All Entries in the "culture of safety" Category
Create patient safety solutions that are right for you
Editor’s note: Columnist Catherine Hinz, MHA, works as a leader in patient safety at HealthEast Care System in St. Paul, MN. Hinz previously worked at PatientSafe Solutions, Inc. Hinz has also completed a patient safety internship with the Agency for Healthcare Research and Quality. The following is an excerpt of her monthly column, which can be found in its entirety in Patient Safety Monitor Journal.
Patient safety has long stood on a variety of tenets, some of which have formed the process and basis for how professionals (both leaders and clinicians) conduct improvement work. Some of these are well-known and accepted: Patient safety is a right. A high level of patient safety performance is nonnegotiable. Quality, risk, and patient safety are inseparable. A healthy culture is at the core of ideal patient safety performance.
I agree with all of these; however, there are two tenets of the patient safety movement that, while I believe do exist, I am beginning to question more as my leadership perspective evolves: that organizations do not compete over patient safety, and that sharing best practices is one of the best ways to improve across units, systems, and organizations.
Let’s first talk about competition. Historically, organizations have not experienced the shortage of resources, restricted access to capital, and flat patient volumes they are experiencing now. Therefore, the competition among organizations has never been fiercer. The uncertainty of health reform, organizational structure, and new regulations adds a layer of complexity that also has not been seen before. Regardless of the final outcome of health reform, it is certain that reimbursement will, more often than not, pit peers against each other in races of efficiency, cost reduction, and quality.
It is a certainty, then, that competition will reign even in the realm of patient safety. Organizations will discover new and better ways to avoid adverse events and near misses, and they will be incentivized in many cases not to advertise the mechanics of how they did it-no matter how helpful sharing these best practices might be for other, lagging organizations and the communities they serve. As it does now, safer care will improve reputations thanks to public reporting and greater consumerism in healthcare choices, but it will also potentially allow hospitals to retain or collect additional payment, creating more competition.
The market forces are providing the right environment for competition to be a strong contributing factor in the race for improved patient safety and zero harm, but not necessarily toward sharing practices; therefore, the idea that we should not compete in all things patient safety might not be the best path forward.
CAUTIs still a problem
Bit of a plug, but I think my visitors will find HCPro’s webcast on CAUTIs (catheter-associated urinary tract infections) extremely relevant, especially as CAUTIs cause 35% of all hospital-acquired infections every year, with 38,000 patient infections, and costing hospitals $400 million a year, according to an October 2011 National Quality Forum’s Partnership for Patients/ National Priorities Partnership webinar.
And don’t forget that The Joint Commission named CAUTIs a National Patient Safety Goal to be fully implemented by 2013. The Partnership for Patients also aims to reduce preventable CAUTIs by 50% by 2013.
So join nurse practitioner Mikel Gray, PhD, PNP, FNP, CUNP CCCN, FAANP, FAAN, and chief of infection prevention and 2012 APIC conference speaker Brian Koll, MD, FACP, FIDSA, for a live presentation of proven methods on CAUTI reduction, including how Beth Israel Medical Center reduced the number of CAUTIs by 83% using proven organization-wide catheter best practices such as evidence-based practice, staff education, daily need assessments, multidisciplinary teamwork, monitoring, and root-cause analysis. You’ll also get best practices to educate and train your entire staff.
Just a note that now, you can buy the live audio and download the on demand version free.
Win-lose? Why quality measures might lead to poor HCAHPS scores
New research indicates that implementing quality measures can improve clinical outcomes but may create a lower patient perception of quality care.
Ohio State University researchers studied lots of data from all over and determined that, at least in the short-term, implementing standard quality measures might negatively hit your patient satisfaction scores.
The problem is this: Standardization is good for preventing and catching potential errors, and it’s good for tracking and benchmarking. It’s also necessary for regulatory compliance in a lot of ways. Unfortunately, this standardization sometimes overshadows the patient, who can be treated a bit like a cog in the machine instead of a unique individual.
Is this a problem in your hospital? Like most things, I think communication here is the bridge that can melt standardized processes and patient perception into a one cohesive and positive experience. For example, if you give a patient a test or medication because the quality measure indicates the patient qualifies for it, does the patient know that?
An semi-educated guess of mine is that physicians often withhold telling patients that standards, regulations, and public reporting make them prescribe or do anything. But I think if you let patients know that based on research, doing X, Y, and Z is shown to help patient like yourself, most will be appreciative and find the experience more pleasant.
Ultimately, better clinical care and standardized processes will allow for providers to have more time with patients and patients will be healthier, so it may very well smooth over in the end. Right?
What do you think? Is it communication, or are hospitals becoming too standardized and obsessed with quality measures? Or is this a blip that will pass?
Transparency… are we there yet?
Apparently not. Public reporting of surgical site infections is required in only eight states. That fact was brought to light by a new Johns Hopkins University report, which calls for more reporting. Lead author of the report, Martin Makary, MD, notes that patients still have little information when choosing hospitals.
Personally, I think the bigger issue is that public reporting gives hospitals, from the top down, a real push to do better. I think Makary does too:
“Nothing motivates hospitals to improve quality and listen to their front line staff like public reporting,” he says. “In order for the consumer to interpret publicly reported SSI rates, it is imperative that the data be collected and reported in a standardized manner,” he and his co-authors wrote.
I would have to agree. Surgical site infections not only result in 8,000 deaths a year in the U.S., they occur in 4% to 25% of patients who undergo major surgical procedures, and their cost to the healthcare system is about $10 billion annually (these stats are mentioned in the report and come from other studies).
Makary calls out state hospital associations for not supporting public reporting. What do you think? Is public reporting the way to change hospital culture?
A win for public reporting?
We all know that CMS is collecting, publicly reporting, and basing reimbursement on quality efforts. We also know that not all hospitals are happy about this. There has been much debate over these quality measures, whether they actually measure quality, the fact that they’re untimely and unfair. But today we have news and some data that might show that at least on a smaller scale, public reporting drives change.
Enter The New Jersey 2011 Hospital Performance Report, the New Jersey Department of Health and Senior Services eighth annual report on the quality of care in New Jersey hospitals. The state’s hospitals outperformed the national average in seven of 10 patient safety metrics, jumping from the bottom 10 to the top 10 nationally for quality over the last 12 years.
Improvements at the state’s hospitals “did not just happen by chance,” said Dr. Peter Gross, former chief medical officer at Hackensack University Medical Center and a co-chair of the state’s quality improvement advisory committee, who participated in the commissioner’s teleconference. “The health department … by setting up this report, encouraged competition among hospitals to get better, and it obviously has worked.”
What do you think? Is this a win for public reporting?
In the hospital, we’re all just big babies
A new column in the New York Times today dives into the idea of using common
practices and techniques usually reserved for children and applying them in the adult arena.
For example, physicians may be less likely to order too many tests for children because they know that drawing blood or getting scanned may be scary, painful, and confusing to a child; but these are not considered for the adult, though the same might be true.
Children generally have overnight company, and wake up to someone familiar after surgery. With adults, this is not always the case, yet the benefits children receive from these practices (comfort, reduced stress) might be the same for adults.
I think what Perri Klass, MD, is saying in this column is that there is an aspect to this new idea of patient-centered care that has been a staple piece of care in pediatrics for decades. With the fear of illness, the confusion brought along by medications and anesthesia, the unfamiliarity of a new setting, and potentially painful tests and surgeries, are adults really all that different from children when they’re in the hospital? Why is pediatric care all that different from adult care?
What do you think?
Patient safety in 140 characters
In honor of patient safety week, the National Patient Safety Foundation hosted a tweet chat, in which participants all follow the same hashtag (#keyword) to have a large conversation. If you missed it, you can read the conversation by searching twitter for “#PSAW2012.” I suggest checking it out (you don’t even have to have Twitter to conduct a search) for the resourceful links alone. Comment below or tweet @PSeditor if you joined and what you liked about it.
Here are some of the topics and facts brought up in conversation:
- Health literacy:
Twelve percent of adults have good health literacy
E-literature might help follow up with patients post-visit
MDs tend to interrupt patients after 18 seconds of speaking
- PSAW:
Getting PSAW recognized by more of the general public to spread awareness beyond the healthcare setting
Why PSAW is observed, recognized, but not celebrated
Next PSAW is March 3 –9, 2013!
Here are some resources brought up in conversation:
NSPF’s new “Ask Me” video
AHRQ’s “Questions are the Answer” video
IMSP has new tools and resources
Health Literacy: Reducing the Burden of a Complex Healthcare System
Patient Safety Week 2012: Informing the Journey, Not Changing the Destination
Checklists that patients and doctors follow can improve hospital care
Dreaming the dream (by Peter Provonost)
Navigating the Health Care System: Advice Columns from Dr. Carolyn Clancy
Do Electronic Medical Records Save Money?
What’s in a Name? Safer care, for one.
20 Tips to Help Prevent Medical Errors: Patient Fact Sheet
Twitter chat, HCPro discount, in honor of Patient Safety Awareness Week
I hope you are all aware that next week is Patient Safety Awareness Week (PSAW)! In honor of the event, I have some announcements:
Twitter Chat
First, the National Patient Safety Foundation, the organization that created PSAW, is hosting a Twitter chat. Twitter chats are a great way to talk to new and familiar colleagues from all over. It’s easy enough to follow and participate: the key here is #PSAW2012 – use it in your tweets to join the conversation; follow the hashtag to read what others are saying. The topic? Patient engagement. NPSF staff will answer questions, offer tips, and provide links to resources. When? Wednesday, March 7, at 1 pm ET.
HCPro Discount
Save 15% on HCPro products during Patient Safety Awareness Week!
In celebration of Patient Safety Awareness Week, HCPro is offering 15% off your entire order from March 4th to March 10th! Click here to visit our website and browse our wide selection of books, training videos, live webcasts and more. Be sure to enter coupon code PSAWK12 at checkout to receive your discount. Call 800/650-6787 to place your order and mention Source Code EZINEAD or visit The HCPro Healthcare Marketplace.
We have great patient safety-related products, including books on Occurrence Reporting, Quality Improvement for Nurse Managers, Creating a Just Culture, Performance Improvement, Assessing the Risk (for suicide), of course Patient Safety Monitor, and many, many, more!
AHAP Conference opportunities
The Association for Healthcare Accreditation Professionals (AHAP) is hosting its 6th Annual Conference May 10, 2012 – May 11, 2012 in Orlando, FL. It offers so many amazing opportunities to save money, get expert advice, and show off your hospital a bit. I should also note that if you’re one of the first 50 paid registrants you’ll receive a free full-day ticket to any Walt Disney World® Theme Park*! Download the online brochure to learn more.
So what is it and why am I talking about it? The 6th Annual AHAP Conference brings together survey professionals from across the country to discuss solutions and best practices to achieve continual survey readiness and compliance with ever-changing standards and regulations.
What are the opportunities?
- Accreditation Specialist Boot Camp.
- Presentation of the first annual Accreditation Professional of the Year award
- Unique roundtable discussion with representatives from HFAP, DNV, the American Heart Association, and The Joint Commission
- Exciting new poster event featuring research and best practices from your peers. Find out how to submit a poster and save 50% on your registration.
- Learn about:
- Regulatory changes in 2012 and top RFIs: Staying ahead of The Joint Commission and CMS
- What accreditation professionals need to know about Life Safety Code®
- To certify or not to certify? Seeking The Joint Commission disease-specific certifications
- Making the switch from The Joint Commission to DNV: One hospital’s experience with both surveys
- Understanding tracer methodology and the survey process
- A practical approach to policy management
- Suicide Risk: Solutions to rapid assessment, Environment of Care, and documentation issues
- Understanding hospital recognition programs for optimal cardiovascular and stroke care
*Offer ends March 8th.
Ask your staff: How can we earn your trust?
Every time I explore a quality improvement initiative with a hospital for Patient Safety Monitor Journal, I always ask two questions:
- What was your biggest challenge?
- What advice would you give to other hospitals?
Especially as of late, the answers revolve around just culture. Quality directors, nurse managers, patient safety professionals, CNOs all tell me the biggest challenge is staff trust and buy-in; the key to success is involving them in the process. We all know the key to improving is knowing what’s wrong, but unless there’s trust between the organization and the staff, you won’t find out that information.
The most recent AHRQ Culture of Safety survey – Hospital Survey on Patient Safety Culture: 2012 User Comparative Database Report – leads me to believe perhaps the knowledge of how to improve culture and safety is there, but it’s not yet in practice to the fullest extent.
This is a big survey, including data from more than a half million healthcare staff from more than 1,000 hospitals, and deserves a good look:
Teamwork within a unit was strong; 80% of respondents agreed or strongly agreed to that sentiment. Generally, staff felt that management supported them and a culture of safety, and that the organization was including systems meant to support staff and reduce errors. To me this says that the talk is there: Staff members are aware that managers and leadership care about safety, and those systems should support them, not hinder them. Seventy-five percent say that management’s actions show dedication to patient safety; 72% believe the systems are in place to prevent mistakes.
Yet when it comes to reporting or speaking up, staff are still wary. Only 62% felt there was communication openness in their organization, and the lowest scoring domain was nonpunitive response to error, with only 44% positive response to questions related to the subject.
When it gets more specific – and more personal–the rates drop lower. Most interestingly is the difference between these two questions:
- Staff will freely speak up if they see something that may negatively affect patient care: 75% agree/strongly agree
- Staff feel free to question the decisions or actions of those with more authority: 47% agree/strongly agree
To whom staff must speak their concerns seems to be a critical indicator as to whether they actually will. This is certainly an issue with culture. The vast majority of respondents (76%) had direct patient involvement, and 35% were nurses. Considering disparate levels of authority create the team responsible patient care, I find this low response to that particular question quite concerning.
Also noteworthy: exactly half believed mistakes are held against them. It’s no wonder the survey indicates vast under-reporting of adverse events, a claim supported by the recent report by the inspector general of the Department of Health and Human Services.
I think the next step for hospitals is to find out what it will take for staff to trust hospitals. What will it take to get a nurse to report an adverse event he or she was involved in? Or demand a time out be performed to a surgeon?
Such a large shift in thinking might take time, as we all k now in decades past healthcare has been notoriously punitive. Still, perhaps we should start by asking our staff what it will take to earn their trust.After all, involving them has been the key to so many other instances of quality improvement success.
