The Growth and Challenges of Today’s Healthcare Chief Quality Officer
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Guest post by Michael R. Raddatz, Jr., Associate

The American Medical Group Association recently formalized its definition of a high-performing health system, and one of the six benchmark elements that AMGA cites is “quality measurement and improvement activities.” These activities include preventive care and chronic disease management, ongoing patient outreach programs, continuous learning, applied data analytics, transparent reporting, and more. Successfully done, they allow a hospital or health system to meet key strategic goals such as lowering readmission rates and improving standardization of care.

These activities represent an intimidating list, yet they will only become more critical to accomplish as health reform continues and hospitals are increasingly challenged to provide higher quality healthcare at lower costs. In the past, quality initiatives such as those above may have fallen under the domain of a mid-level department head and were primarily related to risk management. Their objective was to keep the organization out of trouble as a means of staying in business and continuing to provide care.

Thankfully, this approach has changed over the past 10 to 15 years, as hospitals and health systems realize that an overemphasis on compliance does not necessarily lead towards better patient care and, in fact, can inhibit it. This change of course has led to a corresponding change in the position titles and responsibilities of those charged with overseeing quality—from director-level positions to C-level ones, with Chief Quality Officer being the most prominent title. Having C-Suite representation obviously goes a long way towards defining and improving organizational quality.

Defining the Healthcare CQO Position and Reporting Structure

Michael Raddatz

The roles and responsibilities of Chief Quality Officers can vary greatly from one organization to the next. In smaller organizations it is not uncommon for the position to have no direct reports. Often ad hoc teams guided by Six Sigma blackbelts or Lean experts spearhead important quality initiatives. At the other end of the spectrum there are organizations with such large staffs that the term leanis ironic. Frankly, this differing structure between organizations really depends on what each organization is looking to gain from quality.

It is safe to say, though, that Chief Quality Officer roles are expanding across the board. The following language is excerpted from a position description from a CQO search that Witt/Kieffer recently conducted. Qualified candidates were expected to have:

  • a minimum of five years of experience leading a highly performing quality team within a hospital and/or health system;
  • experience as a leader for performance excellence and quality;
  • working and applied knowledge of a performance improvement methodology, such as Lean, Six Sigma, and/or Kaizen;
  • in-depth knowledge of national trends and be active nationally within the quality and performance improvement space;
  • relevant experience using advanced clinical technologies to drive operationally efficiencies and outcome improvement;
  • the ability to translate broad strategies into specific objectives and initiatives;
  • responsibilities including systems and process redesign, implementation of evidence-based and industry best practices throughout the organization.

One of the challenges that organizations have in regards to a position such as this is where to place it within the organizational structure. Departments such as risk management and infection control can fall under quality, as can management engineering, process improvement and Lean/Six Sigma. 

Just as important is whom the healthcare Chief Quality Officer reports to. While in the past it may have been commonplace to have the position under the Chief Nursing Officer, today having it report to the Chief Medical Officer or Chief Operating Officer is more common, and oftentimes appropriate.

Some organizations are placing the CQO even higher, having him or her report directly to the CEO. In doing this, a layer of leadership is removed and the organization can be truly strategic about its approach to outcomes and quality of care. What better way for the chief executive to have a handle on organizational outcomes and transformation than to have the top quality executive close at hand? This in turn can help to facilitate collaboration among clinical leadership, between nursing and medical administration, with the CQO as the link between both departments.

Where Are Tomorrow’s Chief Quality Officers?

So where do we find these new leaders of quality? Organizations can look internally at consensus builders who have shown a passion for innovation. There may be, for example, a nursing leader on the team who is already doing significant quality work.

Operations is another department from which to find potential CQOs. Individuals such as service line executives who already collaborate with nursing and medical leadership might have interesting insight on how to impact quality. Or medical directors in areas such as the emergency department or anesthesia work with the continuum of care and likely have interesting insight on how to impact quality.

It is also possible to look outside healthcare in related industries where quality is critical, such as pharmaceuticals or medical device. The best advice is to keep an open mind when it comes to identifying potential candidates for quality leadership. 

No matter their background experience, healthcare quality executives can benefit from career development activities including membership in professional associations such as ASQ, IHI, or NAHQ. It is also wise to pursue specified training, such as the Certified Professional in Healthcare Quality (CPHQ) designation offered through the NAHQ.

The role of the healtchare Chief Quality Officer is still maturing, which means there are many opportunities for these executives to shape their roles and responsibilities and make their mark in the field.

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