Welcome to the December issue of the Indidge Advantage newsletter.
Our first article asks the question; Are Hospitals Safer? The next article discusses staff education as it relates to quality healthcare in these times of economic crisis. The last article is about improving patient satisfaction and the patient experience.
Over the course of the year, we have strived to provided information that is of value to your healthcare organization. We wish you and your family a very Merry Christmas and we look forward to seeing you next year!
The Indidge Advantage is produced by Indidge Systems, a healthcare software solutions company specializing in Compliance and Risk Management solutions.
by Cheryl Clark
November marks the 10-year anniversary of the Institute of Medicine's "To Err Is Human," the first of its 11-volume "Quality Chasm" series on improving patient care and avoiding mistakes.
Since the landmark report, health providers have been chagrined by the revelation that they were killing "a jumbo jet" full of passengers every day, about 98,000 preventable deaths a year. And many of them reacted to the allegation by launching a broad spectrum of efforts to reduce medical mistakes.
But are we really better today at preventing mistakes and safeguarding our systems from causing harm than we were 10 years ago?
"We're safer in many more places, and more of the time," says James Conway, senior vice president of the Institute for Healthcare Improvement in Cambridge, MA.
"We're seeing very courageous people in many organizations doing exceptional work. We're seeing sobering discussions about the circumstances in which patients died unnecessarily, confronting the reality of the patient who was harmed with graphic detail, using the name of the patient, and their age."
There is in many places, Conway says, more accountability and more responsibility. There is more acknowledgment that mistakes are preventable, and not just part of the background noise that says it's OK because bad things happen in medicine sometimes.
But on a national level, he's not so sure. He's concerned that in many regions, facilities have not become "expert at looking for trouble. We're just learning to identify what harm is," he says.
First the good news.
- Many states now require reporting of adverse events and some require public reporting of hospital-acquired infections, patient falls or pressure ulcers. In some states, health officials hold press conferences to publicize hospital errors that caused, or had the potential to cause serious patient harm or death. At least one state, California, imposes hospital fines and publishes the incident report in all its excruciating detail on the Web.
- Medical residents' hours are now restricted to prevent errors caused by fatigue.
- Providers in many hospitals that normally compete have joined hands to unify how they label high-risk intravenous medications, to avoid a new doctor or nurse from misusing a potentially lethal drug because the facility's coding or storage system was not the same as their previous hospital.
- The Institute for Healthcare Improvement launched a number of safety strategies, including its "100,000 Lives Campaign." Following that campaign, the IHI launched its "5 Million Lives Campaign" to understand and address those medical mistakes, an estimated 40,000 per day, that injure patients and take a toll on their quality of life.
- Providers are setting goals for their communities. Hospitals are starting to use the IHI "global trigger tool" to more accurately measure areas of care that might be causing avoidable harm, including the 28 adverse events now required to be reported.
- Facilities were urged to adopt a "no-blame" system to encourage providers to report their own missteps, in the chance the practice or situation might be easily repeated by a colleague. Disclosure of those mistakes and transparency has become acceptable at many facilities as well.
- Central Line Associated Bloodstream Infections have been reduced.
- Many facilities are using "checklists" before beginning surgery or a complex procedure.
- The Centers for Medicare and Medicaid Services will no longer reimburse health facilities for the cost of caring for a patient with a preventable hospital-acquired infection.
- More attention is being paid to physicians' diagnostic errors, and the importance of being candid with patients and patients' families when preventable errors occur.
But many significant challenges remain.
Hospital mistakes
On the negative side, lots of serious mistakes are still happening. Earlier this month for example, Rhode Island Hospital, the state's largest, was fined $150,000 for performing its fifth wrong-site surgery since 2007. The latest incident prompted the state to order the facility to install video cameras in all its operating rooms.
Foreign bodies, such as sponges, clamps, hemostats, and towels, are too often left inside patients during surgery, because surgical teams don't take seriously enough requirements that they count and record all such items incoming and outgoing.
Infection control lapses
Kathy Warye, chief executive officer of the Association for Professionals in Infection Control and Epidemiology, said a major issue is lack of scientific information about bacterial, viral, and fungal infections that are so frequently transmitted in healthcare settings.
"We don't understand some of these infections, like C. difficile, well enough to know whether they can be prevented," she says. "Science hasn't yet filled the gaps." Aside from that, she says, another stumbling block is the lack of healthcare executives' support to control preventable infections.
Health executives, she says, "still aren't fully cognizant of what infections ultimately cost," Wayre says. "They look at infection control as a cost center, and in the last economic downturn, 20% of respondents [to a survey] said they had to cut back on surveillance, and 41% said their resources were cut across the board.
Today, 29 states require some public reporting of healthcare infections. And if the current House version of health reform bill passes, it will be 100%.
"Transparency leads to improved outcome, and in many states there is evidence that it's played a key role," Wayre says.
Hospitals need to conduct comprehensive risk assessments to determine if they should be screening patients on admission for infections they may have acquired in their communities, but which could pose serious health issues for other patients, adds Wayre.
Medication errors
It was just two years ago that actor Dennis Quaid's twins were given Heparin in an adult dose that was 1,000 times stronger-rather than the proper dosage of Hep-lock.
Allen Vaida, a pharmacist and executive vice president of the Institute for Safe Medication Practices, says "we have made great strides in understanding that medication errors are an issue, but we still have a long way to go."
Vaida says hospitals should implement barcoding of medications. "Only 5-20% of hospitals now do it. We should be striving for 100%," he says.
Second, he says, "we have to do a better job learning from others." Too many hospitals see tragic mistakes that happen elsewhere and say, "That happened in California. I'm in Ohio. It doesn't happen here.
"We need to realize we're in a risky business, and ask the question 'Could that happen here?'"
by Deanna R. Miller, RN, MSN/HCE
With the economic crisis affecting the healthcare arena, hospitals large and small must tighten the budgetary belt. This difficult task weighs heavily on hospital CEOs across the nation. Should leadership positions be eliminated? Should nursing FTE's be cut?
Historically, one of the first hospital departments to experience the crunch is the nursing education department. Reimbursement for seminars and out-of-facility education is an easy expense to eliminate and monies once budgeted for training are frozen. With a short-term perspective, it's easy to believe these cuts will have little effect on hospital operations and those currently employed within the facility, but unfortunately, this is a false assumption.
The future of ongoing improvement in quality healthcare has a strong dependency on life-long learning that is hosted and encouraged by staff development departments and their educators across the country. It is a Joint Commission requirement that the competency of all clinicians be validated at least once per year, but without needed equipment and budgeted salaries for qualified practitioners to validate competency, that mandate cannot be met.
Each day there are evidence-based changes and updated techniques surfacing as the result of clinical research and testing of best practices around the world. Communicating these changes and teaching new techniques to clinical staff in healthcare facilities is the responsibility of staff development professionals and clinical educators. Positive patient outcomes rely directly on the skills and knowledge of the clinicians caring for them.
During the past year, several sentinel events and near misses have been reported related to the administration of Heparin. As a result, safety measures have been created and implemented in healthcare facilities around the world, such as a double check system in which two clinicians independently calculate the dosage of Heparin and then compare the calculated dose, and a tighter control of the anticoagulant by the hospital pharmacy. The need for clinician education and post-education validation was mandatory. Without this education, future critical events and deaths are likely to occur.
The Joint Commission defines negligence as a "failure to use such care as a reasonably prudent and careful person would use under similar circumstances." The cost of nursing negligence by far outweighs the savings that staff development budget crunching results in, let alone dangers to our patients from medical errors caused by incompetent clinicians.
In light of these concerns, too stringent cuts from the staff development department's budget during economic hardship should be a warning sign. Consideration must be given to future costly litigation fees as a result of substandard care and the difficulty of launching new quality improvement initiatives without educated staff development professionals to oversee them.
by Gienna Shaw
Hospitals and health systems have had an eye on patient satisfaction over the past few years and have, more recently, been ramping up their patient experience initiatives-and it's starting to show. Patients were more satisfied with their care at inpatient facilities than during any of the previous six years, according to a recent report from Press Ganey Associates, Inc.
Patient satisfaction has steadily increased since 2003, with 85% of those surveyed reporting satisfaction with care in October 2008, according to The 2009 Hospital Pulse Report: Patient Perspectives on American Health Care.
But the best news in the study is data that shows it's not just the patients who are benefitting from a better experience. Hospitals are reaping rewards for their efforts, as well.
According to the study:
- There is a direct correlation between highly satisfied caregivers and satisfied patients-that in turn helps recruitment and retention of doctors, nurses, and technicians.
- Organizations with high satisfaction ratings are the most successful financially-satisfied patients are more likely to recommend the facility to family and friends and high ratings enhance community reputation, both of which increase market share and volume, according to the report.
- Better staff buy-in to improvement efforts leads to a more positive atmosphere for patients and better quality care.
- And research continues to show more satisfied patients are less likely to file malpractice suits.
But there's still room for improvement, according to the South Bend, IN-based agency. It recommends hospitals focus on five areas related to questions to patients about their likelihood to recommend the hospital to others. They are, ranked in order of importance:
- Response to concerns and complaints made during the patient's stay
- Degree to which hospital staff addressed the patient's emotional needs
- Staff effort to include the patient in decisions about his or her treatment
- How well the nurses kept the patient informed
- How promptly staff responded to the call button
The top priority-response to concerns and complaints-is a real opportunity for hospitals, according to the report. Service recovery "can make a big difference for patients," the report notes. "A key differentiator of 'good' versus 'very good' care is what happens when something goes wrong or the patient's needs are not being met."
The survey report includes a number of charts, graphs, and statistics, including a list of states with the highest inpatient satisfaction, inpatient satisfaction by specialty, type of admission, bed size, and patient age. (Care to guess which age group is the least satisfied?) There's also a case study about the Oakwood Southshore Medical Center in Trenton, MI, which took a team approach to improving patient satisfaction.
One day a housework-challenged husband decided to wash his sweatshirt.
Seconds after he stepped into the laundry room, he shouted to his wife, "What setting do I use on the washing machine?"
"It depends," she replied. "What does it say on your shirt?"
He yelled back, "DENVER BRONCOS."