Next Generation of Quality in Children's Health Care

Just returned from the Children's Hospital Association Next Generation of Quality in Children's Health Care Design Workshop in Dallas earlier this week. This meeting convened about 50 thought leaders in pediatric quality from across the country to identify a framework and implementation strategies for the next generation of quality in children's health care.

Here is a distillation of my notes from the meeting:

(1) Health disparities and the positive difference that quality improvement makes: An example is the glaring difference between steadily improving outcomes for cystic fibrosis versus the dismal and variable outcomes for sickle cell disease, largely due to funding for systematic quality improvement in cystic fibrosis.

David Nichols, American Board of Pediatrics

(2) Balanced quality portfolios: Following the publication of the Institute of Medicine report, 'To Err is Human', significant attention and resources have been dedicated over the past two decades to patient safety. Increased attention over the next decade needs to be paid to the other five domains of quality - timeliness, effectiveness, efficiency, equity, patient-centered care.

(3) Patient and family partnerships: Deepen patient and family engagement – get patient advocates onto your teams, integrate them into decision-making to set priorities, engage them meaningfully in quality improvement and co-designing care, provide easier access to medical information, leverage feedback and innovations from online patient networks, and increase the use of patient data collected at home from wearable technology.

(4) Learning health systems: Integrate improvement science, quality improvement, and clinical operations, so that new learning and research is translated to change in local clinical practice without delay.

(5) Standardization: Standardized clinical pathways help us implement evidence-based care, reduce variation in care, and get to shared mental models. Developing and updating clinical pathways takes lots of resources and time, and so using publicly-available robust pathways, with attention to our local context, helps us get to clinically effective care faster.

(6) Outside the hospital walls: Move from the concept of "children's hospitals" to "children's health systems". There has been significant attention paid over the past two decades to improving care in inpatient settings. Increased attention over the next decade needs to be paid to quality improvement in ambulatory specialty care, primary care and community settings, as well as social determinants of health.

I graduated from pediatric residency a year before the IOM report, 'Crossing the Quality Chasm' was released. Since then, I have witnessed the amazing progress in quality that children's hospitals have made. Significant strides have been made in improving patient outcomes, collecting and using health data, team-based care, and training in improvement methods.

We need to look back with pride at all these accomplishment, yet pay attention to ensuring that our priorities for the next generation of quality are aligned with current population and health care needs of our children and their families.