For a long time, Quality and Safety Event reporting have been recognized as important but often downplayed tasks when it came to getting the attention of executives and allocating resources. Shifting investments and allocating resources has become even more of a challenge as budgets continue to get tighter and tighter.
Quality-related reimbursement, as applied through Value-Based Purchasing (VBP), MACRO/MIPS, ACO programs and other components in the pay-for performance (P4P) model, have only increased the pressure without providing much guidance on how to actually improve quality.
Although the goal of submitting quality and safety reports and data to external organizations is becoming something more than just checking a “to-do” item off the list, much of the reporting and education efforts in hospitals and other healthcare organizations fall short of making real advancements in Performance Improvement.
The ROI that can perk up executives’ attention and guide their investment is to make Performance Improvement more effective and efficient. While Performance Improvement has been a focus for decades, most organizations focus on the wrong things, such as manually gathering information and data and over-educating staff on the theories and science of QI methodologies. Others are still wasting their time with more meetings, more documents and artifacts and more working overhead.
Worse still, all of these efforts suffer negligible support from innovative IT solutions that are specifically designed to support more efficient and effective Performance Improvement. This is the year, maybe even the quarter, to change that.
Start from the Top
Championing the shift from investing in reporting to investing in the Performance Improvement process itself has to come from the top. Senior management up to the C-suite needs to not only lead, inspire and set the direction, but also provide the resources and fully communicate the importance of creating a smarter and more efficient Performance Improvement process.
Instead of merely asking staff and managers to just “work harder and better,” the goal needs to be about making their job easier and more streamlined.
7 Steps to Better Performance Improvement
An efficient Performance Improvement system needs to be supported by innovative and intuitive IT and can be achieved by taking the following steps.
Improving ROI with Technology
Each of these steps has the potential to be a project in its own right and a daunting task at that. Fortunately, a growing awareness of how Performance Improvement and Quality and Safety reporting can feed one another is prompting a shift in technologies and platforms to support this new focus.
ActionCue CI was built intentionally to increase ROI by changing how Performance Improvement is managed and facilitated using the steps outlined above. Learn more about how ActionCue can help executives, risk/quality managers and clinical staff bring Performance Improvement into the 21st century.
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.
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.
Researchers at Los Alamos National Laboratory in New Mexico say that tracking Wikipedia page views can forecast the spread of influenza and dengue fever.
The researchers claim their algorithm allows them to overcome the challenges that hamper the reliability of other similar data surveillance methods based on Internet information.
Google Flu Trends, is a web service operated by Google, which provides estimates of influenza activity by aggregating Google search queries. But, early last year it was reported that they drastically overestimated peak flu levels, casting some doubt on the search giant’s ability to predict flu trends.
“Using simple statistical techniques, our proof-of-concept experiments suggest that these data are effective for predicting the present, as well as forecasting up to the 28-day limit of our tests,” the Los Alamos researchers say. “Our results also suggest that these models can be used even in places with no official data upon which to build models.
Though there are still detractors to the notion of using such systems to predict disease outbreaks, it is no doubt amazing to witness the many uses to which the growing volumes of meta data available on the internet will be used.
Read the full report here.