Patient Safety and Quality: Reimagining the Role of Finance

“Every system is perfectly designed to get the results it gets.”—Paul Batalden, MD, senior fellow, Institute for Healthcare 
Improvement (IHI), and founding chair, IHI Board of Directors

To Batalden’s point, when it comes to patient safety and quality, the fee-for-service system is perfectly designed to get the results it has gotten: treatment of preventable complications as they occur, and organizational structures that put safety and quality improvement initiatives squarely in the domain of clinicians, who work hard to help finance leaders see the need for funding them. As value-based payment takes hold, there are new opportunities to collaborate with our clinical colleagues from a different perspective. Although changing the payment system was perhaps necessary to create those opportunities, it’s not sufficient to bring them to fruition. What else we can do to make this type of collaboration a priority for finance leaders?

Batalden shares IHI’s experience with creating “sustainably improving health care” in a video I watched recently. He says that the first time people are invited to work together to improve the healthcare system, they accept; they’re curious. But the second invitation is met with skepticism because the first was a significant time commitment. By the third invitation, people say: “You know, I’ve got my day job. Why don’t you check with somebody else this time?” That’s when Batalden realized that this approach is self-limiting. To create a sustainable approach, Batalden says, we must link professional development, in its most fundamental sense—that is, the things that give people joy, competence, and pride in their work—with improving outcomes.

That advice may be directed primarily to clinicians, but it also should resonate with finance leaders. Consider the structure of value-based payment: It’s basically a web of financial penalties and incentives. Finance leaders have responded to the first set of regulations and have put processes in place that address them. But have the regulations fundamentally changed the way finance professionals see their roles? Have they helped finance leaders connect with the intrinsic satisfaction of improving safety and quality of care? Probably not. Will the next set of regulatory carrots and sticks do so? I have my doubts. The next set may be delegated to task-doers because, in setting up the processes, we’ve “done our part.”

Our challenge is to go beyond externally imposed payment requirements, to recognize and seize opportunities to co-create with others a sustainable approach to improving healthcare safety, quality, and value. That’s why HFMA has joined the Patient Safety Coalition, a multistakeholder group established by the National Patient Safety Foundation (NPSF) that is dedicated to enhancing the delivery of safe care. HFMA and NPSF are collaborating on research about the business case for patient safety. Research results are expected this spring.

Meanwhile, we can explore ways to broaden our perspective and to weave quality and safety into the fabric of what we do. For starters, open a dialogue with your clinical colleagues. They will welcome the opportunity. It’s this kind of agenda, quite frankly, that makes healthcare finance different from any other financial role in business: the opportunity to make a difference in peoples’ lives. It’s that important.

Follow Joe Fifer on Twitter: @HFMAFifer

From the President’s Desk

Joe Fifer expands on his ideas in his February column.