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New Center Report Identifies Strategies for Embedding Quality Improvement into Critical Access Hospital Operations

The National Rural Health Resource Center, in partnership with the Flex Monitoring Team and Stratis Health, today released Building Sustainable Capacity for Quality and Organizational Excellence, which outlines practical, rural-relevant strategies that critical access hospital (CAH) leaders and staff can adopt to more fully incorporate quality improvement efforts into their organization’s culture and develop a shared sense of responsibility for quality patient care.

The report, based on discussions among rural health quality leaders from across the country who attended the Critical Access Hospital Quality Infrastructure Summit, in Bloomington, Minnesota in March 2023, offers a framework of nine strategies or “core elements” that are key to creating a culture of quality in CAHs.

The core elements include:

  • Leadership Responsibility and Accountability
  • Quality Embedded Within the Organization’s Strategic Plan
  • Workforce Engagement and Ownership
  • Culture of Continuous Improvement Through Systems
  • Culture of Continuous Improvement Through Behavior
  • Integrating Equity into Quality Practices
  • Engagement of Patients, Partners, and Community
  • Collecting Meaningful and Accurate Data
  • Using Data to Improve Quality

Each core element is accompanied by a list of criteria that can be used by hospital leaders to evaluate their organization’s performance in that area.

By putting these core elements into practice, CAHs can move from a “checking boxes” approach to quality that’s focused on individual measures, to an approach where quality is embedded into all that a hospital does — its policies, processes and practices.

The Flex Monitoring Team, a consortium of researchers from the University of Minnesota, the University of North Carolina at Chapel Hill and the University of Southern Maine funded by the Federal Office of Rural Health Policy to evaluate the impact of the Medicare Rural Hospital Flexibility Program, will begin collecting data this fall from the country’s CAHs on the degree to which they have already put these core elements into organizational practice. That data, along with information about hospital service lines and other quality measures, will be gathered through the new National Critical Access Hospital (CAH) Quality Inventory and Assessment, the results of which will help enhance support to CAHs in their quality improvement activities. The core elements will also be included as a new measure in the Medicare Beneficiary Quality Improvement Program.

The report and details about the National Critical Access Hospital (CAH) Quality Inventory and Assessment can be found at