Evaluating the challenges of working in the healthcare industry


Considering the current challenges facing healthcare providers, such as falling reimbursements and increasing competition, hospitals and integrated delivery systems throughout the country are embracing a proven strategy used in successful businesses: benchmarking. By comparing and measuring their processes using data from various sources, including market research, state and national databases, and within the organization itself, healthcare providers can identify opportunities for improvement. This translates to reduced healthcare costs, improved quality of care, and ultimately, better health outcomes for patients.

Clinicians practice their skills daily. They read research, have clinical talks, and reflect on previous treatments in order to enhance their care. These measures undoubtedly improve patient care, but do not guarantee satisfaction or improved outcome ratings. Furthermore, the aim of attaining outcomes and satisfaction scores is not to boost your ego and show everyone how amazing you are, but to objectively analyze your level of care and make any required changes.

The World Health Organization describes an outcome measure as a change in a person’s health attributable to an intervention or sequence of interventions. Outcome measures are the quality and cost goals that healthcare organizations strive to achieve. Outcome metrics are often reported to the government, commercial payers, and quality reporting organizations. National organizations are primarily responsible for defining and prioritizing outcome indicators. Health systems prioritize outcome indicators depending on demands from the state and federal governments, accreditation criteria, and financial incentives. Although national healthcare outcomes are defined, health systems may set better goals. If these are met or exceeded, it helps improve care quality and also the marketing efforts of healthcare companies.

Because healthcare expenditures have risen rapidly over the last 50 years, far outpacing average cost-of-living increases, payers such as individuals, governments and health plans require reliable quality indicators to demonstrate that these increases are justified. Quality measurement entails gathering and interpreting data. However, the ever-increasing abundance of available health information makes data gathering and analysis difficult. Furthermore, the digitization of healthcare is being exploited and complemented using technologies such as analytics, cloud computing, mobile and social, which have been expedited by the deployment and use of electronic health records (EHRs).

Outcome metrics are the gold standard in gauging quality. Still, an outcome is the product of many factors, many of which are beyond the control of providers. Risk-adjustment approaches, which are mathematical models that correct for differences in a population’s characteristics, such as patient health status, can assist in accounting for these concerns. However, the science of risk adjustment is still in its early stages. According to experts, better risk-adjustment strategies are required to reduce the reporting of misleading or false information on healthcare quality. But what are the things we need to be reporting on and analyzing? 

Measuring up

To correctly assess healthcare quality, you must first understand what you are measuring. However, there is no universal definition of quality. Instead, there are hundreds, if not thousands, of quality measures – standards for assessing healthcare professionals’ ability to care for patients and populations. Each quality metric focuses on a distinct area of care delivery. However, these are some of the main ones that help identify improvement areas.

Mortality rates

Mortality rates provide a broad picture of a population’s health. They are influenced by healthcare quality and more general social, economic and environmental issues. Avoidable fatalities are classified as either preventable or treatable. It is deemed avoidable if a fatality may be avoided via good public health and primary preventive initiatives. On the other hand, curable mortality could have been averted with prompt and effective healthcare interventions, including secondary prevention. Preventable deaths represent the state of public health, whereas curable deaths reflect the availability, accessibility or quality of healthcare measures. They can be used to examine the quality and efficacy of healthcare systems.

Patient experience

The term ‘patient experience’ refers to the variety of encounters that patients have with the healthcare system, including with health plans; doctors, nurses and personnel in hospitals; physician practices; and other healthcare facilities. Patient experience, as an essential component of healthcare quality, comprises various characteristics of healthcare delivery that people value highly when seeking and receiving care, such as timely appointments, easy access to information, and effective contact with healthcare providers. Understanding the patient experience is a critical step toward patient-centered care. The extent to which patients receive respectful and attentive care to individual patient preferences, needs and values can be assessed by examining several components of the patient experience.


Simply put, timely treatment implies providing health services as soon as feasible. This is especially true for emergency services, which must be available whenever and wherever required. Routine medical care, such as check-ups and treatments, must also be completed on time. Providing health services on time keeps patients safe and allows them to receive the finest care possible. Conversely, patients can suffer catastrophic repercussions if care is delayed. For example, delays in detecting a significant illness can result in severe consequences or even death.

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Patient safety

Patient safety is described as the aim of reducing and mitigating harmful acts within the healthcare system and applying best practices that have been proven to result in optimal patient outcomes. Patient safety challenges, mitigation techniques, and best practices must be understood by everyone involved in patient safety, including patients, their families and healthcare personnel. Unintentional outcomes or side effects of hospital procedures are examples of hospital occurrences. This indicator assesses healthcare providers’ capacity to deliver comprehensive, high-quality patient care while avoiding unfavorable reactions. Tracking hospital occurrences is critical for understanding the quality of care provided. Incidents provide precise data on how a hospital can enhance its services while lowering patient mortality and readmission rates.

Readmission rates

There are various reasons why 30-day readmission rates are a valuable quality indicator and an area of focus for development. Readmissions are generally unwelcome for patients and can be costly for hospitals with limited resources. Importantly, readmissions have been linked to the quality of care given to patients at many phases of the clinical route, including initial hospital stays, transitional care services, and post-discharge assistance. However, readmission rates are an imperfect statistic with significant limitations. Not all reasons for readmission are within the healthcare service’s or hospital’s control, and are also not a reflection of patient preference or experience. This is critical to remember when attempting to draw meaningful conclusions from observed changes in readmission rates.

Uptake of new professionals 

The uptake of new nurses and nurse training is a crucial factor to consider when evaluating the quality of healthcare. With the demand for healthcare services on the rise, there is a growing need for qualified and competent healthcare professionals. One way to address this need is by offering affordable online MSN programs that provide a flexible and accessible pathway for nurses to advance their skills and knowledge. By evaluating the availability and effectiveness of such programs, it is possible to ensure that healthcare providers have access to a skilled and motivated workforce. This, in turn, can lead to improved patient outcomes and better overall health and wellbeing for communities.

Learning from the data

Raw data, like many natural resources, has limited value until it is polished to be usable by humans. Therefore, advanced analytics approaches are required to transform data into a valuable commodity. The practice of evaluating data in its various structured and unstructured forms using diverse methods is known as data analytics. The idea is to identify trends and uncover insights that would not have been apparent otherwise. All businesses stand to gain from using data analytics to translate this valuable raw material into business knowledge, but none more so than the ever-changing healthcare industry.

For decades, measuring hospital quality has been difficult. The complexity of a hospital’s services indicates that measuring its quality will be equally complex. Every hospital offers a comprehensive range of medical and surgical treatments to inpatients and outpatients. These services must be provided by highly trained professionals employing advanced technology and abilities. Furthermore, patients present with various illnesses and pre-existing patient and case features. As previously noted, analysts use a variety of measures, each of which is geared to target a unique facet of quality.

EHRs, chatbots, and data dashboards are data analytics tools and technologies that are essential components of the healthcare data analytics environment. They simplify data collection and the scheduling of patients. They present patient data in context instead of simply as a list of medical codes. They also assist healthcare administrators in making predictions based on actionable information. 

Healthcare data collection begins when a patient contacts a clinician and continues throughout their journey. Data is collected by automated systems to identify, schedule, diagnose, treat, prescribe for, and follow up with patients. Healthcare practitioners can use data visualization technologies such as healthcare dashboards to monitor patterns in general health, uncover efficiency in a practice, obtain help with staffing and scheduling, and ultimately improve the quality of service. However, these measurement indicators have fluctuated significantly over the past few years, meaning that we may not have an accurate picture of the quality of healthcare service we receive. That has been down to one driving factor: the COVID-19 pandemic. 

COVID-19’s impact on performance measures

The COVID-19 pandemic has shown a variety of strengths and vulnerabilities in the US healthcare system. One source of strength is the great efforts and dedication of healthcare personnel who are committed to giving the best possible care to patients even under the most difficult of working situations. However, obtaining the data required to understand the quality of care provided to patients throughout this pandemic has proven difficult. As a result, there is a scarcity of information that may assist doctors in improving care delivery in the present while also learning for the future. This case demonstrates how the existing system of measuring quality and safety is overly labor-demanding, has substantial data lags, and has inadequate standards to allow for rapid data sharing.

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Priorities vary during a pandemic. This has meant a narrow emphasis on patient care and team member safety, and a daily reorganization of employees to handle the most urgent care needs. Many procedures and processes, such as ongoing performance evaluations and annual reviews, have been adjusted or, in some cases, placed on hold due to this narrowing of operations. Providers are discovering that ignoring these assessments is not ideal in the long run. They are beginning to rethink how to improve them when nothing appears normal.

Improving data quality

The completeness, consistency and accuracy of data are referred to as data quality. It also measures how well the data fulfils the creator’s or recipient’s intended use. Data can be of high or low quality depending on how it was retrieved and processed. It’s no surprise that use of a data quality management system is becoming more widespread, with the volume of data doubling every two years and a shortage of human resources to examine it all. Data quality should be reviewed throughout its lifecycle to ensure that we only gather, store and analyze the required data. Improving data quality is critical as it guarantees that the data used is correct, consistent, complete and relevant.

Here are some excellent data quality tips to help you get the most out of your data.

Identify impacts

You should determine the relationship between procedures, key performance indicators (KPIs), and data assets, and then make a list of the organization’s current data quality concerns and how they affect service quality and other business KPIs. Following a clear link between data as an asset and the criteria for improvement, data and analytics executives may develop a targeted data quality improvement program that clearly defines the scope, a list of stakeholders, and a high-level investment plan.

Assess current data 

Before adopting any data quality enhancement strategy, you must understand where you are now. The data quality sophistication curve can help you assess where you stand regarding data management initiatives and what your subsequent actions should be. Almost half of organizations today are reactive or uninformed, implying plenty of space for data quality improvement. Data evaluation should be a constant activity. The most successful healthcare organizations are constantly evaluating the quality of their data and the efficacy of their existing data management strategy. A continuous review of data enables an organization to respond to areas of concern and make necessary improvements.

Set guidelines

It is critical to follow data governance laws and regulations. Failure to do so may result in fines, penalties and severe consequences. Because different healthcare teams use organizational and customer data differently, it’s best to hold company-wide talks to develop data governance principles and decide how to execute them. These policies should cover every aspect of data collection and administration, such as where and how data is stored and who is authorized to process it. Implementing these principles may imply establishing automated pipelines to ensure that specific data is removed as soon as it is processed or that data in specific fields is only formatted in a particular way.

Eradicate silos 

Data that is siloed can never give its entire value. It is impossible to have a holistic view of your organization and a single source of truth when silos exist. In addition, users in various departments replicate their data instead of sharing it when data is isolated, resulting in confusion, inconsistencies and lost agility. By removing silos, everyone in your organization can see your data at once and have a single source of truth.


Developing the correct measurement system for healthcare organizations is challenging yet critical. Measurement systems are the foundation for health screening, measuring treatment progress, and tracking whether improvement is maintained. When data is reviewed by patient demographics and across time, the correct measurements can assist researchers in determining if an intervention is beneficial to specific populations.

Even so, it’s hard to define whether a healthcare system or organization is ‘working’ or not. As the measures listed above are all individual sections within the healthcare industry, how do you define whether the whole system is working? Of course, if all of these measures succeed, it’s easy to establish that an organization is doing well. At the same time, if they fail, we can conclude that an organization requires drastic improvements. However, this is often not the case, and most organizations will excel in some areas and need improvements in others. In this circumstance, it comes down to judgment. Will there ever be a way to remove this judgmental factor from the equation? As we consume more and more quality data, this is becoming a more distinct possibility.