Quality requirements- which initiatives are related to finance and compliance, and how do we make it all work?

The number of Quality initiatives and Quality requirements that a healthcare facility is expected and often required to participate is growing exponentially. While Quality has often, although not always, had a place in most healthcare organizations, there is an immediate need to "move this up on the organizational chart." Historically, Quality initiatives were small, local programs that were intermittently measured or sustained. This is not meant to degrade past Quality initiatives, but meant to point out that Quality in the current healthcare environment is often tied directly to reimbursement and compliance. Many facilities are finding it hard to keep up with the increasing expectations in the Quality arena, often with no increase in funding or increase in staff. This often results in organizational Quality measurement, but no actual Quality improvement. When this happens, it completely undermines the tremendous amount of work that initially occurred in order to provide the data. An additional problem is that many facilities have either multiple data gathering systems in place, completely disjointed systems, and even manual chart extraction requirements that severely hamper the ability to provide real-time information. Funding is required to simply bring up the Quality infrastructure in many locations to the point that an effective system can be in place. It will benefit organizations to spend the necessary time and investment to gather, organize, and describe all current Quality initiatives, which will ultimately allow organizations to develop a strategic understanding and strategic plan. It may very well be the case that Quality initiatives that are not currently tied to finance, reimbursement, and compliance may need to be redirected or put on hold. A limited number of resources must be deployed to the most important and needed arenas. This exercise will also allow organizations to eventually restart programs that were initially placed on hold by redirecting or refining specific efforts into a direction that aligns with the overall strategic Quality plan. Healthcare Quality should be undertaken with a strategic plan in place, with an understanding of financial and compliance implications, in order to appropriately improve the patient care deliver system.