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Effective Use of Quality Staff Resources

Patient Safety Quality Monthly, July 31, 2007

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This month's column is written by Marla Smith, MHSA, associate consultant with The Greeley Company. Smith is a former quality and medical staff office professional who has been a full-time consultant with The Greeley Company for the past three years, focusing on quality measurement and peer review redesign.

How do we measure the efficient utilization of quality staff personnel/resources? Or, simply stated, how many FTEs does it take to successfully support both hospital and medical staff quality?

The first step in answering this question is to separate quality staff members into two main categories: hospital-based quality and physician-based quality. The two groups are different in several ways. Hospital-based quality staff members are geared toward examining hospital/organizational strategic initiatives and regulatory and state-based requirements as they pertain to the organization/systems operations as a whole. Persons responsible for medical staff quality focus on physician competency/patient care, peer review, and ongoing education for the medical staff.

Quality directors are faced with a growing dilemma: the need to stretch limited personnel among many different tasks/responsibilities. In order to effectively and efficiently staff a quality department, quality directors continually struggle to justify the need for one or two extra full-time employees. Some helpful steps in the justification process include the following:

1. Determine where the responsibility for hospital and medical staff quality currently lies. For example, is the medical staff services department currently responsible for medical staff quality? If not, see if the responsibility for this process can be divided.
2. Perform an assessment of the current quality process (i.e., examine current employees' tasks/responsibilities/job descriptions).
3. Review the current indicator data sets for both hospital and medical staff and determine which data outcomes are relevant and which are not.

In my experience, an effective staffing ratio to support the medical staff peer review/ongoing practice evaluation process is one full-time employee (FTE) per 100 beds. On the hospital quality side, one full-time quality coordinator should be able to support up to 4 to 6 hospital-based quality project teams, depending on the complexity of the projects.

As healthcare quality continues to grow in importance not only internally but also in the eyes of external regulatory agents, it makes sense to focus on this issue. Historically, quality-based initiatives have often been created and implemented as a reactive response. Going forward, effective quality programs need to take a proactive approach to examining their quality process and staffing. 

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