Category Archives for Helping Hospital CEOs

Quality Improvement Performance Indicators: Prioritizing Your Data

In a recent blog post, the Center for Improvement in Healthcare Quality shed some light on an area of concern for many hospitals: the prioritization of data collection within their QAPI program. Hospitals are constantly working to monitor, report on and improve patient safety and quality of care, many of them collecting data on hundreds of performance indicators, but it’s impossible to monitor every single area.

This is where prioritization of data collection comes into play. The Centers for Medicare and Medicaid Services expects hospitals to prioritize high-risk, high-volume or problem-prone areas, but unfortunately, the agency is not specific on what areas qualify as such. However, the CIHQ suggests prioritizing performance indicators that are frequently cited for not being incorporated into a hospital’s QAPI program, such as:

Medication Use

• Sterile Compounding and IV Admixture
• Management of Hazardous Medications
• Medication Administration Practices for High-Risk Meds

Infection Prevention & Control

• Sterilization of Instruments & Supplies
• High-Level Disinfection of Instruments & Supplies
• MDRO and Isolation Practice
• Disinfection and Cleaning of Dialysis Machines & Equipment

Physical Environment

• Environmental Controls of Sensitive Areas (Temperature, Humidity, Air Balance)
• Maintenance and Operation of Critical Medical and Utilities Equipment
• Life Safety System Testing and Maintenance
• Implementation of Interim Life Safety Measures
• Protection Against Radiation Hazards

Food & Nutritional Services

• Food Service Preparation, Storage, and Cleanliness

Clinical Services

• Ordering Restraint & Seclusion
• Monitoring of Patients in Restraint & Seclusion
• Administration of Blood & Blood Products
• Protection of Patients at Risk of Self-Harm
• Administration of Sedation / Anesthesia
• Surgical and Invasive Procedures

While we support CMS and CIHQ in urging focus on certain performance indicators when a limited number can be tracked and addressed, hospitals should be very careful about reducing the number of tracked indicators due to time and resource constraints, because that could potentially have a damaging effect on the organization. The motivation to do so is often present and understandable, when hospitals are utilizing inefficient and labor-intensive performance tracking processes and tools. This is precisely the fundamental issue that Prista’s ActionCue CI application was designed to address.

ActionCue CI is your Fast Path to Insight™, monitoring all 19 performance indicators listed above and more, right out of the box. Its intuitive online dashboards provide critical QI/PI information to those who need it, when they need it. With gains in efficiency and productivity from using ActionCue CI, staff can carry out the quality, safety and improvement activities of the hospital, and cover and drive improvement on a larger number of measures, reducing the chances of being blindsided by a clinical performance issue or a derogatory survey finding.

In addition to comprehensive and efficient data collection, ActionCue helps hospitals take real actions to improve patient care, allowing staff to quickly investigate event causes and manage corrective actions through electronic event reporting. Many hospitals see significant increases in staff participation, communication and cooperation.

While it’s certainly important to take all necessary steps to avoid a CMS citation, ActionCue helps hospitals take quality and performance improvement a step further by truly creating a “Culture of Quality,” representing a collective and sustained commitment by organizational leaders to emphasize safety every single day.

Is Your Quality-Safety System Really a Do-it-Yourself Project? Should it be?

We frequently describe ActionCue Clinical Intelligence as redefining and facilitating the management process for quality-safety improvement. Understanding that taking on quality-safety improvement can bring some apprehension, we want to make clear that we do this to bring a radical increase in efficiency to the process of improving patient care delivery for clinical staff, managers and executives.

Whether a facility or system’s solutions for quality and safety management, tracking, and reporting consists of paper and Excel spreadsheets, internally developed systems, or commercial applications, most of those scenarios have something in common: They require clinical management to spend a good bit of time on manual work. This can include:

• Researching required performance measure definitions and their application within the facility
• Setting the structure of criteria, measures, reports, graphs and notifications within the system
• Entering, manipulating and checking data multiple times as it moves from safety tools and organizations to the quality management arena, and on to the places, tools, and people involved in performance improvement and management information systems
• Creating and executing the mechanisms for communication and collaborating with various staff to carry out multiple fractured workflow processes
• Producing forms, diagrams and other artifacts, the primary purpose of which is to demonstrate adherence to the chosen process and methodology
• Using additional tools, systems or steps to produce static reports in a variety of formats for management review meetings
• Revising and re-doing much of the above repeatedly in response to changing external reporting requirements, additional or revised inquiries, recurring meetings, staff turnover, etc.

It should be noted that in many cases, a good bit of that manual work could be done by administrative workers but is too interwoven in the clinical and quality-safety work to hand it off without major disruption in productivity. In other cases, it requires the clinical professionals to develop skills in information technology and data manipulation that should arguably not be required of them. Both of these instances seriously dilute the application of their best skills, education and professional abilities to improving quality-safety.

Unfortunately, many clinical managers and their senior management accept this kind of manual effort, and the resources it consumes, as the norm for working in quality, safety and improvement. Some believe it is the only way for solutions to work exactly as they want. Even by turning to multiple commercial software vendors, much of this same function building is required as the vendor happily customizes their product and charges significantly for it both upfront and on a continuous basis, while tying up hospital staff in planning and reviewing the customization. After-sale charges can even become the vendor’s primary business model. At Epic Systems’ User Group Meeting in September of 2016, CEO Judy Faulkner said she identifies Epic as a programming shop. The company spends just over 50 percent of operating expenses on research and development each year. With that perspective, how likely is it that such a vendor is going to make the application itself match the needs of its users, or reduce the work of installation, amount of training needed, or degree to which the vendor’s billable time is needed for ongoing administration and updates?

Costs that may be dispersed into the operating budget are often “hidden,” but really add up when considering the Total Cost of Ownership (TCO) for the solution. Almost all of this fits into the “administrative overhead” component of healthcare costs, which is understood by most in the C-suite of hospitals today to be increasing disproportionately.

Once this “build our own” mentality sets in, inertia takes hold. It is common for quality and safety solution acquisitions to focus on one of these “toolkits,” or basic products needing customization that lasts months after purchase. Over time, the organization feels as if it has invested so much into their status quo solution that they certainly don’t want to make a substantial change and start the process all over again. This is especially true when it could impact the many overt work processes in which they have also invested time, money and training.

Many managers initiating searches for quality and safety management solutions may not realize that a well-designed “turnkey” application—embodying not only effective technology but also expertly-crafted healthcare operational design—can be configured in days, not months, to fit their organizations and operations, and similarly be reconfigured to match their evolving needs. While turnkey applications such as ActionCue may be uncommon in healthcare IT, distancing the organization from the practice of costly extensive internal or vendor-teamed software development is something companies in almost all other verticals have done over the years. Although this requires some adjustment in perspective when reviewing products designed for a large healthcare marketplace, the very common mentality of “doing what you’ve always done” is something healthcare providers can simply no longer afford.

Re-Thinking: Four Ways to Advance Healthcare Quality and Safety

For decades, I practiced and taught others a model of developing new software products in which the creator begins with at least two innovation concepts before thinking about technology choices, features or even architecture. These concepts must represent a new way to reach important objectives, not just tweak current tasks and activities. They must eliminate current hurdles and transcend problems. This model has proven to be the best way to ensure that the benefits of the product stem from fundamental values, are sustainable, provide room for growth, and build on an evergreen strategy.

In some cases, healthcare staff, management and executive IT users are hesitant to change the way they do things, but such changes have been proven to be the only way to make substantive progress. These innovative concepts are at the core of Prista’s ActionCue Clinical Intelligence platform, helping healthcare professionals reach real quality improvement goals that are fundamental in alleviating the operational, financial and regulatory issues with which hospital leaders wrestle every day. Even if hospital leaders believe the quality and safety activities in their organization are productive and successful, we believe those activities could be significantly more effective, positively impacting patient outcomes, revenue, staff workload, management and executive participation, and the culture of quality in the organization. The following are four ways healthcare organizations and management can advance healthcare quality and safety.

1. Shift focus toward goals instead of traditional activities 

For individuals and organizations, doing “what we’ve always done” is comforting, pays respect to past decisions and accomplishments, and, importantly, avoids any risk in trying to improve by doing things differently. Some will focus on “risk” in that statement; others on “better.” Improvement, something we discuss often, inescapably means change, and the degree to which we avoid changes in process can systematically limit improvement. The tendency is to start rationalizing complacency and praising stability, solidarity and tradition.

The problem with the willingness to hold on to traditional activities manifests itself when organizations maintain the functional silos of Quality, Risk Management and Performance Improvement in hospitals. Whether individuals, groups or entire departments, tradition supports these institutions having different leaders, processes, tools, methodologies and data. With these functions compartmentalized, their objectives—and rewards—are limited to their respective stages of development instead of contributing to the overall goal of improvement. Simply reporting metrics and incidents is the finish line for some, while others carry on with other activities. This leads to dependence upon human endeavor to unify all those differences, in traditional mechanical ways, to serve the goal all healthcare organizations should be working toward: better patient care and outcomes delivered with efficiency.

The ActionCue application provides innovative consolidation of all performance metrics. No more silo-ing of core measures, audits, EOC, or protocols. Event reporting and investigation and improvement action plans are highly integrated. All data and information flows together and is readily accessible, enabling each task and activity to tie into performance improvement.  Not only does this design serve the common goal better, it saves the staff, managers and executives a lot of time and mental exertion.

2. Own quality-safety improvement internally and make it efficient 

Historically, most of a hospital quality department’s activities were focused on submitting data, reports and documents to external regulators and other stakeholders. A good portion of that information is intended for licensure/accreditation, long-term research and, especially in recent years, reimbursement. The aim in hospitals, typically among overworked managers, has become to “check the box” noting required submissions have been accomplished. Using the compiled information internally to improve quality and safety has become secondary to executives looking for checked boxes, and such perspectives tend to trickle down as real and perceived guidance. Yet, the return and yield from the submissions to those external organizations, in terms of enabling patient care improvement, is usually disappointing and always later than desired. With that view of comparative value, it is sometimes difficult for clinicians to remain motivated to genuinely improve quality and safety, and it’s equally difficult to get budgetary investment for innovative, efficient tools and processes as opposed to maintaining the traditional—and sub-optimal—activities and approaches.

ActionCue is far more than a reporting tool. It is a composite platform for the entire clinical staff, management and other stakeholders to work collaboratively and efficiently, while pursuing continuous improvement, which has long been little more than a slogan or buzzword.  Its value in executive awareness and required reporting is exceptional. Users report a near elimination of “survey preparation” and surveyors from several states, as well as accreditors such as CIHQ, TJC and DNV, have commended its clarity, accessibility, accountability and demonstrated utilization and results.

3. Improve division of labor between humans and technology 

Many healthcare IT users have come to understand that many applications are little more than an electronic filing cabinet, mostly utilized for storage and retrieval of information in the same format as that in which it was input. This places a burden on staff to compile commonly used information, perform calculations, and turn raw data into intelligence and insight. For a long time, organizations’ leaders have accepted that quality and safety efforts require a large amount of time and effort in mundane process mechanics. Applications serving important enterprise functions should focus on collaboration and workflows that not only match the natural tasks and processes of users, but also shape the users’ behavior by embodying methodologies and disciplines that yield the targeted results with efficiency and accountability.

Additionally, when the application is designed to partner with the user in his or her work through well-known, disciplined workflows, it can provide valuable, relevant, up-to-date content in the context of the task at hand, such as researched industry and academic performance measures, evolving best practices, educational materials, forms, contact information and a wealth of other materials the user, or the user’s work group, no longer have to spend time researching, compiling and updating. This sort of sophisticated, enabling design should become commonplace in healthcare IT applications, as it has been for decades in other fields.

ActionCue’s design goes beyond ease-of-use to advance the way in which healthcare organizations engage with information in an application. The platform proves to be an enjoyable working team member, increasing productivity and facilitating education and improvement towards goals. ActionCue users develop and maintain a strong “Culture of Quality.

4. Opt for a turnkey application utilizing a SaaS model 

The technology used to support hospitals’ important quality and safety work usually starts out as a “toolkit” in which the organization invests a lot of time, money and attention to build and maintain the intended “solution.” Ranging from paper and Excel spreadsheets, to internally developed tools and applications, to major commercial systems that undergo extensive customization by their vendors and “add-on” technicians and analysts, healthcare organizations spend a lot of money and resources—often incrementally staffing consultants and specialists— to get the job done. Despite the high costs, many organizations believe such an approach is the only one that will work, and it is often based largely on what they have used historically. In such a setting, real innovation is rare and very expensive.

When an application provider has utilized healthcare expertise in its core design, delivery and support functions, it can anticipate a great deal of the functionality needed by its users and apply best practices to deliver a “turnkey application,” ready to run right after the sale. Foregoing full customization can be readily accepted as a trade-off for saving tens of thousands of dollars (or more) in visible and hidden costs. Turnkey applications also frequently have value-adding content that is continuously researched and updated, providing constant improvement in the use of the application. Setting a high bar when reviewing turnkey applications and providers has long been the standard approach for organizations of all sizes outside of healthcare that are adept at considering total cost of ownership (TCO).

The next step forward in evaluation of a solution is the true Software as a Service, or SaaS, business model. With the fundamental distinction of being web-based and accessed via a browser, SaaS applications save buyers a great deal by avoiding the costs of acquiring and maintaining expensive computing and storage infrastructure to support on-premise systems.  Leading companies offering SaaS model applications go much further than “renting software,” thought by some to be an unnecessary expense. The best practitioners of the SaaS model accomplish three major things that are impossible, difficult or very expensive with other models.

• Update the application frequently: Because the process of distributing updates is simpler and less expensive than with on-premise software, SaaS-model companies frequently provide quarterly or even monthly updates. Such updates typically include enhancements and extensions of functionality, as well as adaptations required by regulators and other authorities in healthcare. This same advantage in efficiency makes it possible and likely that the delivery of software corrections and “fixes” can take place in hours, instead of weeks or months, as is often the case with on premise software.
• Operate efficiently and pass savings on to customers: SaaS-model companies operate on the latest technology platforms, facilitating rapid development and deployment of changes, making them far easier and less expensive to maintain. Companies that have started out as such build their entire operations around utilizing the most up-to-date technologies and methodologies, so their internal operating expenses are lower than those of traditional software companies. These and other efficiencies allow SaaS-model companies to pass their savings along to customers, driving down prices, usually as non-capitalized monthly or annual subscriptions.
• Provide proactive, expert support: Unrelated to the technology side of the SaaS model, the best of these providers work on the principle of an ongoing collaboration with each of their customers. The frequent updates and efficient operations mentioned above allow SaaS-model companies to focus on providing support staff that are highly skilled, have in many cases done the work of the very users they support, and are responsive to, or anticipatory of, the evolving needs of their customers. In the case of healthcare quality, safety and improvement efforts, this approach involves leveraging research on evolving performance measure definitions, best practices, and information submission mandates carried out by the support staff, and integrating them into the application for all to use, saving a great deal of the users’ time.

Understanding what SaaS-model companies represent and offer, healthcare executives can appreciate that this means of operating is exactly what is needed in the strategic advancement of healthcare information technology.

As a fully actualized example of a SaaS-model offering, Prista and its ActionCue application transform the relationship an organization has with its information technology. No longer a bottom-line cost, source of frustration for staff, or drain on productivity, ActionCue is a critical facilitator of clinical performance improvement, providing tactical and strategic benefits for the organization’s people and processes, and delivering ROI.

Taken one by one, any of these departures from the status quo would be valuable and beneficial to a hospital and even more so for a healthcare system. Each of these steps forward would be truly strategic, with broad and long-term positive effects. But taken altogether, these changes in thinking and the realization of them in a platform like ActionCue Clinical Intelligence is truly a transformational step forward for healthcare organizations.

The Equifax Data Breach – What You should do to Protect Yourself!

This advice is from Prista’s partner and advisor for HIPAA Compliance, Third Rock.  Considering the vast number of individuals impacted by this breach event, and the seriousness of the issue, we thought it would be good to share this.  Please consider these steps for your own effort.  You can also see this article from their current newsletter, find other resources and subscribe to their newsletter here.

If you would like more insight or help with your organization’s HIPAA Privacy and Security compliance, you can direct any questions or follow-up to Robert Felps at Third Rock, via email or call 512-310-0020.

Stealing headlines from Hurricane Irma was the revelation that Equifax experienced a major data breach during the summer.  Equifax is one of the “big three” credit monitoring services and therefore the data they collect on each of us is broad and deep.  They estimate that data for 143 million people –  nearly half the population of the United States – has been stolen!

What does this breach mean for you?  Your financial history and ability to buy a home, new car, or even get healthcare could be at stake.  Here are recommended steps to protect you and your family.

1. Be skeptical! Equifax is looking out for itself, not you!  They will fight to survive this fiasco, spending the minimum required. Don’t give away your rights – read all documents carefully before signing. Don’t rush to sign any agreements. The aftermath of the breach will play out over months, not hours, and new information will emerge every week.
2. Be cautious! This breach is so large, scammers will take advantage of it.  Be wary of offers to sign up for credit monitoring services and giving out any additional personal information!  Validate the authenticity of any such services. Research these services because many do not provide the protection you need or believe you will receive.
3. Assume your data has been stolen, even if Equifax says your data has not been stolen! Breaches tend to grow over time because companies often under-report to minimize the bad publicity. As the company investigates the breach, they are also likely to uncover more theft that wasn’t obvious at the beginning of the investigation. For instance, on Tuesday of this week, it was publicized that EquiFax suffered additional breaches this year before this major breach.
4. Check the Equifax website set up to inform people if their data was stolen. The link to the site is  equifaxsecurity2017.com.  Questions abound about whether the website provides accurate responses or not!  Remember, be skeptical!
5. Keep all your records! Record all your interactions with Equifax. Ask for email confirmations after phone conversations. Save email as PDFs.  Any costs you incur, get receipts and put them in a specific location or folder.
6. Check your credit report at; https://www.annualcreditreport.com/index.action. This is a free service and you can get one free report a year from each credit reporting service.  I recommend getting one report every 4 months from a different service so you can maintain a fairly regular status of your credit information.
7. Freeze your Credit – this is your last option and prevents companies from checking your credit score in an effort to get additional credit. This is not something you should do without evaluating your circumstances.  If you are planning to purchase a new car, take out a loan, or get a new credit card, you should evaluate your options.

Healthcare Innovation, Leadership and Action—Part 4

In a recent webinar for our ActionCue clients, Prista’s panel of experts answered questions about healthcare innovation and the role of leadership in creating action that improves patient safety and quality.

We covered nine of these questions in previous posts—Part 1, Part 2 and Part 3. In this one, we will discuss the final three questions. Before we begin, let’s review who the panelists in this webinar were.

As President and Founder of Prista, Don Jarrell brings more than 30 years of technology experience in products management, application design, technology strategy and intellectual property management licensing. Don has provided the vision for Prista and for the ActionCue application.

Billie Anne Schoppman is a Registered Nurse and CPHQ (Certified Professional in Healthcare Quality) with more than 30 years of experience in the healthcare industry. As the Chief Mission Officer at Prista, she brings her passion to create the most efficient environment for improvement.

Dr. Jake Redden is a member of Prista’s Advisory Board with expertise in patient safety, healthcare quality, human factors, crew resource management, and safety culture, and is certified in healthcare quality and patient safety.

10. What is the biggest or most strategic impact when using the kinds of innovations we’re talking about that directly benefit user organizations?

Don Jarrell: We talk a lot about innovation in terms of daily impact because we’re trying to adjust behavioral interactions regarding the quality and safety efforts, but we’re actually improving the entire management process too.

When we can use technology to shape the workflow and keep it moving so that incident investigations don’t stall, data doesn’t get unreported and various reports don’t drive right into the performance improvement segment, we’re changing the process by which hospitals are managed.

It’s not about giving a motivational speech and turning up the heat on people to get results. It’s about actually changing the process and facilitating what management is expecting by their presence and their actual involvement in the workflows to some degree, not in a way that’s going to overburden them or keep them connected at arm’s length, but in a way that uses all of the leadership principles Dr. Redden talked about.

These things will change the way the organization is actually carrying out its management process, and that’s what we’re really after. We’re not asking anybody to act heroically based on being super revved up in their motivations. We’re simply enabling them to work a little harder and contribute a little more. That will naturally turn into a sense of satisfaction that really helps sustainability.

Dr. Jake Redden: What I always look for from a strategic impact is the production of improvement. We’ve got to measure the amount of work done towards making improvements, whether it’s the number of policies updated, daily process audits, kaizens, rapid process improvement events, standard working element or SOPs.

We’ve got to get our front line employees to first speak up for safety and then be involved in the production of improvements. That is where the real strategic impact is going to come from. We drive innovation with improvement productions in order to make our units in hospitals more efficient, safer and patient focused.

11. What can managers who want to address system issues do when they don’t feel executives are listening? 

Don Jarrell: If the CEO is not responding to input that they’re getting from managers, senior managers should be able to ask “Why don’t you think this is important?” Or phrased more positively, “What could we do to convince you that this is important? What change to the mechanics or the presentation of information or the flow of information could make you feel more engaged and like this was a higher priority?”

I don’t think there’s any way you can force somebody, but you can certainly dialogue with them to start off, just asking them the very simple why or why not questions, in a non-accusatory way, so that you can actually find out what the barrier is and how it can be addressed.

Dr. Jake Redden: The joke I use with my provider partners is the same joke I use for my executive team—you’ve got to tell them something three times before they’ve heard it once, and you’ve got to tell them three more times so they will think it was their idea.

What I always recommend people do is to make things visual for executive teams. They have a limited amount of time, so you’ve got to get in there and make the bad side of the information as visible as possible. Put it up there three different ways and continue to put it up there every single month in a unique, innovative way. Eventually they’re going to say, “You know what? We should do something about that.”

Again, you’ve got to be consistent. You’ve got to stick to it. If they don’t buy it the first time, you’ve got to subtly continue to sell that through frequency. You’ve got to make it visual until they finally admit there’s an issue, and then they’ll get involved with helping make that improvement.

12. Where can I get answers to my questions about performance improvement or healthcare quality?

Dr. Jake Redden: There are a ton of resources out there. Both Billie and I are big fans of the National Association for Healthcare Quality (NAHQ). If you look up what it takes to become certified in healthcare quality, they have an excellent reading list that they keep up-to-date. For patient safety, there’s the National Patient Safety Foundation, in association with the IHI.

It’s really tough being a quality leader in healthcare because there’s no quality school you can go to. I’ve seen hospitals that have just brought in lead engineers or improvement leaders from manufacturing and automotive. They don’t quite adapt to the culture, and they don’t develop the interpersonal relationships or adjust to the uniqueness of provider partners and our nurse leaders.

Of course, you can’t just bring in a nurse or a floor tech and expect them to have that kind of systems thinking ability or the 10,000 foot view of how we drive improvement for the long term through culture changes, either. You’ve got to find individuals who think differently and continually reinvest in those folks through seminars and classes

Billie Anne Schoppman: Drexel University has an online MSN degree in safety and risk management in healthcare, which is a great opportunity for learning. I think they’re going in the right direction and it’s good to see. You can also check out CPHQ and the CPHRM. They’re kind of separated, and I’d love to see them combined. It’s all about integrating it all together.

We are delighted that you have joined us for this series as we reviewed 12 important questions about Healthcare Innovation, Leadership and Action. Reach out to us via email or on social media if you have questions, comments or input on additional questions you think should be addressed.