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.
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.
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.
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.
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.
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.
A few weeks back we talked about how hand-hygiene can significantly decrease hospital-contracted infections, and by extension reduce healthcare organization costs — not to mention reduce unnecessary infection-related deaths. A new study out shows that hand washing frequency drops off near the end of healthcare professional worker’s shifts.
Led by Hengchen Dai, a Ph.D. candidate at the University of Pennsylvania, researchers analyzed three years of hand-washing data from more than 4,000 caregivers in 35 hospitals across the U.S. They discovered that hand-washing compliance rates plummeted an average of 8.7% by the end of a normal 12-hour shift.
Hospital-contracted infections account for nearly 100,000 deaths per year in the United States, making it a serious problem in need of attention. From December 2006 through December 2008, the Institute for Healthcare Improvement (IHI) initiated the 5 Million Lives Campaign with the aim of supporting the improving medical care, and significantly reducing levels of morbidity (illness or medical harm such as adverse drug events or surgical complications) and mortality.
Hospitals participating in the Campaign were asked to prevent 5 million incidents of medical harm over the two-year period. The IHI continues its efforts to reduce incidents of medical harm in the article What Zero Looks Like: Eliminating Hospital Acquired Infections.
There is no doubt that hospital-acquired infections are a serious issue. There are also large amounts of evidence that shows a few simple methods can significantly reduce their number.
The road to lower mortality rates, and reduced hospital costs, begins with establishing a commitment to a culture of quality. Then providing staff with the tools they need to easily record, measure and report their performance.
Few health stories in 2013 captured as much news coverage and attention than the launch of the Federal Health Exchange website and its rocky beginnings. Many were excited by the prospect of lower health insurance costs, promised by the administration, and flocked to the website to sign up. But, due to technical difficulties, hundreds of thousands of customers were left out in the cold and unable to enroll in coverage. Insurance companies reported very few applications received even months after the site’s launch.
By November, 2014, the problems that plagued the site earlier had seemed to be fixed with the officials announcing 100,000 application submissions on the first day of open enrollment. But, higher than expected premium cost and lower coverage for consumers — combined with complicated and costly systems for hospitals — highlights just how much further ‘Obamacare’ has to go before it will be seen as a success.
While Ebola didn’t start in 2014, it sure came on like a lion then. The Centers for Disease Control and Prevention reported that, as of January 6, 2015, a total of 21,007 cases were reported, and nearly 9,000 deaths were attributed to the disease.
The inevitable happened which captured headlines around the country, igniting a firestorm, sending people running for surgical masks and hazmat suites to protect themselves from the disease. But, was it much-ado-about-nothing? Within a few weeks, everything seemed back to normal again.
Enterovirus D68 (EV-D68) took the U.S. by surprise in 2014, with a confirmed total of 1,153 people within 49 states and the District of Columbia affected.
Amid the ongoing debate whether e-cigarettes are a less dangerous alternative to smoking, the use of these devices soared in 2014. A U.S. National Institutes of Health survey found that more than double number of 10th graders are likely to have tried e-cigarettes, to those who will have tried traditional cigarettes.
No matter where you land on the issue of healthy meals in public schools one thing is for sure, the kids weren’t happy in 2014. Championed by First Lady, Michelle Obama, federal regulations on what constitutes a healthy meal were met with opposition from the recipients of those lunches. Kids around the country took to social media, tweeting photos of their meals along with the trending hashtag #ThanksMichelleObama.
When most think about a patient seeking assisted suicide we picture a face of many more years than that of Brittany Maynard’s, an attractive 29-year old woman from California. Brittany suffered from cancer and moved to Oregon in 2014 to take advantage of the state’s “Death With Dignity Act” — at the same time capturing the nations attention to the serious subject of an individuals right to die.
A small but growing number of parents who have shun vaccinating their children, based on beliefs that vaccines cause conditions like Autism, are unwittingly playing a role in the resurgence of once-rare childhood diseases. In 2014, California suffered its worst outbreak of pertussis, also know as ‘whooping cough’, in 70 years. CDC statistics also show that U.S. measles cases have reached a 20-year high.
Although the legalization of marijuana in Washington state, Oregon, and Colorado was for recreational use, I have added it to this list for the social significance it points to. Namely, the changing tide in public sentiment toward pot and its use. Many states have already, up-till-now, had laws for its legal medical use. However, in many cases, the wider view of pot as a ‘bad thing’ stymied its spread as a potential option for those seeking a serious alternative to pharmaceuticals. This recent wave of states legalizing its use could signal a change in opinion, and open doors for patients looking for other options.
America, and the world, was shocked when it learned that one of its beloved stars had committed suicide. Robin Williams took his own life after years of struggling with depression. After his death, Williams’ wife revealed he had also recently been diagnosed with Parkinson’s disease, and an autopsy revealed his brain showed signs of Lewd Body Disease, a form of dementia that can cause hallucinations and concentration problems.
Although it’s not confirmed these conditions played a role in William’s suicide, his death has shed light on several frequently misdiagnosed or understood disorders.
Restaurants and concession stands must now post calorie counts on their menus. Under newly finalized FDA rules, chain restaurants, vending machines, and theatre and amusement park snacks must post their calorie counts. Personally, I don’t want to know my ‘elephant ear’ is 1,500 calories… I just want to shove it in my face while spinning 800 rpm’s on the tilt-a-whirl.
By first depositing living cells encapsulated in a hydrogel with a 3D printer, scientists at Weill Cornell Medical College were able to construct and grow the first artificial ears that look and act like real ones. Using human cells, specifically from the same patient, reduces any possibility of rejection.
Nurses once again topped the list of ‘professions with the highest ethical standards’ in Gallup’s 2014 survey on honesty and ethics. Way to go nurses… Whoop, whoop!
A North Carolina man became the first patient in state history to receive a “bionic eye”, Argus II retinal prostheses, allowing him to see light for the first time in 30 years. Then, in the later half of the year, a double arm amputee was fitted with robotic arms that he was able to control… wait for it, with his mind! How freakin’ cool is that?
I know you can relate to this situation. You’re walking through a parking lot when suddenly a car alarm starts going off and doesn’t stop, and (I’m willing to bet), you keep on walking without looking back. Sound familiar?
When car alarms first emerged back in the 80s they were few and far between. The ear splitting sounds of the alarms turned heads of onlookers, to what could be a serious situation in need of attention. It didn’t take too long, however, for us all to become desensitized to the familiar warbles and chirps, and we no longer paid any attention to them — defeating their purpose.
The same desensitization, or fatigue, happens with clinical alarms in hospitals. But, there are ways to help reduce alarm fatigue according to a study published in Pediatrics.
In the study researchers at Cincinnati Children’s Hospital Medical Center, led by Christopher Dandoy, M.D., of the hospital’s Cancer and Blood Diseases Institute, found that a standardized, team-based approach could dramatically reduce alarm fatigue — helping to eliminate the possibility of not responding to a true event.
The researchers created a standardized cardiac monitor care procedure for the hospital’s 24-bed pediatric bone marrow transplant unit.
As part of the project, Dandoy and his team developed a process for ordering monitor parameters according to age-appropriate standards, pain-free daily electrode replacement, personalized daily cardiac monitor parameter assessment and a reliable way of appropriately discontinuing monitors. Under these protocols, the median number of daily cardiac alarms fell from 180 to 40, while caregiver compliance increased from 38 percent to 95 percent.
“Cardiac monitors constitute the majority of alarms throughout the hospital,” Dandoy said in a hospital announcement. “We think our approach to reducing monitor alarms can serve as a model for other hospitals throughout the country.”
Fewer false alarms, he added, will allow hospital staff to devote more attention to significant alarms. Although the process was enacted in a pediatric unit, Dandoy and his team said it was applicable to “most units with cardiac monitor care.”
“Hospitals are greatly concerned about alarm fatigue because it interferes with patient safety, and it exposes patients–and the hospitals themselves–to grave harm,” said Michael Wong, executive director of the Physician-Patient Alliance for Health & Safety, who presented findings at the Society for Technology in Anesthesia, earlier this year that hospital staff are exposed to an average of 350 alarms per bed, per day based on a sample from an intensive care unit at the Johns Hopkins Hospital in Baltimore.
Cincinnati Children’s Hospital Medical Center says nationwide adoption could increase patient safety
You can read the full study here.
Researchers from Oregon Health & Science University and Kaiser Permanente Northwest’s Center for Health Research argue in an article published in the November/December issue of Annals of Family Medicine that Health Information Technology, in particular health records and health information exchange, can be a conduit for keeping patients insured — which can lead to higher percentages of scheduled visits.
“There is a significant business case for implementing health IT systems to help keep patients insured,” the authors say. “Patients who lose coverage are often unable to schedule visits, so they seek care outside of visits … in ways that are not commonly reimbursed.”
One way to help keep patients insured is by sending them a simple reminder of their policy renewal dates.
“A good starting place is the data already being collected and/or automatically imported,” the researchers say. “[Patient-centered medical homes] could work with their healthcare systems and/or EHR vendors to create or enhance electronic interfaces with insurance plans, populating EHR fields with more detailed information about patients’ health insurance coverage status.”
The full article can be found here.