Keeping Cost , Quality and Outcomes at the Heart of Healthcare Environmental Services Practices
By John Scherberger , FAHE , CHESP Editor ’ s note
This article is part of a yearlong series describing an Industry journey led by environmental services and infection prevention toward better patient outcomes , quality and cost savings .
In the April 2021 issue of Healthcare
Hygiene magazine , the Environmental Services Optimization Playbook ( EvSOP ) article titled “ Value- and Science-Based Healthcare Evaluation and Purchasing ” took a very critical look at the lack of scientific and value-based processes in environmental services ( EVS ) departments .
The article used the whimsical Lewis Carroll poem The Walrus and the Carpenter to highlight the many ostensible and , to many observers , nonsensical and dissonate issues considered when making many EVS purchasing decisions . It ’ s as if some people become the Walrus and concentrate on topics , such as if a product appears in a group purchasing organization ( GPO ) agreement and not the science needed to ensure that cost , quality and outcome is the sole guiding principle .
The Association for Healthcare Resource and Materials Management ( AHRMM ) of the American Hospital Association ( AHA ) is the leading membership group for healthcare supply chain professionals . It is essential to understand this about AHRMM : “ The AHRMM Cost , Quality , and Outcomes ( CQO ) Movement refers to the intersection of cost , quality , and outcomes , and a more holistic view of the correlation between the following : Cost ( all costs associated with delivering patient care and supporting the care environment ), Quality ( patient-centered care aimed at achieving the best possible clinical outcomes ), and Outcomes ( financial reimbursement driven by outstanding clinical care at the appropriate costs ) as opposed to viewing each independently .” With just a bit of editorial action , the quote is taken directly from
their website at : https :// www . ahrmm . org / cqo-movement / what-is-cqo
This article is not about AHRMM ; however , it is very notable that they do not say that neither cost , quality , nor outcome is the primary driver of their movement — it is a holistic intersection of the three considered to achieve the best clinical outcomes . Please note that clinical is science-based . Also , over the last few years , some organizations have added to the Triple Aim , making it a Quadruple Aim . Worldwide , the Institute for Healthcare Improvement ( IHI ) has been asked the same question : “ Why doesn ’ t IHI support the fourth component since others have done it ?” The IHI states on its website that the fourth defining component for these organizations could be “ improving the health of populations , enhancing the experience of care for individuals , and reducing the per capita cost of healthcare , attaining joy in work , or for others , it ’ s pursuing health equity . Some organizations highlight other priorities . The military health system , for example , has added readiness as its fourth aim . Although IHI supports other organizations prioritizing these worthy efforts in pursuing a Quadruple Aim to deliver on the organizational strategy .” If delivery of a Quadruple Aim is successful , IHI urges the organizations to keep the following four points in mind :
• Remember that the Triple Aim is about patients . At its core , the focus of the Triple Aim is to improve the lives of patients . Triple Aim outcome measures put patients at the center of care . Any modifications to the original Triple Aim should not take us away from our highest priority .
• We haven ’ t finished pursuing the original Triple Aim . In almost every organization and virtually any environment , we still have a long way to go to achieve Triple Aim outcomes . There are still gaps in the health of the populations that we serve . We miss too many opportunities to improve the care experience . We haven ’ t done enough to improve healthcare quality while reducing costs .
• Don ’ t lose focus . Don ’ t let a fourth aim turn your organization ’ s capacities and capabilities away from optimal delivery of the Triple Aim . No organization has unlimited resources , so we must deploy what we have in an intentional , purposeful way . Make sure you respond truthfully to a complex question : Will we spread ourselves too thin if we pursue more than three aims ?
• Measure what matters . If you pursue a Quadruple Aim , you ’ ll need to reconsider your measurement strategy as a whole . Rarely do you hear anyone complain about measuring too few things ; be mindful of limitations on your staff ’ s bandwidth and use deliberation and consideration to determine what data is necessary and how to collect and analyze it .
With the IHI thoughts in mind , it is the intention of this article to focus on the Triple Aim of Cost , Quality and Outcome ( CQO ).
What does CQO have to do with healthcare environmental services ? CQO must be embedded in all EVS-related decisions because EVS helps save lives .
As asked in the April 2021 issue of HHM :
• Why are science- and value-based processes not part of the “ DNA ” of the procurement process decision-making when considering EVS tools ?
• Why is science- and value-based product evaluation bypassed when considering or purchasing EVS tools ( disinfectants and healthcare-grade ultra-microfiber products and subsequent reprocessing to hygienically clean outcomes through an accredited / certified healthcare laundry ) for infection prevention processing of the environment ?
• Why are EVS departments excused from science- and value-based product evaluation for essential functions of infection prevention trap-capture-remove tools purchased or services contracted ?