Four Pillars for Sustainable Centers of Excellence

CEs focused on researching and improving quality and safety in healthcare must operate on a foundation of sound organizational principles and practices to remain sustainable. This section highlights organizational activities that are particularly relevant to sustaining operations and CE success.

Environmental Scanning

Environmental scans gained popularity in the business world as “the acquisition and use of information about events, trends, and relationships in an organization’s external environment, the knowledge of which would assist management in planning the organization’s future course of action.”⁹ The purpose of an environmental scan is to ensure that a business can respond strategically and flexibly to changing circumstances in its environment.¹⁰ 

Environmental scanning is a valuable planning tool CEs can implement to understand the healthcare and research organizations within which they function as well as the local and national healthcare policy environment those organizations are subject to. This knowledge may support the CE’s alignment with regulatory mandates, community pressures, or reimbursement changes they may not otherwise have anticipated.

Guiding Questions for Environmental Scanning

1. What is the larger organizational and structural environment to which the CE is connected?
   • Rural or urban hospital.
   • Academic medical center.
   • For-profit health system.
   • Federally qualified health center.
   • Research institute.
   • Medical school or university.
   • Other.
2. How would the CE describe its connections within that organizational environment?
   • Embedded within an academic department or division.
   • Reporting to the research enterprise.
   • Part of a quality/safety department.
   • Standalone funding for an individual researcher or other diffuse connection.
   • Other.
3. Who are the stakeholders whose active engagement is required for the CE’s success? Define a broad group of stakeholders to prioritize later. Stakeholders may include:
   • Patients and families seeking care at the healthcare organization, the community at large, or subsets of the community.
   • Quality/safety/risk management departments and multidisciplinary research collaborators.
   • Healthcare executives, physicians, and nursing leaders.
   • Technology and analytics specialists and clinical informaticists.
   • Finance departments and philanthropy partners.
   • National patient safety or research organizations and national content experts/advisors.
   • Others.

Business Operations

Many CEs are not fully integrated into the healthcare systems in which they reside. To successfully align, integrate, lead change, and capitalize on windows of opportunity, as described in the following four sections, the CE will benefit from a foundation in strong business operations processes and performance. 

A performance management system that includes priority setting and definition of activities, as well as short- and longer term outcomes, can ensure that resources are dedicated to the most important drivers of success. These outcomes can, in turn, spur planning for competencies needed by the CE to achieve those goals. Strategies for recruitment, development, and retention of the relevant workforce can then be created and executed.

Any CE seeking to directly influence the quality and safety of care in their system should think through internal competencies with process improvement tools, change management, and implementation science. Having these competencies can allow the CE to more effectively influence or contribute to improvements in clinical processes and outcomes. 

A recent meta-analysis attempted to describe frameworks and metrics for the sustainability of healthcare programs, innovations, and interventions.¹¹ It suggested that “embedding implementation science and healthcare service researchers into the healthcare system is a promising strategy to improve the rigor of program sustainability evaluations.”¹¹ The CE can access competencies in these subject areas by:

• Hiring experts into the center. 
• Partnering with existing organizational excellence, process improvement, business analytics, or quality and safety departments.
• Providing partial salary support to allow participation of existing health system experts. 

Healthcare delivery organizations are constantly adjusting to changes in their funding environments. The need for flexibility can put the funding of CEs from the healthcare system’s operational budgets at risk. To ensure that the CE’s value is understood, robust marketing and communications strategies can help. In addition, CEs need to create financial plans that define existing sources of funding and identify potential new sources of funding to support larger scopes of work or sustain existing work when current funding ends. 

Guiding Questions for Business Operations

1. Is there an established communications or marketing plan for the CE to regularly share its work with all relevant stakeholders?
2. What are the internal process measures of success for the CE? 
   • Meeting specific goals of research or implementation grants.
   • Training a targeted number of healthcare providers per year.
   • Growing revenue by 10 percent in the next year.
   • Achieving a minimum number of peer-reviewed publications (e.g., at least five).
   • Demonstrating improvement on a specific diagnostic performance measure.
3. Has the CE defined the staff competencies needed to achieve its goals? Is there a defined recruiting and retention plan to ensure those competencies are developed and retained?
4. What are the potential funding sources to support the CE over the medium to long term?
   • Philanthropy, research grants, foundation grants.
   • Health system operations support, revenue from training/education beyond local engagements, member revenues from setting up multi-institutional learning collaborative and data sharing entities.
   • Partnership with national patient safety consulting companies.
   • Revenue from providing expertise and a data platform to technology entrepreneurs seeking to develop patient safety and diagnostic excellence solutions (potentially through a local innovation center).

Strong financial plans and business operations set the foundation for CEs to implement a strategy for sustainability. In the following sections of this brief, we discuss how the four pillars of sustainability are a useful structure for CEs to frame their sustainability plans.