How one expert says it should be measured, practiced, and improved

Quality care is vital to any medical organization’s success and, of course, the health and outcomes of their patients. But most physicians don’t receive any formal training on quality during their schooling or residency, which means most learning on the topic happens on the job.

Dr. Arif Kamal, Chief Medical Officer of Acclivity Health, recently presented on this problem during the annual NHPCO 2020 Virtual Conference, and offered viewers of his session some professional insight on how exactly quality should be measured, practiced and improved. 

“Physicians undergo a lot of training and there’s a lot of focus on the need for quality improvement, but we infrequently get training on quality assessment or improvement skills. You can do didactics in the classroom, but there’s a need for hands-on, real-time learning associated with projects you’re currently working on,” he explains.

Here, Dr. Kamal answers questions about the fundamentals of quality care in community-based palliative care programs.

What defines quality in palliative care?

“Quality in community-based palliative care programs is about effectiveness, agility, practicality, efficiency, patient-centeredness, and responsiveness. It is data-driven, contextual, and based in common sense. The aim of quality improvement initiatives is to provide better health outcomes, increase patient satisfaction with the care experience, lower per capita cost, and retain engaged, resilient clinicians.”

What are the guiding principles of quality in palliative care?

“The National Consensus Project from 2019 is a guidebook about quality standards for the fields of palliative care, hospice, and end-of-life care. When that came out, there were a lot of aspirational aims in those guidelines. It outlined the floor, meaning, “We expect all organizations to meet these guidelines. The middle, so to speak, means to strive to go above and beyond those expectations. The ceiling is the gold standard — it’s where you’re offering the highest possible quality care to your patients.”

Has COVID-19 exacerbated quality hurdles?

“During COVID, there have been enormous pressures for revenue recovery and to hold market share. There is an increased focus on efficiencies and workflow and a reduction in force for non-revenue-generating employees. There’s also some careful optimism about shared payment models. But quality improvement is about being responsive to changes, so the primary skill people need in the face of COVID is being agile and tailoring their care to new demands.

There will be an acceleration of the aggregation of health care organizations because of financial pressures, and as that happens, being able to demonstrate your value is going to be important. The only way to demonstrate that is to show continuous quality improvement.”

How can you track quality in your organization, and set goals for improvement?

“In order to practice that continuous quality improvement, you need accurate, timely data on performance. What a platform like Acclivity Health’s does well is to give practices both insights into areas they’re focused on, but also a vision into the areas they may not know about, particularly patient populations who might benefit from extra layers of support.

With quality, you want to have a line of sight into the areas you didn’t know were of concern. Data can uncover those issues for you. There’s that uncovering of the ‘Aha!’ moments, realizing a population had some inherent risk we weren’t aware of, and we can now be responsive to those patients we serve.”

If you’re curious how a data-driven platform could help your practice track and improve quality, email us at