Category Archives for Patient Safety
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.
- 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.
- 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.
- 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.
- 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.
- 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:
- When management are clear and active advocates of quality, teamwork is fostered.
- When teamwork increases within and across units, there is more open and transparent communication.
- When there is more open communication, learning and continuous improvement is enhanced.
- 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.)
Top Healthcare Quality Issues of 2015
Source: HealthLeadersMedia.com
Six quality issues warrant the attention of healthcare leaders: misdiagnoses, star ratings, socioeconomic adjustment for readmissions, the end of Partnership for Patients programs, Medicaid parity expiration, and Disproportionate Share Hospital cuts.
Healthcare has experienced fascinating changes during the last few years, and 2015 will be no exception.
Major programs stemming from the Patient Protection and Affordable Care Act are well under way, dozens of new quality measures and data galore are flowing into the public domain, and quality of care remains in the spotlight for providers at all levels.
There are sure to be tweaks, especially where measures and performance commingle to affect payment. But here are six quality issues that warrant your attention in 2015.
1) Measuring misdiagnosis
If physicians’ diagnostic accuracy were like air travel, one in 20 planes would not land when or where it should, and one in 40 flights would put passengers at risk of significant harm, or even crash.
Those are estimations from an April 2014 report from Houston Veterans Affairs and Baylor College of Medicine researcher Hardeep Singh, MD, and colleagues who say that 12 million U.S. outpatient adults may be given incorrect or delayed diagnoses every year.
Singh says reducing misdiagnosis must be a major quality focus for 2015 because providers and patients should not tolerate error rates this high.
Singh’s report in BMJ Quality & Safety estimated that 5.08% of outpatients receive an inaccurate diagnosis, and that half of those errors have the potential to cause severe patient harm, such as a missed opportunity to treat cancer at an earlier, easier stage. These misdiagnoses can result in avoidable or extended hospitalizations or even death.
Though misdiagnoses may be a patient safety issue on a par with medication errors or infections, providers don’t measure or track them. It can be hard to assign blame: sometimes patients don’t know or fail to reveal relevant details. But sometimes the fault is the provider’s, for failing to take an adequate history or conduct a proper physical exam.
…Story continued on original site.
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How would you like your hospital to have a ‘Culture of Quality’?
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U.S. Boosts New Ebola Drug
The U.S. government says it will help develop a new Ebola drug — one of five drugs that are being tested against the deadly virus. This one’s made by North Carolina-based BioCryst Pharmaceuticals.
“BioCryst’s drug, BCX4430, is a small molecule that prevents the Ebola virus from reproducing in the body,” the Health and Human Services Department said in a statement. “Small molecule” means it can be taken as a pill.
“In non-human primate studies, the drug was effective against Ebola virus and Marburg virus, another virus in the filovirus family, indicating that BCX4430 may be useful as a broad spectrum antiviral drug.”
It’s being developed alongside ZMapp, Mapp Biopharmaceuticals’ antibody-based treatment; Canadian company Tekmira’s drug that interferes with genetic material; an antiviral called favipiravir and blood-based treatments using plasma from Ebola survivors.
Makers of a pill called brincidofovir have stopped testing it.
“We are making progress quickly to develop product candidates for clinical evaluation and to make products available that protect against this virus,” said Robin Robinson, who directs HHS’s Biomedical Advanced Research and Development Authority.
More than 25,000 people have been infected with Ebola, according to the latest report from the World Health Organization, and more than 10,000 deaths have been recorded, although at least half and likely more of the patients have died, WHO says.
Officials say as long as Ebola is circulating, people can bring it to the United States. An American with Ebola is listed in fair condition at the U.S. National Institutes of Health. That patient and another 16 Americans were evacuated from Sierra Leone earlier this month.
On Tuesday, the University of Nebraska said five of the people quarantined there have been released after showing no signs of Ebola for 21 days.
…Story Continued On Original Site
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How would you like your hospital to have a ‘Culture of Quality’?
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How Cloud Computing Enables Interoperability
CMS has signaled a renewed focus on interoperability, a welcome development for healthcare professionals anxious to more easily exchange insightful data. But there’s still the matter of how well the people involved in various collaborative “Big Data in Healthcare” initiatives operate together.
At some point for most of us in our careers – usually early on – we’ve encountered a project that was initially heralded with a great deal of fanfare, only to ultimately fizzle out after failing to gain enough buy-in. For all the excitement surrounding Big Data projects, many are at similar risk of a premature end if stakeholder concerns aren’t addressed at the outset:
- Who will host the data?
- How will data privacy concerns be handled?
- How have restrictions on data use been addressed?
- Do existing consents allow for data sharing?
- Will the data need to be de-identified? If so, using which methodology?
- Who will be responsible for acquiring, maintaining and distributing it?
- How will the data be protected as it’s routed to its new home?
- How well will it be protected in its new home? Who will have access to it?
For this to work, a neutral ground is usually needed, offered by a trusted third party.
The cloud: breaking down barriers to data exchange
In healthcare, massive amounts of data are not stored in pre-defined, structured tables. Instead, they are often composed of text, notes, numbers, images, formulas, dates, and other facts that are inherently unstructured. In fact, certain kinds of data sources are being created so quickly that there is no time to store it before the need to analyze it.
Savvy healthcare executives see Big Data as an opportunity to break down the paradigm of siloed data. They know that isolated data can be inefficient. Yet even while supporting the vision of Big Data, many healthcare leaders are traditionally reluctant to share data outside their own firewalls. Due to competitive considerations and confidentiality risks, there must be a level of trust in the quality and security of the receiving organization’s health data management systems for the data owner to be willing to share it. No one wants to risk a HIPAA privacy or security violation at the hands of another entity.
‘Dirty’ data can yield hidden treasures
To make an effective Big Data play, data sharing arrangements must be made, data flows defined, data analytics engines and the underlying infrastructure created, and the proper data governance must be agreed upon by all relevant stakeholders. It is at this stage that a trusted third party data warehouse environment is critical for success.
…Story Continued On Original Site
Looking for ways to make your Risk/Quality Management job easier?
How would you like your hospital to have a ‘Culture of Quality’?
Save up to 30% on your RM/QI & PI programs.