Outcomes of completed quality activities in an Australian tertiary hospital, 2015-2019

Quality activities including quality assurance and quality improvement are an integral part of safety and quality governance for hospitals. Previous studies identified that (i) majority are for quality assurance and knowledge-acquiring purposes and (ii) adherence to the quality cycle as well as impact on patient-related outcomes at the hospital level are unclear, neither associated with costs. This study aims to (i) assess adherence to the quality cycle for quality activities in a large Australian tertiary hospital; (ii) report outcomes of quality activities at the hospital level, including impact on patient-related outcomes measured by the occurrence of hospital-acquired complications; and (iii) estimate time and costs for data collection. This quantitative study utilized three data sources. First is the hospital's electronic quality management system, Governance, Evidence, Knowledge and Outcome that identifies completed quality activities over a 5-year period; second is Tableau dashboards for hospital-acquired complication performance; third is Microsoft Teams Forms used to capture time of data collection for bedside observations and retrospective notes reviews. Median sample size and median hourly rates in 2018 were used for calculations. A total of 1768 quality activities were completed over a 5-year period representing an average of 353 quality activities per year, of which 87.8% were initiated by clinicians and 12.2% planned and coordinated by safety and quality or equivalent. The activity reports indicated that less than a fifth (17.1%) brought about improvement in process measures and only 7.1% improved outcome measures. Two-thirds of the quality activities (66.3%) provided recommendations based on their findings, but evidence of action plan was available in 14.1% of the reports only. No association was found between the number of activities completed and overall hospital-acquired complication performance. Retrospective data collection (64.7%) was common. The estimated time and cost for data collection averaged at 3490 h/year, equivalent to 1.8 full-time employees, for a cost of $171 000 at the nursing rate (A$49.0), $280 000 at the medical rate (A$79.5), and $200 000 at the Health Service Union rate (A$58.9). Most quality activities were clinician-initiated. Implementing change and achieving and sustaining improvement were the two challenging stages in the quality cycle. No clear association was observed between activities completed and improvement in patient-related outcomes although some improvement in processes. A paradigm shift may be needed to engineer quality activities in hospitals to be more outcome-oriented. Opportunities exist for hospitals to consider how quality activities can be organized to maximize returns from investment.