Harnessing CLA to Boost Quality Improvement in a Philippine Hospital

In 2020, Garcia Memorial Provincial Hospital (GMPH), a small hospital in Bohol, Philippines, had 297 cases of denied Philippine Health Insurance Corporation (Philhealth) claims amounting to $65,000, which could have been used to significantly improve its capacity to deliver quality services. After conducting problem analysis exercises, the hospital realized that the denials were mostly due to charting and documentation errors and deficiencies. This raised questions about the quality of their services, as charting deficiencies often indicate incomplete care. To address this issue, GMPH implemented a continuous quality improvement (CQI) initiative to ensure proper documentation of services and reduce Philhealth denials. However, since they had already tried to use this initiative in the past and failed to effectively implement it, this time, the hospital deployed a variety of CLA approaches such as internal collaboration, adaptive management, and continuous learning and improvement.

The GMPH, like other hospitals in the Philippines, is mandated by the government to implement CQI - a method of improving quality through data-driven, deliberate, and iterative processes. Along with Philhealth accreditation, CQI encourages health facilities to go beyond compliance with quality standards by intentionally improving the quality of their processes and services. However, when the GMPH began implementing CQI in 2018, both its management and staff had difficulty navigating CQI processes and tools. This, coupled with their inability to realize improvements through CQI, made them think that the intervention was just extra work with no real value, and their enthusiasm for it gradually waned. However, in 2020, understanding that they would not be able to address their persistent problems without improving their work processes, the hospital's management attempted once again to implement the intervention. This time, they became more strategic and bolstered it with CLA. They capacitated their staff on the intervention, focused  on charting issues and denied insurance claims, and allotted more time for learning sessions . The results were remarkable: within  a year of implementing a CLA-boosted CQI, charting errors decreased by 75% and hospital earnings increased by $1.1 million due to a significant decrease in denied Philhealth claims.