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August 2013 Archive for High Reliability Healthcare

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Observations and Lessons Learned on the Journey to High Reliability Health Care.

OPPE and FPPE: Tools to help make privileging decisions

Aug 21, 2013 | Comments (1) | 92691 Views

By Robert A. Wise, M.D.
Medical Advisor
The Joint Commission

Since the continuation of clinicians’ privileges at a hospital hinges on the quality and safety of care delivered to patients, the review of privileges is a critical – and sensitive – process. This responsibility falls on the medical staff, which monitors the performance of all practitioners who are granted privileges and makes recommendations to the governing body of the hospital concerning which medical staff members should receive new or maintain existing privileges. 

In order to make the decision of privileging more objective and continuous, in 2007 The Joint Commission introduced its Ongoing Professional Practice Evaluation (OPPE) and Focused Professional Practice Evaluation (FPPE) processes. These tools were created to work together to help determine if the care delivered by a practitioner falls below an acceptable level of performance. It is important to note that neither tool on its own is capable of making an adequate assessment, but instead it is the thoughtful and judicious use of both that is required. The following is an explanation of these two tools.

  • OPPE is a screening tool to evaluate all practitioners who have been granted privileges and to identify those clinicians who might be delivering an unacceptable quality of care. It is important to emphasize that OPPE is not designed to identify clinicians who are delivering good or excellent care. Therefore, the criteria used for OPPE may also identify some clinicians who have no quality of care issues (i.e., identification of situations that turn out to be false positives). As with all screening tests, a positive finding must be followed up with a more specific diagnostic test, one that should have high specificity for poor care.
  • FPPE is the follow up process to determine the validity of any positives (whether true or false) found through OPPE. This process is applied only to the small number of clinicians who were identified by OPPE.

Since the outcome of the FPPE is so important, the review, decision and follow-up process developed by the hospital – usually at the department level – must be objective and capable of accurately determining when a clinician’s performance is falling below an acceptable norm. To accomplish this goal, it is important that a thorough and thoughtful process be developed by each department with substantial input from peers.  

Effective communication: A physician competency and responsibility

Aug 07, 2013 | Comments (0) | 21664 Views

Schyve 11 10By Paul M. Schyve, M.D.
Senior Advisor
The Joint Commission

Information. It may be the core of our practice as physicians. We gather the latest information about the science of disease and of health care. We gather information from our patients – and often from their families – about their signs and symptoms, their health history, their medications and other treatments. And we gather more information from their laboratory tests and imaging, and from the observations of other members of our treatment team.

As physicians, we synthesize and analyze this information and then disseminate it to the treatment team. Unfortunately, failures in effectively communicating information among the health care team are a common cause of errors that lead to patient harm. To prevent these errors, health care organizations and our physician practices have learned to standardize both nomenclature and communication processes and procedures (e.g., using checklists) when communicating information, including when patients transition from one physician or treatment team to another, from one care unit to another, and from one health care organization to another.

But in one situation, too much “standardization” can create errors: when we communicate information to patients and their families. These errors can result when there are barriers to effective communication, such as patients who speak different languages, have different cultural beliefs, or hide poor literacy skills. We worry that our patients don’t follow our advice. But how often do they want to follow our advice, but cannot because they don’t understand it? This is not their fault – but it is our responsibility to overcome these barriers if we are to be their physicians who “first do no harm.” When we fail to successfully address barriers to effective communication, not only can each individual patient be harmed, but in aggregate, we generate health disparities among our patients, related to cultural, ethnic, and racial differences, language differences, and literacy levels. When it comes to communicating effectively with our patients and their families, “one size does not fit all.”

Effectively communicating is a significant responsibility of a competent physician. Both the American Board of Medical Specialties and the Accreditation Council for Graduate Medical Education identify six general competencies that physicians should have, including interpersonal and communication skills, defined as “skills that result in effective information exchange and teaming with patients, their families, and other health professionals.”

At The Joint Commission, we recognize the crucial role effective communication plays in the quality and safety of the care that health care organizations and physicians provide to their patients. We have worked with experts in the field of communication and with health care organizations that have faced the challenge of literacy, language, cultural, racial, and ethnic barriers to effective communication, and have identified solutions that work with their patient populations. Based on the science and experience learned from these sources, and with the assistance of a panel of national experts, The Joint Commission has prepared two free guides:

The principles and many of the practical methods included in these guides can be utilized in a physician’s practice. I hope that you will find among them ideas that can help you in your practice to more effectively communicate with your patients – and to better protect them from inadvertent harm.