The Partnership Continues: NeuroMedical Center Rehabilitation Hospital, Baton Rouge, Louisiana

Prista Corporation welcomes Midwest Surgical Hospital, the newest member to the ActionCue Team.

Midwest Surgical Hospital, located in Omaha, Nebraska, is a physician-owned facility that opened in 2008 with surgical suites and inpatient beds designed to the specifications of their physicians so they can operate in the safest, most efficient setting possible.  Midwest Surgical Hospital is licensed as an acute care hospital by the state of Nebraska and is fully accredited by the Accreditation Association for Ambulatory Healthcare, Inc. (AAAHC).

Interoperability: An EHR Litmus Test

By Don Jarrell

Interoperability has become a watch word in the healthcare business. The need to deploy electronic health record (EHR) systems across the board has put a strong spotlight on the need for different digital healthcare systems to communicate with one another, from doctor’s offices to hospitals to labs to insurers. Right now, they don’t. Perhaps more accurately, they don’t communicate fully and easily.

The interoperability problem is not a new one in the business world, nor is it confined only to the healthcare industry. The financial sector and the oil and gas industry have both succeeded in making complex data sets accessible across different vendors’ systems, so we know it can be done

Most if not all of the coverage given to this issue by the media is focused on the difficulties it presents to the provider-patient-insurer side of healthcare. While this is certainly part of the problem, there is more to the equation.  Many companies like ours provide solutions on the operational/quality/safety side of healthcare, and we continually see the effects that lack of EHR interoperability has on the patient quality and care staff with whom we work. Instead of improving operational processes, digital EHR systems create more work. For example:

• Needed data and information must be extracted “by hand” from the EHR and then re-entered, often with human “processing” in between.
• Data that could be useful as care quality indicators is not accessible from the EHR.
• Staff must fill data holes themselves, falling back on the (inefficient) use of spreadsheets and paper.

In short, what is experienced by too many users of EHR systems is akin to the closing scene of Raiders of the Lost Ark – vast storage with little chance of efficient retrieval for useful purpose.  Data warehouses are supposed to process all that data into easily-retrievable, value-added information products that serve the needs of users outside the system.

In an interoperable world, hospitals will use all the data available to them, no matter where the data resides, to manage and improve quality, and they will do so efficiently. All their digital systems will have access to discrete data elements and will be able to use this data easily. Equally important, there won’t be a demand for the labor-intensive tasks now required of staff.

For now, while we wait for full interoperability to arrive, the best you can do is be an informed consumer. Understand the interoperability issue, and be wary of sales peoples’ claims about the ability of their product to communicate agnostically.  Apply a litmus test to salespersons’ claims by making these key requests:

• Show me how a clinical manager can retrieve clinical care counts like the total number of Patient Days, Foley days, ventilator days, or medication doses administered.
• Show me how a quality manager can retrieve summarized operational and financial data used in quality and clinical performance management, like Cost per Patient Day, Length of Stay variables, and Admission, Discharge and Transfer (ADT) tallies.
• Explain to me how much of the difference between the demonstration and my “day 1” experience with the application comes from customization that takes time and that we must pay for.

At best, lack of interoperability is frustrating. At worst, it can put a hospital at risk. There is a lot of data locked in an EHR system, and much of it could make a significant difference to patient care quality and safety. Applying this litmus test to any EHR system you are evaluating will help identify the system that will best interface with the rest of your digital systems with the data that you need to operate efficiently.

A Culture of Quality: What It Is and What to Break to Get It

By Don Jarrell

Is there a healthcare organization anywhere that doesn’t want to provide top quality care? This is one of the highest priorities among healthcare professionals and hospital managers. It also may seem like an unachievable dream for many. Between staffing limitations, regulatory requirements and inter-department difficulties, many organizations don’t see a clear path to achieving their quality goals.

Providing top quality care and operating/performing efficiently require a certain way of working throughout the organization—a culture of quality. Embedding a culture of quality is a transformative undertaking and often requires big changes to achieve. Said more bluntly, it means breaking a lot of things.

What is a culture of quality? There are five fundamental components.

1. An overall perception of quality. This is a subjective view, an opinion, held by staff and management that is rooted in day-to-day experience. It is influenced greatly by the other four components.
2. A learning organization. A hospital with a culture of quality is committed to continuous improvement. While errors in patient care are certainly not encouraged, staff members do not play the “blame game” when a mistake does get made. Instead, the organization takes the opportunity to learn from mistakes in order to improve.
3. Open, transparent and bi-directional communication. Because a culture of quality is non-punitive, there is no reason to avoid reporting events. There is no such thing as an event that is too insignificant to report—this includes capturing “near misses,” which will contribute to a more complete picture of care status. With this kind of comprehensive information gathering, the organization has a much more complete basis for learning and performance improvement. When errors do get made, feedback is constructive. No one, including management as well as staff, feels that they need to hide information from others or share only with a few individuals or departments. This fosters more robust two-way communication between the organization’s management and the “in the trenches” professionals, which will naturally increase focus on quality.
4. Teamwork. A culture of quality is inclusive, both within units and across units. Functional and informational siloes do not exist, and when the need arises individual will cross functional lines to help.
5. Management advocacy. A culture of quality exists from the top down. Management from the highest level in the organization and into all operational units are active advocates of the culture. Apologies for the cliché, but they walk the walk and talk the talk—and the commitment to quality moves from a statement on a wall plaque to a statement made by the daily actions of every member of the organization.

How are you doing so far? Does your organization have a check against each one of these components? If not, how can you get there?

To figure out how to create a culture of quality in an organization that lacks one, it is useful to decide what needs breaking. Often, an organization that does not have a culture of quality has the opposite characteristics to those listed above. For example:

• Units are in informational and functional siloes, so there is a “this is not my problem” attitude when crises arise or help is needed elsewhere in the organization.
• Information is hoarded rather than shared, both within and across units.
• Management may talk the talk of quality, but they don’t follow through in day-to-day activities and therefore don’t demonstrate any commitment to it.
• Event go unreported, and the same mistakes keep reoccurring.

A useful way to find what needs breaking is to take the list of characteristics above and turn it on its head. In other words:

1. When management are clear and active advocates of quality, teamwork is fostered.
2. When teamwork increases within and across units, there is more open and transparent communication.
3. When there is more open communication, learning and continuous improvement is enhanced.
4. And when this string is in place, there is a clear overall perception of a commitment to quality.

This prompts questions like:

• How can management clearly demonstrate its commitment to quality on a daily basis? The answer might be as simple as the old “management by walking around” strategy—get management out of their office suites and into the units, asking questions and observing activity.
• What will motivate staff to play well with others? Take away the blame game, make it safe for questions to be asked and mistakes to be identified. Foster cooperation by eliminating reasons for hoarding information and resources.
• How can information be made more readily accessible to everyone? Find ways that information can be accessed by anyone, any time, without having to run the gauntlet of authority.
• What will switch us into learning mode? Make that readily accessible information easy to analyze and set up ways to gain deeper insights from it, then act on those insights in order to make improvements.

Figuring out what needs breaking to transform to a culture of quality depends on your own particular environment, but there is one often-overlooked catalyst that will support transformation in any organization. Software that includes the five fundamental components of a culture of quality in its design is invaluable because it promotes a culture change simply through daily use. In other words, incorporate the right software into the right places, and you will see the right changes occur naturally—and sustainably.

Computers vs. Humans: Divide to Succeed

by Don Jarrell

Time after time in our work with hospitals engaged in improving quality and safety management, I have seen management and staff making the same big mistake. They try to do work that they are not suited for, and more often than not end up overwhelmed because of it.

They are doing tasks that their computers should be doing.

When it comes to dealing with all of the information surrounding quality and safety management:

• Computers have perfect memories; humans not so much.
• Computers can store huge amounts of data without forgetting one thing; a human can have a hard time finding the coffee cup they just laid down.
• Computers can analyze reams of data without fatiguing; humans become error-prone after just a short time engaged in this kind of activity.

Said another way:
Computers are good at:

• Capturing
• Storing
• Computing
• Repeating
• Reporting

People are good at:

• Creating
• Solving
• Deciding
• Learning
• Acting

Would you ask a computer to do any of the things that people are good at? I hope not. Forget all the talk about artificial intelligence whirling around these days; the fact is that business computers today are not able to match humans in the creating-solving-deciding-learning-acting space.

And the same is true going the other way. Asking a human to infallibly capture-store-compute-repeat-report on an ongoing basis is very far from effective. In fact, it can be significantly risk-prone. Humans should not be doing the work of computers, just like computers are never expected to do the work of humans.

How does this relate to patient care quality and safety management? Data is being generated 7/24/365. Unless all that data is being captured by a computer set up to do productive things with it, humans are left to make sense of it before they can ever get to the tasks that they are good at. Though they may use computers—in the form of endless spreadsheets—to help them organize and analyze, there is no way a human can match a computer for efficient capture-store-compute-repeat-report tasks. As a result, many quality and safety managers spend too much time dealing with data and not enough time gaining insights for solving, deciding and taking action.

The equation for effectiveness, and for improving quality and safety programs, is appropriate division of labor. Set up the computers to do what they do best so that the humans can do what they do best. Think of the computer as an “intelligence enhancer,” taking on tasks it is suited for and providing rich results that can be used by humans to solve challenges and make improvements.

(Side note: I do have a caveat here. I’ve been saying “computer” throughout, but in reality it’s not the computer so much as the software that makes the difference. You can have two identical computers running different software packages designed to perform the same functions, and end up with widely different results. In order to make the division of labor really work, you must have well-designed software that fits your purpose. I’ll be addressing this topic in a future post.)