:
- Create and implement a comprehensive Primary Care Network
- Develop a full range of ambulatory services
- Provide management and physician leadership, and related supportive
information systems
Goal 3: Pursue total quality management in all
activities, services, and programs.
Supporting strategies:
- Design and implement effective patient/care management systems
- Document and implement, "best practice"
- Redesign patient care to assure optimal clinical outcomes, high
service satisfaction and smooth care delivery processes
- Report the results to internal and external publics
Goal 4: Achieve success in the managed care
marketplace.
Supporting strategies:
- Continue aggressive efforts for physician and hospital service
contracting
- Create a comprehensive access and information system, including
demand management
- Pursue an active "relationship management" approach with
all payers
- Develop and offer a broad range of managed care-related educational
programs for physicians, employees, and others
Goal 5: Promote physician and clinical integration.
Supporting strategies:
- Continue physician integration work within LUPF
- Integrate the LUMC and WSHMC primary care physicians and sites into a
single primary care network
- Align the interests and relationships of LUPF and WSHMC specialists
with those of primary care practitioners
- Work to develop collegial relationships between LUPF and WSHMC
specialists
- Improve coordination and communication with referring physicians
- Align economic incentives
Goal 6: Expand information systems development and
systems integration through implementation of the information systems plan.
Supporting strategies:
- Improve patient management systems, core transaction processes, and
records processing
- Provide broad-based, integrated information technology supporting to
all sites of service
- Support clinical and management, decision-making
- Develop and install new strategic foundation systems
C. Patient populations of strategic importance -
degree to which the project focuses on populations deemed to be of strategic importance
such as:
- Product lines: cancer, cardiovascular, trauma-burns,
neuroscience, pediatrics, and women’s health
- Populations identified by Continuum of Care Committee:
geriatrics, congestive heart failure, diabetes, asthma, chronic obstructive lung disease,
HIV-AIDS, chronic pain.
2. Outcomes
For each criteria in the category, i.e. medical outcomes,
health status, access and satisfaction, a project with a large positive impact on a
significant outcome in a large number of patients is given the maximal score. A project
with minimal impact on a few patients should receive the lowest score. If in doubt, use
your best judgment to estimate.
A. Medical outcomes: objectively measurable morbidity
and /or mortality, e.g. infection rates, lung function, strokes, loss of limb, number of
inflamed joints, visual acuity, survival rates,
B. Health status (also referred to as health related
quality of life, functional status, well-being): those of those aspects of health directly
experienced by the patient. This outcome includes physical functioning in activities like
bathing or dressing; social functioning; bodily pain; general mental health; limitation in
roles such as work or other regular activity due to physical or emotional problems;
vitality; and general health perception. To emphasize, these are the patient’s
perceptions that can be eventually quantified via formal, scientifically valid survey
instruments.
C. Access to care: the ability to see the clinician of
the patient’s choice, at the date, time, location, and within the time frame
preferred by the patient.
D. Patient/family satisfaction: a personal evaluation
of health care services and /or providers. This may include satisfaction with the manner
in which care was provided; satisfaction with the health benefit derived from the care
provided; and/or a personal evaluation of the costs and benefits of services received.
E. Physician satisfaction: the physicians’
evaluation of the efficiency, ease or effectiveness with which their work is performed.
3. Process Improvement
For each criteria in the category, i.e. key processes, system
integration, continuum of care and redundancy, a project with a positive impact on a
significant outcome in a large number of patients is given the maximal score. A project
with minimal impact on a few patients should receive the lowest score. Again, estimate
if in doubt.
A. Improves a key process: processes that are directly
related to important outcomes in a large number of patients are scored higher. For
example, a project that improved operating room turnaround time or reduced the number of
outpatient clinics canceled on short notice (two processes) would result in improved
patient satisfaction for a large number of patients and more revenue (two important
outcomes). Alternatively, a project that sought to improve a process that had an uncertain
relationship to outcomes of importance for a small group of patients should receive a
minimal score.
B. Facilitates system integration: processes that are
likely to produce significant improvements in effective and efficient working
relationships between important components of LUHS (e.g. LUMC and West Suburban) would
receive a higher score.
C. Facilitates the continuum of care: a process that
improves the ability of a patient and his/her information to effectively move from one
site of care within LUHS to another. For example, a process that substantially improved
communication between primary care and subspecialty physicians would significantly impact
a large number of patients in an important way and would receive a high score.
D. Is redundant with other efforts: a project that
seeks to resolve a problem not being addressed elsewhere in the organization receives a
higher score. Conversely, a project that duplicates quality improvement efforts in other
areas would receive a lower score.
4. Financial Impact
A. Financial status: projects that result in a major
positive impact on the financial "bottom line" should receive a higher score.
Such results may be achieved via reduced cost per case, improved revenue per case, or an
increase in volume of patients. Projects that significant improve our ability to compete
for important managed care contracts would receive higher scores.
B. Attractiveness to payers: projects that address
patient populations, medical conditions, approaches to medical care or other issues that
have been explicitly identified by payers to be of importance should be given higher
scores.
5. Project Feasibility
A. Resources required: the fewer the resources
required for a project the higher it should be scored. A project that requires a large
input of personnel time and/or costly equipment should receive a lower score.
B. Length of study: timely completion of performance
improvement projects is valuable. Projects that require less than 6 months to plan,
implement and collect a reasonable amount of data are given higher scores. Projects that
require more than a year to complete similar tasks should be given a substantially lower
score.
C. Impact on other programs: projects that positively
impact other programs (e.g. by making their work more value added, less costly, more
satisfying) are scored higher. Projects that negatively affect other programs (e.g. by
creating disruption, making work more complex, more costly, less satisfying) should be
scored substantially lower.
D. Availability of effectiveness leadership: ready
availability of leadership of demonstrated effectiveness is scored higher. The lack of
availability of effective leadership combined with substantial barriers to the acquisition
of such leadership should be given a minimal score.
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