New Division of Quality and Health Improvement

In an age when you can order a book from Amazon, know immediately if it's in stock and when it will be delivered, track the shipment every step of the way, and expect excellent customer service if something goes wrong, medicine is behind the times when it comes to incorporating quality metrics. That’s the opinion of Dr. Scott Owens and one of the reasons behind the creation of the Department of Pathology's new Division of Quality and Health Improvement or DQHI. Dr. Jeffrey Myers, Vice Chair of Clinical Affairs and Quality appointed Owens to the position of director of the new division in December of 2014. Myers' vision for the division has become its motto of sorts, "Pathology will transform the patient experience."

Myers explained, "This is not 'quality assurance' in the usual sense. Instead DQHI creates the bandwidth to rethink the many ways in which pathology can affect value-based care for not only UMHS patients but also patients served through our MLabs portal." He’d like the new division to explore and implement different ways that Pathology delivers its services to have a significant impact on our patients, taking quality to a level beyond the day-to-day.

DQHI Manager Brian Tolle, left, and DQHI director Dr. Scott Owens.Owens explained, "We're not just looking at day-to-day operational quality, although that's part of what we're looking at, but what we'd really like to do is sort of break the mold and make it a value creation division. I think the real impact for the institution, for medicine as a whole, through this will come from that side where we're looking to break down barriers, where we're looking to do something completely different that nobody has thought of before."

"This is not 'quality assurance' in the usual sense. Instead DQHI creates the bandwidth to rethink the many ways in which pathology can affect value-based care for not only UMHS patients but also patients served through our MLabs portal."

Dr. Owens first became interested in quality as it relates to the practice of pathology when he was a member of the faculty at the University of Pittsburgh. In his time at the University of Michigan, he has built a network of clinical colleagues to help identify opportunities for value-based healthcare collaboration and sponsorship. He's also responsible for ensuring that the division’s priorities align with departmental and institutional priorities. He said that while the DQHI will certainly have to mesh the department and institution’s goals with the goals and ideas that come to them through DQHI, it's part of the division’s job to make sure those ideas are heard, bringing them back to department and institution leaders and making the case for implementation.

Pathology is uniquely positioned because work in the laboratories is much like manufacturing. "We crank out tests, whether it's me looking at a slide under the microscope and making a diagnosis or, particularly, when you look at the side of clinical pathology where they're operating in rooms full of machines, full of people much like an assembly line." says Owens.

Historically, Pathology has been paid on a per test basis but that will have to change with the move to a value-based-model and DQHI strives to rethink the value proposition of health care defined as quality (i.e., outcomes, safety, service) divided by cost over time.

"Despite the best intentions of everyone, every health professional in this institution and others, we have trouble holding ourselves to the same standards as other industries when it comes to health care, and our main products directly and intimately involve people." Owens said, emphasizing that our "deliverables" impact human lives as opposed to Amazon orders.

Before the creation of the new division, each laboratory ensured that its operations met the quality standards required by our accrediting agencies but there was only one person who served an over-arching quality role for the department. John Perrin, the DQHI's Quality Assurance Manager for the Division of Anatomic Pathology, was responsible for that task. "Honestly, it was just too much work for one person to even think about doing." he stated.

Suzanne Butch, who is DQHI's Manager of Clinical Pathology Quality Assurance, was also helping out with quality on the Clinical Pathology side. The laboratory faculty and staff were increasingly coming to John and Suzanne, asking for assistance with root cause analyses, and more.

Suzanne Butch, Manager of Clinical Pathology Quality Assurance, reviews specimen problem data from the blood bank with Senior Business Analyst Marianne Mara. Administrative Assistant, Lisa Brown, is in the foreground.When the idea of expanding quality within the department first arose, John and Suzanne both intended to be involved. They're currently working as liaisons between the laboratories and the DQHI providing expertise in quality monitors and metrics, Lean practices, and problem solving methodologies. However, they never imagined they'd be working with such a large team. "I was surprised how big it got suddenly. It wasn't just the two of us, which was my original vision. Suddenly we have a manager, there's compliance, there are two project managers, there's (analysis) support, an administrative assistant, and a faculty director. It became this huge thing. From very small to, suddenly, a big department." said Suzanne.

John added, "Honestly the Quality Division is long overdue." He continued to voice that the project managers were a big boon and incorporating an IT person into this division was a good idea because all the necessary components are interrelated and needed to get fully functioning, high quality work done.

Brian Tolle was brought in as the division's manager in February, 2015. He believes his role is to ensure that the team’s efforts are coordinated and aligned and that there are clear priorities within the division, enabling them to be executed to provide maximum impact. In the short time he’s been here, he feels that the critical role a quality division can play in patient care in the Department of Pathology has already been reinforced. "Everyone in the Pathology Department has the patient experience in mind each and every day. The Quality Division can add value by taking that individual mindset and ensuring our inter-related systems are designed to deliver an exceptional patient experience," he said. Tolle is also responsible for helping to remove obstacles that might prevent DQHI team members from achieving results.

Tolle and Owens are currently setting up meetings, working from the director level down, assessing what is done within Pathology that adds value from the perspective of our patients and clinical partners, as well as finding out how the DQHI can assist the labs in doing their jobs. "We're meeting with them asking, how can we help you? What problems do you need to solve, and what are the priorities as you see them for solving these problems?" Owens said.

"Everyone in the Pathology Department has the patient experience in mind each and every day..."

To help organize efforts to ensure a comprehensive approach to quality, DQHI chose the Clinical and Laboratory Standards Institute's Quality Management System as a quality framework. This Quality Management System consists of twelve Quality System Essentials that cover all aspects of quality and laboratory management. In addition, DQHI is working with select labs to introduce the Michigan Quality System's Lean in Daily Work. DQHI's Administrative Assistant, Lisa Brown, explains that Lean in Daily Work is all about using a visible board where everyone in a lab can put down ideas and track the progress of projects to make daily improvements. Lean in Daily Work also includes Gemba walks where teams actually go into the environment where the work is being done to understand how things really work and where to make improvements. This allows everyone involved to better understand challenges and be more informed when it comes to brainstorming solutions. Lisa’s interest in joining the team came from an interest in feeling like she had more of a role in making a difference in the patient experience. "It's my little bit of being able to help other people. I have a daughter who has medical issues. She's almost 20, and we've been in the hospital, almost her entire life, on and off. Even back then, I knew there were so many different little things that people could do that would make a difference and now I feel like I'm finally part of that." she said.

In addition to Lean practices, the team will support the mission of continuous quality improvement efforts by providing expertise in regulatory compliance, quality monitors and metrics, and problem solving methodologies.

Marianne Mara, the Senior Business Analyst from Pathology Informatics whose work is centered in DQHI, will help gather and analyze the data. As part of both DQHI and Pathology Informatics, her major focus currently is creating reports for the labs in order to help them get a visual of the tests they are running, decrease the gaps, and focus on quality, compliance, and value-creation.

Offering expertise in regulatory compliance, Compliance Manager Kellen Kangas said, "I feel that this is a great opportunity for the Department of Pathology to move forward to align themselves with industry best practices." He, along with project managers Amy Harrison and Jeff Lott, round out the team. Amy manages DQHI initiatives that involve collaboration with other departments at the health system. Jeff is the project manager for departmental initiatives and projects that involve improving Pathology practices or developing and implementing new practices. Both bring expertise in managing large scale change projects to create value. All members of DQHI are excited to be assembled to improve patient care.

Thomas Franks, Senior Med Tech - HLAOf course, the laboratories have some of the usual concerns, when the quality division comes in, about being watched, or being forced to do more work. Myers explained that although the mission of DQHI overlaps with the robust operational quality programs that already exist in our clinical enterprise it is not intended to replace them. Owens hopes that as the labs see the benefits that come out of the new division, the concerns they have about having a quality division will be alleviated. He relates that the labs are doing a good job. They're putting everything they have into it in most cases but he thinks that people who are interested in quality in medicine have to make the case that it's time to think about more standardized work, to think about ways that we can create value for patients. "Patients shouldn't come here because it's the University of Michigan and it's the biggest game in town, and that's where their doctor referred them. Rather, they come for the same reasons that they choose Southwest over Delta, or vice versa, there's going to be value in it if they come here."

Working together will go a long way in improving patient care. There are already projects in the works to see if there are any tests being under or over-utilized. The division is partnering with Dr. Scott Flanders and other colleagues in Internal Medicine to look at a variety of tests to determine if their utilization is appropriate from a clinical standpoint. This is just one way, using data mined from the laboratory information system, that Pathology can initiate discussions with clinical partners about opportunities to transform the patient experience. 
Mia Kost, Med Technologist, Histocompatability

"Patients shouldn't come here because it's the University of Michigan and it's the biggest game in town, and that's where their doctor referred them. Rather, they come for the same reasons that they choose Southwest over Delta, or vice versa, there's going to be value in it if they come here."

Said Owens, "I don't want to overuse a trite cliché, but it’s just blowing up these old ways of doing things and thinking in terms of how are we going to create more value, that makes the proposition for patients coming to University of Michigan all the more attractive." Just like ordering that book from Amazon, the Department of Pathology Division of Quality and Health Improvement is striving to provide the best service possible in an efficient and timely manner for our clients. Pathology WILL transform the patient experience.