Becker's Clinical Quality & Infection Control

30 QUALITY IMPROVEMENT & MEASUREMENT Study Finds Physician Satisfaction Not Associated With Better Quality Care By Emily Rappleye A lthough high levels of job satisfac- tion can improve burnout and re- tention rates, enjoying the practice of medicine does not appear to be correlat- ed to better quality care or fewer medical errors, according to a study published in Health Affairs. Researchers measured job satisfaction as well as patient and clinician outcomes at a baseline and again one year later. ey polled 168 clinicians across 34 medical practices. In the baseline year, 74 percent of clinicians reported joy in practice. Satisfied clinicians were associated with less chaotic work environments, more cohesive workplace culture, better communication, greater trust and greater alignment of values between leadership and employees, according to the study. Satisfaction at the baseline was associ- ated with lower stress and burnout, and less desire to leave the group or practice. A year later, those who reported improved job satisfaction were found to be nearly three times less likely to report burnout and more than eight times as likely to report intentions to stick with the job. e study was con- ducted from 2011-14. However, researchers noted no changes in care quality or frequen- cy of medical errors. ey suggest improved job satisfaction and retention over a period of time longer than the study could lead to better care coordination and therefore better outcomes. "Improvements in quality and errors may take longer or stronger interventions," the study authors wrote. "[C]linician satisfaction may be more important in terms of morale, loyalty to the organization, and reductions in turnover than in terms of direct im- provements in patient satisfaction and other patient outcomes." n Children's National Quality Initiative Reduces NICU Chest X-Rays, Cuts Costs By Brian Zimmerman A quality improvement initiative implemented at Washington, D.C.-based Children's National Health System successfully reduced the number of chest X-rays conducted in the neonatal intensive care unit, de- creasing the risk of errors and cutting costs, according to research presented Sept. 15 at the 2017 American Acade- my of Pediatrics national conference in Chicago. The updated NICU X-ray protocol represented part of a larger initiative to reduce unintended extubations, which occur when an infant's breathing tube accidental- ly pops out. Chest X-rays increase the likelihood of this adverse event. Before the intervention, newborns underwent an average of 0.45 chest X-rays per patient day. After the program was implemented in July 2015, that figure dropped to 0.23 chest X-rays per patient day. Additionally, by the end of 2015, the NICU monthly X-ray spend dropped from $289,520 to $159,424, producing nearly $1.6 million in annual savings. "When you reduce the frequency of patients in the unit being moved, you decrease the chances of the breathing tube coming out accidentally," said Michelande Ridoré, program lead in Children's division of neonatology, who presented the research at the AAP conference. "By reduc- ing unplanned extubations in the NICU, we can improve overall clinical outcomes, reduce length of stay, lower costs and improve patient satisfaction." n Critics Argue Anthem's Outpatient Imaging Policy is at Odds With Promoting Quality By Morgan Haefner S ome healthcare analysts say Anthem's new imagining policy for hospital-based MRI and CT scans counters quality improvement ef- forts, according to Kaiser Health News. On July 1, Indianapolis-based Anthem ended coverage of hospital-based MRIs and CT scans without prior approval in Indiana, Kentucky, Missouri and Wisconsin, and expanded the policy to Ohio Sept. 1. Hospitals will need to submit a precertification request for any patient receiving an MRI or CT scan at the facility, and in most cases the imaging service will only be covered at the hospital if Anthem deems the request medically necessary, among other factors. The change aims to incentivize the use of cheaper alternatives at freestanding facilities. However, Leah Binder, president and CEO of the Leapfrog Group, told Kaiser Health News the policy may be at odds with quality improvement initiatives. "To achieve true value, you have to have high-quality care at a good price. Anthem would be better off judging the quality of these [imag- ing] diagnoses" than setting payment based on where they are provided. n

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