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February 2014 Archive for High Reliability Healthcare

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

In pursuit of high reliability

Feb 26, 2014 | Comments (0) | 18283 Views

By Anne Marie Benedicto
Executive Vice President, Support Operations, and Chief of Staff
The Joint Commission

The Joint Commission believes that the large-scale transformation of health care to a high-reliability industry is necessary to ensure that health care is consistently excellent and consistently safe. In a recent Milbank Quarterly article, Joint Commission President Dr. Mark Chassin and the late Dr. Jerod Loeb describe a model for high-reliability health care that incorporates the interrelated components of leadership, safety culture and Robust Process Improvement (RPI)®. 

You may not be familiar with that last term.  Robust Process Improvement or RPI® is a systematic, data-driven methodology that incorporates Lean Six Sigma and formal change management.  It is the Joint Commission’s performance improvement methodology.  From my perspective, the deployment of RPI tools and methods is an effective way to begin the transformation.

In April 2008, The Joint Commission embarked on a long-term, corporate-wide initiative to dramatically improve the efficiency of its internal operations, increase customer satisfaction and increase the quality of its products and services. This was initiated through the adoption of process improvement tools and methods – such as Lean Six Sigma, and change management – used successfully in health care and in other industries to achieve dramatic breakthroughs in quality and safety. We call this initiative Robust Process Improvement.

The Joint Commission uses RPI internally to increase our capacity for improvement. A central feature of the initiative is an aggressive training program that features classroom learning coupled with practical application of the RPI tool set to address our organization’s most important challenges and goals.

After almost six years, approximately 40 percent of employees have some level of formal RPI training. RPI-trained employees lead or participate in improvement projects that have touched all areas of The Joint Commission, leading to growth, a stronger core business and processes, and greater customer satisfaction. RPI-trained improvement experts at the Joint Commission Center for Transforming Healthcare use RPI methodology to find solutions to some of health care’s toughest problems, such as health care-acquired infections and wrong-site surgeries. The efficiencies gained through RPI allow us to focus our resources to help our customers provide the best and safest health care for their patients. While high reliability continues to be a long-term goal within The Joint Commission, the impact of RPI as a force for positive change is undeniable.

While a hospital’s deployment of RPI will have differences from the program created at The Joint Commission, comparing notes with our RPI-trained colleagues who work in health care organizations has shown us that many of the benefits are the same: The creation of an empowered work force that looks for opportunities for improvement and has the skills to address the opportunities they find.

RPI is ultimately about the people in an organization. If culture is about beliefs and behavior, then RPI can have a transformative effect on organizational culture by providing a common language, methodology and expectations for quality and improvement.

The journey to high reliability is likely to be a long one.  It will also be rewarding and transformative. RPI can help you get there.


Help your medical staff shine during survey

Feb 19, 2014 | Comments (0) | 23124 Views

By Anne C. Bauer, M.D.
Field Director, Accreditation and Certification Operations

Anne_BauerIt was always easy to tell the medical staffs that were prepared.

As a hospital physician surveyor for a number of years before becoming a field director, I had the opportunity to observe and interact with medical staffs from all kinds of hospitals.  During that time, I noticed a simple trend – organizations that took time to prepare their physicians for their on-site surveys had better experiences.
Physicians want the opportunities to shine and be credited for their excellent work.  They don’t want to be put on the spot, not knowing what is being asked of them.  Frankly, that is not what the physician surveyor is looking for either.  Preparing the medical staff for the activities of the survey and when they are likely to encounter the surveyors tends to prevent awkward and “defensive” encounters.

It’s true that this survey is unannounced, but the accreditation coordinator will usually alert the hospital staff as to the “window” in which the next full survey is likely to take place. This is a prime opportunity to schedule some time for multiple short discussions with the medical staff.

Here’s how to make your medical staff look their best come survey time:

  • During the opening meeting, make sure the staff has prepared a brief overview of their work, including challenges they has tackled, such as patient flow issues in the ED, infection rates or improved hand-off communications. This shows a hospital that is proactive in dealing with the challenges all hospitals face.

  • For the session on the hospital’s medication management system, members of the Pharmacy and Therapeutics Committee should be prepared to talk about their analysis and response to medication variance and adverse reaction data.  This is an area that medical staffs know a great deal about, so being prepared allows them to show off their knowledge.

  • Concerning the maintenance of credentialing and privileging and how they are “overseeing” care at your hospital, the surveyor will want to know how the staff is monitoring the quality of history and physical exams.  The surveyor will also want to understand the staff’s system for Ongoing Professional Practice Evaluation (OPPE) and Focused Professional Practice Evaluation (FPPE).  Making sure everyone knows what these acronyms stand for is a good first step.  Even better, medical staff members should be actively involved in discussion of what quality indicators are being used to evaluate their care of patients.

  • Alert the medical staff that they may be asked to talk about how aspects of care are provided on their service, such as how treatment went in a specific case. Also, stress that this doesn’t mean the surveyor has found a “problem.”  More often, it means that the surveyor is trying to understand this service’s particular approach when they are tracing patient care on the units.

  • Finally, on the last day of the survey there will be a leadership session. This is an open discussion; one in which the medical staff should actively participate to showcase performance improvement projects they have undertaken and their engagement in the hospital. Topics include strengths and weaknesses identified during the survey or “big topics,” such as how organizations achieve high reliability in health care or are anticipating health care reform.

Physicians want to shine and to be credited for their excellent work – the on-site survey presents the perfect opportunity to do just that!


Using OPPE as a performance improvement tool

Feb 05, 2014 | Comments (0) | 42848 Views

By Paul Ziaya, M.D., Field Director, The Joint Commission

blog-PZiaya1Processes for Ongoing Professional Practice Evaluation (OPPE) and Focused Professional Practice Evaluation (FPPE) offer valuable tools that medical staffs can use to determine if care provided by a practitioner is below an acceptable level. The ongoing monitoring process significantly contributes to:

  • evaluation and decision making on the maintenance or alteration of privileges

  • the early identification of trends

  • any needed proactive education and collegial intervention.

However, OPPE can also be used as a tool for performance improvement to avoid adverse outcomes, not just react to them. Ultimately, the value of OPPE depends on:

  • the measures selected by the medical staff

  • how well those measures represent activities that reflect the quality of care and performance

  • how effectively the resulting information is used.

For instance, looking at postoperative infection rates can result in an evaluation of practices and the potential prevention of future infections. 

Organizations that have been able to collect meaningful data in an ongoing way, and provide that data to individual practitioners (particularly if accompanied by peer or benchmark data) have found that practitioners become actively engaged both in validating the data and in self-evaluation and modifications in practice. Some organizations that provide ongoing computerized access to data have found that practitioners will look at their own data even before the semi-annual review and proactively implement changes to their practices. 

Vital to success of the OPPE as an improvement tool is the use of measures that departments agree are valuable. In an effort to drive improvement, some creative departments have selected one or two metrics that reflect areas that they are finding challenging, such as consistent use of an agreed-upon clinical practice guideline or protocol.

Most practitioners will make the changes needed when presented with data showing they are not performing to the same level as their peers. However, there will be those who, despite the data, will not take the appropriate action. For these individuals, the OPPE and FPPE processes provide documentation and powerful tools for making necessary privileging decisions. In the end, professional practice evaluation will be as valuable as each medical staff makes it.