All Entries Tagged With: "quality improvement"
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.
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.
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?
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!
NQF President steps down
The National Quality Forum (NQF) Board of Directors today announced that NQF’s President and CEO Janet Corrigan has submitted her resignation, effective late June 2012. Corrigan has served as NQF’s President and CEO for more than six years.
“Reflecting on our accomplishments over the last six years, I am deeply proud of NQF’s contributions to the overall healthcare quality movement,” said Corrigan. “Working with NQF leadership, our dedicated members, our scores of volunteer experts, and our committed partners at HHS, we have accelerated the critical work of achieving a healthcare system that provides safer, better, and more affordable care. I am eternally grateful for this experience to steer NQF during an unprecedented time of change in healthcare. Sustained, systemic change that benefits patients is within our reach. The strength of the NQF Board of Directors and executive team, coupled with our organizational stability and future possibility to meet our mission gives me the confidence to take the leap to my next chapter in life.”
The NQF Board of Directors has created a search committee to immediately launch a national search for a new President and CEO. John Tooker, MD, MBA, MACP, CEO Emeritus, American College of Physicians will lead the search committee. More details will be available on the NQF website.
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.
Bloodstream infections in pediatric ICUs
A Consumers Report study has found that many pediatric ICUs have high rates of bloodstream infections, often higher than adult ICUs—on average, 20% higher.
As you may recall, Josie King, whose unfortunate story has been made famous by her mother who now advocates for better patient safety, had complications after a central-line bloodstream infection.
Hospitals may want to look at the strategy of 2010 Baldrige-award winner Children’s Hospital at Providence in Anchorage, AK. Children’s cut catheter-related bloodstream infections in the neonatal ICU. Though they didn’t focus on central lines, the strategies might be of interest. They resisted the typical “see one, do one, teach one” method and instead implementing standard teaching methods. The hospital also ensured peace and quiet upon insertion by moving the patient into a quiet room during the procedure. Read more about this in Patient Safety Monitor Journal.
Still, there’s a problem a bit more concerning than the infections: a lot of pediatric ICUs aren’t reporting the data publicly, according to the report::
Of the 423 pediatric intensive-care units in the U.S., information on bloodstream infection rates is publicly available for less than half.
The investigation was left to focus on the 92 pediatric intensive-care units in 31 states plus Washington, D.C. that did report rates.
What can be done? What’s missing? Why aren’t we reporting rates? How can hospitals emulate others that have low rates if we can’t identify which ones they are?
Understanding HIT nationally and on the local front lines
Editor’s note: Columnist Catherine Hinz, MHA, 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 January 2011 issue of Patient Safety Monitor Journal.
In the past couple of months, there have been numerous publications around health information technology (HIT) and patient safety. In November 2011, the Institute of Medicine (IOM) released its report, Health IT and Patient Safety: Building Safer Systems for Better Care. Right on its heels, the ECRI Institute released its top 10 list of technologies1 posing hazards to healthcare delivery. The list exposed dangerous medical devices and other technology systems. It was inclusive of everything from surgical fires to radiation therapy exposure risks. Through these reports and a variety of other publications in recent months, one of the primary take-home messages is clear: It is exceedingly difficult to prioritize where attention should be focused given the breadth and scope of HIT and its potential effects on patient safety and care delivery.
The work of the IOM was particularly interesting as its charge was threefold: summarize the existing knowledge of the effects of HIT on patient safety, make recommendations to the Department of Health and Human Services regarding specific actions that federal agencies should take to maximize safety, and make recommendations concerning how private actors can promote the safety of HIT-assisted care.2 The confluence of those goals came down to understanding the broader design of a safe system, of which HIT is a component part. Indeed, after our patients and caregivers, HIT could be the most significant part of care delivery going forward; it is permeating almost every aspect of the care delivery process.
1. www.ecri.org/Pages/default.aspx
2. www.iom.edu/Reports/2011/Health-IT-and-Patient-Safety-Building-Safer-Systems-for-Better-Care.aspx
