Join the quality revolution, Judge urges - Joanne M. Judge urges Health Care Financial Management Association to invest in quality health care

Healthcare Financial Management, Sept, 1991

Because it depends on resource allocation, quality in health care ultimately is a financial matter. HFMA's 1991-92 Chairman Joanne M. Judge, FHFMA, CPA, told members during the opening assembly at HFMA's 1991 National Convention held June 16-20 in Orlando, Fla.

More than 1,200 registrants attrended the general session, which marked the official opening ofthe convention. The program included the Joseph A. Levi Memorial Keynote Address by Nancy K. Austin, presentation of the Board of Directors Award (see related story), musical entertainment, and video presentations on quality and HFMA's 1991-92 Board of Directors.

Speaking on the 1991 membership year and convention theme, "HFMA: Invest in Quality," Judge said that by thinkign that quality in health care is only a clinical issue, "many financial managers may have distanced themselves from the responsibility for quality in our business." She said she seeks to change that perspective throughout her year as Chairman.

Drawing from her experience on a Pennsylvania state council that develops clinical outcomes data, Judge had some criticism for the healthcare industry's participation in public debate and discussion about the quality of care provided in the United States. "Hospitals have had some serious concerns," she said, "but have generally looked at how to tear apart the process, rather than look at how to make it work."

Revolutionaries wanted. A healthcare financial manager, she said, is "the individual who has both the skill and the vision to show greater industry leadership and [can] say, 'This is how we can do it.' Let's not be reactionaries," she advised. "Let's be revolutionaries."

Judge touched on ideas of the original quality revolutionary, W. Edwards Deming, an industrial engineer who, because of his ideas on quality management, largely is credited with the economic success enjoyed by post-war Japan. "[Deming] says that most of an employee's successes or shortcomings result from the system in which he or she works--in other workds, a system that is the sole responsibility of management," she remarked.

Instilling quality throughout the healthcare industry and within the Association has been the goal of a Chariman's Task Force on Quality Standards appointed by Immediate Past Chairman David H. LeMoine, FHFMA, CPA, Judge said. The "keystone" of the task force's work on quality standards, she said, is a statement of quality "that sets out our understanding of continuous quality improvement [CQI] as an association."

That understanding includes a CQI program in all budget areas, HFMA sponsorship of a major conference on linking financial management and quality improvement, a 1991-92 Matrix committee on quality improvement, a Chapter Liaison Committee to develop recommendations on chapter CQI programs, and a vital indicators program -- "an early warning system to monitor quality in all program budget areas."

"The task ahead," Judge said, "is to move HFMA from an understanding of delivering service to one of satisfying customers. Quality is meeting the needs and expectations of customers."

Meeting customers' needs. Along with developing clinical outcome standards, another example of healthcare organizations meeting their customers' needs came from Lancaster, Pa., where Judge is president and chief executive officer of Community Hospital of Lancaster. Hospitals in that part of Pennsylvania, she said, are "sophisticated and well-equipped" on the inside. Outside they have hitching posts for their local Amish patients who travel by horse and buggy.

A common quality measurement standard in the manufacturing industry is zero defects. For a service organization such as HFMA, Judge suggests the standard of zero defections. "HFMA has an outstanding retention rate of customers -- or members -- at 89 percent," she said. But even those who remain members may "defect" from particular HFMA services if the customer or member value of those services is not constantly monitored.

"If we keep you, the member, satisfied, you are more likely to return for another year," she said. "And that means HFMA maintains a stronger voice in Washington, in our industry, in service to our members."

Judge stressed that quality means" continuous improvement, not acceptable quality levels." As such, she said, the only acceptable goal of continuous quality improvement program is 100 percent quality output. She illustrated the need for high standards by reporting that, if 99.9 percent were considered good enough as a quality standard:

* 22,000 checks would be deducted from the wrong bank accounts in one hour;

* 14,000 defective personal computers would be shipped in one year;

* 12 babies a day would be given to the wrong parents;

* 3,056 copies of each day's Wall Street Journal would be missing one of three sections; and

* Two planes landing each day at Chicago's O'Hare International Airport would be unsafe.

Personal commitment. In choosing the theme "Invest in Quality," Judge said she thought not only of financial implications of the word invest. Quality also requires a personal investment. "To make quality a part of our job, we need to make it a part of our lives," she said. "We need to invest ourselves." To that end, she said, not only do organizations need to implement CQI, but financial managers "need to talk and act on C-PI too--continuous personal improvement."