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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:

  1. Expand the Loyola University Health System and network services to attain a "critical mass" of aligned providers
  2. Develop a marketing strategy that focuses on core markets and products
  3. Design and pursue a full continuum of care
  4. Enhance an integrated approach to care management
  5. 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:

  1. Create and implement a comprehensive Primary Care Network
  2. Develop a full range of ambulatory services
  3. Provide management and physician leadership, and related supportive information systems

Goal 3: Pursue total quality management in all activities, services, and programs.

Supporting strategies:

  1. Design and implement effective patient/care management systems
  2. Document and implement, "best practice"
  3. Redesign patient care to assure optimal clinical outcomes, high service satisfaction and smooth care delivery processes
  4. Report the results to internal and external publics

Goal 4: Achieve success in the managed care marketplace.

Supporting strategies:

  1. Continue aggressive efforts for physician and hospital service contracting
  2. Create a comprehensive access and information system, including demand management
  3. Pursue an active "relationship management" approach with all payers
  4. 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:

  1. Continue physician integration work within LUPF
  2. Integrate the LUMC and WSHMC primary care physicians and sites into a single primary care network
  3. Align the interests and relationships of LUPF and WSHMC specialists with those of primary care practitioners
  4. Work to develop collegial relationships between LUPF and WSHMC specialists
  5. Improve coordination and communication with referring physicians
  6. Align economic incentives

Goal 6: Expand information systems development and systems integration through implementation of the information systems plan.

Supporting strategies:

  1. Improve patient management systems, core transaction processes, and records processing
  2. Provide broad-based, integrated information technology supporting to all sites of service
  3. Support clinical and management, decision-making
  4. 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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Last reviewed: Dec. 13, 2006

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