All Entries Tagged With: "culture of safety"
HHS awards $17 million to projects dedicated to preventing healthcare-associated infections
Last week the Department of Health and Human Services (HHS) announced it awarded $17 million to specific projects in the name of fighting healthcare-associated infections (HAI). Of the total award, $8 million will specifically fund the national expansion of the Keystone Project, a program that successfully reduced the rate of central line-associated bloodstream infections (CLABSI) in Michigan hospitals within 18 months, saving 1,500 lives. The coordination of the program in all 50 states is being run through the American Hospital Association’s Health Research & Educational Trust. Last year, the Agency for Healthcare Research and Quality expanded the Keystone Project to 10 states.
The remaining $9 million will be spent on strategies to reduce other HAIs. In collaboration with the Centers for Disease Control and Prevention, HHS will fund projects that will investigate methods for:
- Reducing Clostridium difficile infections through a regional hospital collaborative.
- Reducing the overuse of antibiotics by primary care clinicians treating patients in ambulatory and long-term care settings.
- Evaluating two ways to eliminate MRSA in ICUs.
- Improving the measurement of the risk of infections after surgery.
- Identifying national-, regional- and state-level rates of HAIs that are acquired in the acute care setting.
- Reducing infections caused by Klebsiella pneumoniae Carbapenemase-producing organisms by applying recently developed recommendations from CDC’s Healthcare Infection Control Practices Advisory Committee.
- Standardizing antibiotic use in long-term care settings (two projects).
- Implementing teamwork principles for frontline health care providers.
I see the Keystone Project as one of the major successes in recent years in the patient safety world. Not only does it reduce the chance for patient harm from an HAI, but it reduces the excessive amount of money that is spent on HAIs each year—a $6.5 billion expenditure. There are lots of patient safety standards out there, but this project has guided facilities in lowering CLABSI rates by using succinct steps with an emphasis on building a culture of safety and top-down leadership engagement.
Has your hospital become involved yet in this project?
The role of accountability in a culture of safety
Two well-known names in the patient safety field, Robert Wachter, MD, professor and associate chairman of the department of medicine at the University of California, San Francisco, and Peter Pronovost, MD, PhD, medical director for the Johns Hopkins Center for Innovation in Quality Patient Care, have published an article in the New England Journal of Medicine (NEJM) about the need to make accountability a larger part of the discussion when it comes to patient safety and a no-blame culture. The whole patient safety movement was set in motion ten years ago with the publication of the Institute of Medicine’s To Err is Humanreport. Wachter and Pronovost say that the industry has come a long way since then, and important steps have been taken in the name of patient safety.
However, it’s time to move past simply acknowledging that the majority of adverse events are the result of human factors, not malicious intent, say Wachter and Pronovost. It’s time that hospital leaders take responsibility for those staff members who routinely fail to perform simple safety checks and actions that would prevent adverse events from occurring. In Wachter’s most recent blog post on his blog “Wachter’s World”, he discusses how he and Pronovost are expecting a backlash from the field for asking for more accountability in the patient safety world. It is time to ask for more from leaders and caregivers to do simple things like handwashing or using a checklist before surgery, though. If the steps have been taken to change how processes work and to emphasize a culture that acknowledges that most errors are systems-based accidents, and those errors continue to occur, it is time to move on and incorporate some amount of accountability into the system, say Wachter and Pronovost.
You can find the NEJM excerpt here, but Wachter’s posts a good summary on his blog if you don’ t have full access to the journal.
This is a topic that touches many emotions, and you may have differing opinions on the topic. I’d welcome any comments on the blog post or how your hospital has attempted to address the culture of safety.
Announcing the winner of the Patient Safety Monitor Contest!
The month-long Patient Safety Monitor Contest has come to a close, and I’d like to thank everyone who sent in entries, read the creative ideas of the week, and commented on the blog. Although there were many great ideas entered into the contest, our panel of judges at HCPro has chosen Abington Memorial Hospital’s (AMH) “Patient Safety First” education program as the winner!
Entered by Robert C. Giannini, NHA, safety/quality specialist at AMH in Abington, PA, the program includes a month-by-month effort to focus on a different patient safety topic each month on a hospital-wide level. It’s an education campaign to train all staff members about the patient safety issues facing hospitals today.
In Robert’s words:
The objective of this monthly program is to promote communication (“a behavior a month”) and hospital-wide alignment in our efforts to establish and maintain a safe and reliable healthcare culture.
The program meshes the Joint Commission’s National Patient Safety Goals for 2009 with the hospital’s own internal goals. Part of the effort involves safety coaches, who are frontline caregivers that make it a goal to involve all of their fellow staff members in the theme of the month. This has been such a success at AMH partly because staff members know that the effort is not going away. It’s publicized in some of the hospital’s newsletters and materials are posted throughout the facility to remind staff members the focus of the month.
For 2009, AMH developed a 12-month Patient Safety First schedule. The focus in January was on hand hygiene. The hospital developed patient education materials to alert patients that handwashing was a focus that month and asked them to be a partner in their own safe care. Additionally, those in charge of the campaign created separate materials for staff members, reminding them that January’s patient safety topic was performing hand hygiene before and after contact with patients or the hospital environment.
Thanks for entering, Robert! As the winner of the contest, Robert receives a complimentary copy of the Patient Safety Officer’s Handbook.
Nurses targeted after anonymous complaint about physician
Two registered nurses from Winkler County Memorial Hospital in Kermit, TX are being prosecuted for reporting complaints to the Texas Medical board about a physician’s standard of practice, according to the local CBS affiliate.
The American Nurses Association (ANA) has joined the Texas Nurses Association (TNA) to criticize the state’s response. Both associations worry about the precedent the action sets for future nurse whistle blowers who advocate for patient safety. An initial hearing on the nurses’ motions to dismiss the case was held July 15 but no ruling was made.
The nurses sent an anonymous letter to the Texas Medical Board. The Winkler County Sheriff’s Department then received a harassment complaint from the physician, and initiated the investigation that resulted in criminal charges. The Texas Medical Board has notified the sheriff’s department that the complaints were confidential and not subject to subpoena. TNA has set up a fund for the nurses’ legal fees.
What do you think of this case, will it hold?
AMA debates advising physicians to hang up their white coats
On the agenda for the American Medical Association’s (AMA) annual conference next week: whether physicians should continue to wear their typical white coats that travel from patient to patient all day long and have a large potential to carry infections, according to The Wall Street Journal’s Health Blog.
The alternative measure would be a “bare below the elbows” approach. Though there’s evidence that bacteria (such as MRSA and C. diff) are often found on the cuffs of coats, there is no proof that infection actually carries this way. Still, with all the other precautions hospitals generally take to prevent infections, the AMA is taking this one seriously. The British National Health System has already adopted a similar policy-theirs also banned jewelry.
Expert information on HCAHPS and patient satisfaction
I wanted to make special note of a book that has just published. HCAHPS Basics: A Resource Guide for Healthcare Managers really is just that–a great resource for anyone who has a part in their hospital’s HCAHPS scores management. The book contains tips and advice from author Carrie Brady, JD, MA, vice president of quality at Planetree, a network of healthcare providers working to advance patient centered care. I personally worked with Carrie, who spent several years as vice president for the Connecticut Hospital Association, helping to develop two statewide pilot tests of the HCAHPS Survey. She certainly knows her stuff, and will show you the way through everything HCAHPS, including choosing a vendor, choosing a survey mode, reporting results, getting leadership support, and steps to improve patient satisfaction. The book contains case studies, including the Cleveland Clinic, and includes a CD with even more useful tips and tools. Click here for more information on this inexpensive resource.
While on the topic, I also wanted to make special note of an upcoming audio conference, HCAHPS: Improve Your Scores and Increase Patient Satisfaction, on June 24th. Expert speakers Deirdre Mylod, PhD, and Kimberly Sparks from Press Ganey Associates will speak about national trends in HCAHPS, benchmarking, leadership support, and more. I’ve also been personally working with these speakers, and I can tell you it’s going to be a great program. For more information about it, click here.
Are your hospital’s patients safe? Depends on who you ask.
A study published earlier this year shows that hospital staff members rate perceived patient safety differently at their own facility. Although this study was published in January of this year in Medical Care, I had not seen the results and thought perhaps you had not seen it either. The researchers surveyed 100% of senior managers and physicians, and 10% of all other staff members about their perceptions of the organization’s patient safety. They analyzed more than 18,000 responses to their survey taken at 92 hospitals.
Turns out, there are fairly substantial differences in perceived levels of patient safety depending on which type of staff member you ask. Overall, 17% of respondents said their organizations lacked a culture of safety. Further, those staff members in the emergency department had a much more negative picture of patient safety within the organization than other staff members; those staff members whose jobs were mostly administrative and nonclinical had a more positive perception of patient safety within the organization. Nurses specifically in the emergency department perceive patient safety to be at a lower level than even other emergency department staff members.
To find the study, click here. You can also find some information through the AHRQ.
When saying “I’m sorry” keeps patients safer and saves money
I came across this article from Crain’s Detroit Business published earlier this month. It outlines how hospitals in Michigan are reaping the benefits of an unanticipated bonus of admitting medical errors to patients: increased financial incentive to do so. Over the past few years, a group of Michigan hospitals been doing the opposite of what most lawyers would advise–that is own up to medical mistakes as soon as they have happened. They decided to do this because it was part of “the right thing to do”–that is, it was thought to help increase transparency, improve patient outcomes, and bring more of an ethical approach to care. An additional benefit, however has been the cost savings.
Henry Ford Health System in Detroit, which has had a “patient apology program” for eight years, has reduced its medical malpractice expenses by 62%, from $45 million to $17 million. The University of Michigan has lowered the amount of money it reserves for medical litigation over the past eight years from $72 million to $16 million, a reduction of 65%. These savings have been able to be put directly back into these institutions to pay for further patient safety programs, equipment, and tools.
Simply being more open with patients has resulted in these savings. The hospitals also make a large effort to illustrate to the patient and/ or the patient’s family why the error occurred through the root cause analysis process.
You can read more here. Has your hospital used any sort of apology technique like this as standard policy? It is certainly not the norm, but perhaps it should be.
New Universal Protocol video is an easy training tool, offers credits
I wanted to let our readers know that a new video from HCPro’s patient safety market is available! It’s a 20-minute video that helps train staff on the up-to-date Joint Commission Universal Protocol standard. I’m personally excited about this as I helped to create the video (and I’m actually in it), and can tell you that it easily explains each of the three main components of the standard (preprocedure verification, site marking, and time out), and also explains how to avoid common mistakes most hospitals make.
The video even offers continuing education credits. (For more information on how to receive the video and credits, click here.) You can also watch the trailer below!
About one-third of surgeons suffer from burnout, study suggests
A new study in the Archives of Surgery has found that 30 – 38% of surgeons across the country suffer from burnouts, according to a piece in Wall Street Journal’s Health Blog.
The study suggests that younger surgeons and female surgeons are at especially high risk for stress and burnout, and found that a number of factors lead to its cause, including:
- Length of training
- Long hours and large workloads
- Imbalance between career and family
- Feeling of isolation
- Grief or guilt over patient death
- Insufficient research time and funding
- High self-imposed expectations
- An inefficient and/or hostile work environment
The study describes an attitude among surgeons that long hours and heavy workloads are expected and emotional responses are not, which researches say feeds stress and burnouts. The study concludes that being overworked is counterproductive and leads to self-destructive behavior that may affect quality of care.
