All Entries Tagged With: "patient-centered care"

HCPro celebrates National Nurses Week!

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?

Visitation rights and restrictions

I wanted to share with you an opportunity to learn more about patient visitation rights and restrictions because who can and cannot visit a patient while he or she is in the hospital has changed in recent years.

Heavily covered in national news, new federal mandates give patients more authority and autonomy to decide who may visit them as they try to recover. To align with these mandates, The Joint Commission updated two Elements of Performance (EP) under its Patient Rights (RI) chapter. These changes were announced July 13, 2011, and were retroactively effective as of July 1, 2011.

Both changes were made under standard RI.01.01.01, which states that the hospital must promote, respect, and promote patient rights. EP 1 requires hospitals to have written policies on patient rights, and a new note for hospitals that use Joint Commission accreditation for deemed status, says the EP now requires hospitals address in those policies visitation rights procedures, such as restrictions or limitations (including those clinically necessary).

It’s safe to say that any hospital that either accidentally or purposely infringes on those rights is going to end up big trouble. And it’s not just implementing policy–educating patients to be empowered to know their rights, including their rights regarding visitation, is critical. It also enhances patient experience and satisfaction, another area laying heavy on the minds of quality professionals these days as reimbursement is now partially tied to HCAHPS scores.

Wouldn’t it be nice to have a patient safety expert and veteran guide you through this change? To help you do your job in ensuring your organization is compliant with federal and Joint Commission standards? Join Barbara Balik, RN, MS, EdD, senior faculty at the Institute for Healthcare Improvement (IHI), principal of Common Fire Healthcare Consulting, and a member of the National Patient Safety Foundation Board of Governors, for a January 26 webcast to learn what must be done.

What might patient safety have to do with the joy and spirit of caregiving?

Editor’s note: Columnist Catherine Hinz, MHA, currently works at PatientSafe Solutions, Inc. Previously, she served as the patient lead at HealthEast Care System in St. Paul, MN, worked for seven years as an ED health unit coordinator, and has completed a patient safety internship with the Agency for Healthcare Research and Quality. The following is an excerpt from the October 2011 issue of Patient Safety Monitor Journal.

With the advent of electronic health record implementation, never-ending administrative duties, and unrelenting changes, it’s no surprise that practitioners often talk about losing the joy of caregiving. In fact, many patient safety and quality conferences have begun to focus on this theme. Practitioners often lament that medicine is becoming less of a “craft” and turning into a standardized methodology-sucking the joy out of caregiving and making the art of their practice obsolete. Of course, the other side argues that the need to minimize variation and practice pure, objective, evidence-based medicine should be the norm and not the exception.

This divide is especially acute when the conversation centers on clinical practice guidelines, order sets, protocols, and what some providers refer to as “cookbook medicine.” It can lead to a dynamic and sometimes dangerous discussion in any room with a mixed administrative and clinical audience.

At the recent National Quality Colloquium, one session focused on how physician engagement affects the organizational and patient safety culture. It became clear that given the immense changes under way in the U.S. healthcare system, and the need to reduce variation, eliminate waste, and improve quality, practitioners’ feelings of autonomy loss are bound to become more pronounced.

The discussion at NQC reminded me of a recent meeting in my own company. We had invited a group of nursing executives to engage in dialogue with us for a half day, discussing their challenges, needs, and hopes for their frontline staff and organizations. Beyond some of the typical things we expected to hear, like “we have scorecards coming out our ears” and “our systems are so complex, it makes any process improvement work daunting,” we heard something else loud and clear: “If you are going to bring any new technology into our environment, it should help put the spirit back in nursing.”

Log-in to read the full column in Patient Safety Monitor Journal.

Were you at NAHQ?

I spent last week at the National Association for Healthcare Quality’s 36th Annual Conference in sunny Sacramento, CA, as I’m sure many of you did as well.

I was lucky enough to attend a few sessions. Our own Ken Rohde presented his session on polices & procedures, which many of you seemed to enjoy immensely. Though the session included many, many great ideas, a great portion was dedicated to separating your procedures from your polices, as both require different workflows. Procedures in need of change require a quicker turn around time than policies allow for–that makes sense, right? I saw many nodding heads.

I also learned just how much new nurses and residents must learn at orientation – and I’m just talking about the patient safety rules and regs! Presenter Orpha Lubeen’s first tip? Offer food and drinks.

And as I blog, I can’t help but think of the Patient Safety and Social Media session I attended, presented by Anne Huben-Kearney. The session ended with a great conversation about how to educate staff on what is appropriate and what they really need to think about before the click of a camera or mouse. Many of you had specific concerns that are no doubt tough to navigate in this ever-changing arena.

So, my big question is, did you attend? Did you go to these sessions or others? Share your experience and thoughts below, I’d love to start a conversation!

Challenging the ‘business as usual’ patient interaction

Catherine Hinz, our monthly columnist for Patient Safety Monitor Journal,  often brings new thoughts and ideas to those in quality and patient safety, and so I thought you may find this interesting.

Challenging the ‘business as usual’ patient interaction

I was recently out to a business lunch and had an amazing server who clearly delighted in the work she was doing. When a colleague complimented her service excellence, she replied, “I think of each table as a new experience.” She went on to describe her good fortune to work in an environment that appreciates her extroverted style.

I’ve been thinking about this woman’s positive ­attitude, but more so her philosophy and outlook about the work she does. Instead of viewing her job as routine, she engaged herself in her work with attentiveness and passion. It made me wonder how often our caregiving and leadership teams challenge the status quo of how routine care is delivered-not only for the sake of service excellence, but also for that of patient safety.

Let’s take the medication administration process as an example. The process typically starts by obtaining the medications from the pharmacy or a dispensing cabinet, doing the prep work, and, depending on available technology, taking steps to scan the medication barcodes and reconcile physician orders. The nurse will then administer the medications, hopefully coupled with an explanation of possible side effects to the patient and their loved ones. As it stands today, this practice seems to me to be one-sided and anything but engaging.

As health reform introduces new rewards and penalties for service excellence, especially for interactions surrounding medication delivery, does this particular routine process and others like it provide a golden ­opportunity for redesign? I believe it does. Perhaps we would be inspired to do things differently if we asked ourselves questions such as, “If Walt Disney had to administer a medication, how would he do it?” (In fact, Disney is capitalizing on its universal success and offering service excellence programming tailored for healthcare professionals through the Disney Institute.) Or maybe, “If Richard Branson, visionary chairman of Virgin Group, was inserting an IV, how would he engage the patient?” He certainly has changed the flying ­experience for consumers through unique aircraft and travel experience strategies. Or even, “What if WalMart® or Nordstrom’s had stations for medications, what would they look like?”

Read more.

Hinz currently works at PatientSafe Solutions, Inc. Previously, she served as the patient lead at HealthEast Care System in St. Paul, MN, worked for seven years as an ED health unit coordinator, and has completed a patient safety internship with the Agency for Healthcare Research and Quality.

Blog spotlight: Doc becomes patient

How can you make patient experience better? Well, one physician became a patient and got a better understanding of how patient experience is affected by bedside manner. Granted, I doubt becoming a patient was a planned-out strategy of his, but it’s an interesting post about what it’s truly like to be a patient.

“Doctor D” blogs often about the physician-patient relationship. Recently, however, he broke his leg in multiple places, becoming a patient himself. He learns some interesting lessons, including some about pain management (it ain’t easy) and bedside manners (some docs just don’t have it).

Most interestingly, however, is Doctor D doesn’t seem to have any plan to change his own habits after his experience:

As a physician, it was a bit eye opening to experience how inconsistent and imperfect our best pain medicines are. Managing the pain of a fellow human being is about as frustrating a situation as an MD can experience. I doubt my prescribing patterns will change much, but I do have a deeper appreciation for how hard it is to correctly wield the double-edged sword of pain medicines.

Does appreciation matter? Will it be lost in a few short months, maybe even weeks? Is pain management hopeless? Do some physicians lack a bedside manner they will never be able to learn, ever? Should the patient adjust to these circumstances, or should healthcare providers change their ways, and if so, how? This physician went through the experience himself and although might have a better idea of what patients go through, doesn’t seem to think actual practices need change.

Post your thoughts.

Thinking differently, working together at the IHI forum

Last week, I attended the Institute for Healthcare Improvement’s National Forum on Quality Improvement in Health Care, and I certainly wasn’t the only one. Six thousand of you attended in person, and more than 15,000 attended virtually.

The national conference lives up to its hype. It is invigorating to attend so many sessions dedicated to quality improvement. Keynotes from U.S. Secretary of the Department of Health and Human Services Kathleen Sebelius as well as the new president and CEO of IHI, Maureen Bisognano were just the tip of the iceberg.

Bisognano talked about the triple aim of IHI: improving the health of the population, experience of healthcare, and the cost of care. Many, she said, see two pathways to these goals: cutting costs and rationing care; however, Bisognano championed a third: creating new designs.

This was what many sessions I attended were about: working with others to think differently in order to truly achieve different results. Participants were urged to think differently about what harm is preventable, about why physicians may be reluctant to participate in quality improvement efforts, and about the patient experience as a whole, from ED visit to wherever the patient may end up.

I must also mention one of the other keynote speakers, Cory Booker, mayor of Newark, New Jersey. Booker has no experience in healthcare, but he certainly has a different way of implementing actions that is translatable to healthcare. Newark has seen more than 40% reductions in both shootings and murders (as of July 1, 2008, about midway through his first term). Booker credits this accomplishment with aiming incredibly high and focusing on the power of collaborating. To reach high ambitions, he urged, you must take the collective will of a community and embrace it. Engaging the whole of the community, he said, will create results unimaginable of the individual

Those were some of the highlights of the conference. Stay tuned to the Patient Safety Blog and Patient Safety Monitor Journal for more topics covered at the conference.

Were you at the forum? What did you think? What was your highlight of the week? Please share with your peers below!