Clinical Quality Initiatives

Doctor tablet

Launched in 2014, MHA’s Strategic Quality Initiatives department’s mission is to support hospital members in achieving the Triple Aim of better health and better care at lower costs. Technical and adaptive support is provided through active engagement in state and national grants and contracts, and includes in-person and virtual educational events, publications and resources to drive improvement and implementation across a variety of preparedness, quality improvement and population health-related topics. Member-specific projects and trainings are available through the business services line.

  • Missouri Harm Dashboards
  • Resources
  • Resource Library
The Missouri Hospital Association’s Board of Trustees approved a strategy to reduce statewide infection rates by 10 percent from 2016 rates by developing hospital-specific dashboards for three harm metrics — Catheter-Associated Urinary Tract Infection (CAUTI), Central Line-Associated Blood Stream Infection (CLABSI) and Clostridioides difficile, formerly known as Clostridium difficile Infection (C. diff or CDI).

Informing CEOs how their facility compares to other Missouri hospitals is the first step of MHA’s larger strategy to aggressively reduce harm across Missouri. The dashboards provide hospital-level rank and clearly establish a harm reduction goal for each of the three quality measures. The dashboards are provided to CEOs and quality directors to promote efficient, timely communication between executives and quality department leads regarding improvement successes and opportunities. MHA will continue to provide strategic guidance and resources to hospitals to support achievement of 10 percent harm reduction and will update aggregate data quarterly to track statewide progress.

 Summary of State Progress
C. diff
Hospitals with a SIR <1, improvement from hospital baseline and performing better than the state target

Hospitals with a SIR <1 and either improvement from hospital baseline or performing better than the state target

Hospitals with a SIR <1, no improvement from hospital baseline and not performing better than the state target

Hospitals with a SIR >1


Data is for Quarter 1 2019.

Hospitals not currently reporting to the Centers for Disease Control and Prevention’s National Healthcare Safety Network’s data portal are encouraged to begin reporting on CAUTI, CLABSI and C.diff, as applicable.

The HRO Toolkit is a web-based resource that was developed by MHA to support hospitals on the journey to high reliability.

Resource Links:

Recordings and Presentations

Aim for Excellence Webinars


Missouri Antimicrobial Stewardship Educational Collaborative – MASEC

What's Up Wednesday Webinars


Clinical Quality Webinars

  • Early Identification and Standardization of Sepsis Care (August 2016) - Recording | PowerPoint
  • Sepsis Core Measure - SEP1 Bundle - Clinical and Abstraction Tips (August 2016) - Recording | PowerPoint

Patient Family Engagement

Electronic Clinical Quality Measure Resources

Confused about the eCQM Program? The CMS Quality Reporting Center has resources to assist. Available in the eCQM Resources section of the website are an overview of the eCQM Program, a preparation checklist and FAQs.

Additional QRDA-related resources are available in the CMS eCQM Library and the eCQI Resource Center.

In addition, The Joint Commission Pioneers in Quality Program offers resources to assist hospitals on their eCQM journey. Webinar recordings also are available.

MHA Resources

Orientation Resources

Orientation resources, including the QAPI Guide, MHA Survey Manual and Quality Regulatory Orientation Guide can be found on the Regulatory Web page. Reporting guides are located above, under MHA Resources.

NHSN Resources
  • Confer your NHSN rights. Decrease the amount of time spent submitting data! See the Instructional Guide.

Strategic Quality Initiatives Resource Library

The following books and guides are available for check out by MHA member hospitals. These resources will help your hospital continue to identify and improve gaps in quality improvement. Topics include patient and family engagement, health care data, quality improvement, lean six sigma, overcoming change and work/life balance, etc.

Upon request, books will be mailed and can be checked out for a three-week period. Check out is free. For book requests and questions, contact Kristy Strope at or 573-893-3700, ext. 1307.

Quality Improvement

  • Common Knowledge: How Companies Thrive By Sharing What They Know. Nancy M. Dixon. ISBN 978-0875849041. 188 pages.
  • From Good To Great, Why Some Companies Make the Leap and Others Don’t. Jim Collins. ISBN 978-0066620992. 300 pages.
  • The Healthcare Quality Handbook: A Professional Resource and Study Guide, 27th Edition. Janet Brown. Hardwiring Excellence- Purpose, Worthwhile Work, Making a Difference. Quint Studer.2003. ISBN 978-0-97449986-0-2. 277 pages.
  • A Culture Of High Performance- Achieving Higher Quality at a Lower Cost. Quint Studer. 2013. ISBN 978-1-622-18003-5. 283 pages.
  • 10 Powerful Ideas For Improving Patient Care Book 3. Maureen Bisognano and Robert Lloyd with Dan Schummers. ISBN- 978-1-56793-266-9. 78 pages.
  • 10 Powerful Ideas For Improving Patient Care Book 4: Maureen Bisognano and Robert Lloyd with Dan Schummers. ISBN-978-1-56793-287-4. 70 pages.
  • 10 Powerful Ideas For Improving Patient Care: James L. Reinertsen and Wim Schellekens with Dan Schummers. ISBN-978-156793248-5. 74 pages.
  • 10 More Powerful Ideas For Improving Patient Care: Maureen Bisognano and Robert Lloyd with Dan Schummers. ISBN-1-56793-236-3. 78 pages.
  • Value By Design – Developing Clinical Microsystems to Achieve Organizational Excellence: Eugene C. Nelson, Paul B. Batalden, Marjorie M. Godfrey and Joel S. Lazar. 2014. ISBN-678-0-470-38534-0. 346 pages.
  • The Value of Close Calls in Improving Patient Safety – Learning How to Avoid and Mitigate Patient Harm: Joint Commission Resources. ISBN-678-1-59940-415-8. 2011. 182 pages.
  • Return on Process (ROP) – Getting Real Performance Results from Process Improvement: Michael West. 2013. ISBN-678-1-4398-8639-7.352 pages.
  • The Healthcare Quality Book – Vision, Strategy, and Tools: Scott B. Ransom, Maulik S. Joshi and David B. Nash. ISBN-1-56793-224-X. 2005. 495 pages.

Data and Analytics

  • The Health Care Data Guide: Learning from Data for Improvement. Lloyd P. Provost and Sandra K. Murray. ISBN 978-0470902585. 480 pages.
  • Healthcare Analytics for Quality and Performance Improvement: Trevor L. Strome. ISBN978-1-118-51969-1. 2013. 226 pages.

Patient and Family Engagement

  • The HCAHPS Handbook 2- Tactics to Improve Quality and the Patient Experience. Lyn Ketelsen, Karen Cook, Bekki Kennedy- Studer Group. 2014. ISBN 978-1-622-18009-7. 425 pages.
  • The Putting Patients First Field Guide- Global Lessons in Designing and Implementing Patient-Centered Care. Margaret Gerteis, Susan Edgman-Levitan, Jennifer Daley, Thomas L. Delbanco. 1993. ISBN 978-1-118-444494-8. 269 pages.
  • Putting Patients First- Designing and Practicing Patient-Centered Care. Susan B. Frampton, Laura Gilpin and Patrick A. Charmel. 2003. ISBN 0-7879-6412-3. 313 pages.
  • Putting Patients First- Best Practices in Patient-Centered Care. Second Edition. Susan B. Frampton and Patrick A. Charmel. 2009. ISBN 978-0-470-37702-4. 304 pages.
  • Through the Patient’s Eyes-Understanding and Promoting Patient-Centered Care. Margaret Gerteis, Susan Edgman-Levitan, Jennifer Daley, Thomas L. Delbanco. 1993. ISBN 1-55542-544-5. 296 pages.
  • Let Patients Help! “e-patient Dave” de Bronkart and Danny Sands. 2013. ISBN 978-1-466306493. 78 pages.
  • A Roadmap for Patient and Family Engagement in Healthcare. Gordon and Betty Moore Foundation. 2014. 67 pages.
  • Patient-Centered Care Improvement Guide. Picker Institute. 2008. 215 pages.
  • Questioning Protocol: Randi Redmond Oster. ISBN-978-0-9899120-0-6. 2014. 288 pages.

Hospital Leadership

  • The Healthcare Imperative – Lowering Costs and Improving Outcome: The Institute of Medicine Of The National Academes. 2010. ISBN-978-0-309-14433-9. 631 pages.

Lean Six Sigma

  • The Lean Six Sigma Pocket Toolbook: A Quick Reference Guide to 100 Tools for Improving Quality, Speed, and Complexity. Michael L. George, David Rowlands, Mark Price and John Maxey. ISBN 978-0071441193. 225 pages.

Change Management

  • How the Way We Talk Can Change the Way We Work: Seven Languages for Transformation. Robert Kegan and Lisa Laskow Lahey. ISBN 978-0787963781. 256 pages.
  • Made to Stick. Why Some Ideas Survive and Others Die. Chip Health and Dan Heath. ISBN 978-1400064281. 291 pages.

Work/Life Balance

  • Decisive: How to Make Better Choices In Life and Work. Chip Heath and Dan Heath. ISBN 978-0307956392. 336 pages.

Emergency Preparedness

  • Crisis Standards of Care. A Toolkit for Indicators and Triggers. Institute of Medicine of The National Academies. Board of Health Science Policy. Dan Hanfling, John L. Hick, and Clare Stroud. 2013. ISBN 978-0-309-28552-0. 183 pages.
  • Crisis Standards of Care. A Systems Framework for Catastrophic Disaster Response. Institute of Medicine of The National Academies. Board of Health Science Policy. Dan Hanfling, Bruce M. Altevogt, Kristin Viswanathan, Lawrence O. Gostin. 2012. ISBN 9778-0-309-25346-8. (Set of seven small books.)
  • The 9/11 Commission Report. Final Report of the National Commission On Terrorist Attacks Upon The United States. Thomas H. Kean, et al. 2004. ISBN 978-0-393-06041-6. 428 pages.