All Entries Tagged With: "culture of safety"

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.

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HCPro celebrates National Nurses Week!

The many measures of patient safety and quality

Defining quality through a patient’s eyes

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.

There are always times to come back to center-to return to why we work so hard to improve processes, performance, and measures like overall hospital ratings. In the sea of scores, metrics, and meetings we often drown in, we forget to come up for air and see that relationship with patients who seek care and healing from (and with) us.

As of late, I’ve spent more time learning about very specialized patient populations. These are patients who are served by disparate health systems, and who are often cared for by community or state organizations. These are patients with many needs and challenges-mental illness, chemical addiction, homelessness, and other atypical situations where the normal metrics of quality may not apply in the ways they were originally designed.

Think of the patient population suffering from traumatic brain injuries, who may now pose a substantial safety risk to themselves. This population has intensive and specific care needs, and thus they have a different set of expectations of quality, which may be defined in terms of activities of daily life and relationships with caregivers and family.

Through learning more about specialized patient populations, I’ve learned that “quality” can be ambiguous and that its true definition is a moving target. I’ve come to the conclusion that quality really needs to be dictated by the specific needs and desires of the patients and the families who care for them-not by the organizations, who are searching for a simple way to measure and ultimately pay for care.

Patient safety, while closely related to quality in many ways, is far different in that it represents freedom from accidental injury and harm.

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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.

Learn more here.

Just a note that now, you can buy the live audio and download the on demand version free.

HCAHPS information studied by demographics

Interestingly, a new study of HCAHPS scores shows that when you split up the survey by sex, men are more favorable in rating their care. If patients were older and sicker, the difference was even more pronounced. Women were particularly more dissatisfied than men in the area of the information they received regarding medication and discharge instructions. They also tended to rate cleanliness lower.

Unfortunately, I have a sneaking suspicion that more detailed, demographic-related information like this will be used just as marketers use TV demographics to shape their advertisements. Of course, hospitals are business, and patients are already consumers. But how far do we take that?

Studies like this, while informative, might lead to a scenario where a nurse is told how to behave one way around his or her 23-year old male patient, and another way around a 45-year-old female patient. I suppose most care providers do act differently to different demographics, but is it for hospital marketers to dictate to them exactly how to act? Do you think it will ever come to that?

I don’t blame hospitals—with HCAHPS tied to reimbursement, HCAHPS scores must be a focus of attention. I just worry that instead of it giving more power to the patient to change healthcare, healthcare will instead just react by patronizing the patient and pandering to the test.

Hospitals should turn their attention to quality, safe care that focuses on communication with each other and the patient. I believe that is more likely than any well researched marketing effort to provide positive patient satisfaction scores. What do you think about reimbursement tied to HCAHPS? Post a comment below.

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?

Source: HealthLeaders Media

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.

According to NorthJersey.com:

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

Patient Safety Knowledge Quiz

Dreaming the dream (by Peter Provonost)

Navigating the Health Care System: Advice Columns from Dr. Carolyn Clancy

The Price of Tradition

Do Electronic Medical Records Save Money?

Words to Watch – Fact Sheet

What’s in a Name? Safer care, for one.

20 Tips to Help Prevent Medical Errors: Patient Fact Sheet

NPSF Tools and Resources for Patients and Consumers

No One Should Celebrate National Patient Safety Week