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Quality, Reliability & Leadership

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Knowledge and support for health care leaders working for high reliability, quality and patient safety in all areas of health care.

NOTE: Industry leaders are encouraged to submit guest blogs for the Leadership blog. Those interested should contact Social Media Specialist Robin Hocevar.

How Engaged is Your Board?

Mar 03, 2017 | Comments (0) | 1795 Views

By Ann Scott Blouin, RN, PhD, FACHE
Executive Vice President
Customer Relations
The Joint Commission

Gone are the days when membership on a board of directors meant just casting a few votes at a quarterly meeting. Modern boards of directors are truly partners with the leadership team at hospitals.

Despite general consensus that board members retain responsibility for quality, safety and the financial security of organizations, it can be difficult for board members—especially those newly appointed—to understand how they can best contribute.

To that end, The Joint Commission has released the 3rd edition of Getting the Board on Board: What Your Board Needs to Know About Quality and Patient Safety. This publication is written for both board members and executive audiences, offering the patient safety and quality focus that’s often lacking at new board member orientation.

Challenges to Board Engagement
No executive ever sets out to isolate the board of directors; people volunteer their time on a board to make a difference in a cause that’s important to them. Still, a disconnect somewhere along the line is common.

On the part of the health care organization, senior leadership often hesitates to share their problems with the board. Meeting agenda items rarely outline quality and safety problems, with senior leaders often uncomfortable to share patient stories and challenges.

Lacking this guidance, board members don’t always understand that their fiduciary responsibility includes more than just financial guidance. They may not know that their role is broader and, perhaps  are unaware of what reports on quality and safety are reasonable to expect from senior leaders.

Board Structure
Emphasizing quality and safety is often a simple matter of constructing (or re-constructing) the board agenda and supporting materials. It’s far less complicated than it sounds.

The board should always receive a quality and safety report at the meeting. It’s best if this is presented before the very end of the meeting when time’s running out. 

Some organizations allow patients and their families to share their hospital experience—both good and bad—at board meetings.

It’s a real asset to have a dedicated board committee focusing on quality and safety matters, including:

  • Serious safety events review
  • Risk management trends and patterns
  • Impact upon quality and safety issues due to staffing and other challenges

The Right Questions
Opening a dialogue with senior leaders will go a long way toward closing the communication gap. In the book, an entire section is dedicated to questions board leaders can pose to senior leaders and staff.

Recommended conversation starters include:

  • What is the most important indicator of quality we are tracking?
  • Have there been any serious safety events this month? What type? Where did they occur? What did the root causes show? How do we prevent that from happening again? How does this benchmark with other organizations like us?
  • I’ve heard about high reliability; what are we doing to get to move the needle toward zero harm?

Measuring Goals
Another excellent, ongoing discussion topic is how hospitals are measuring improvements on safety risks; the approaches are guaranteed to be varied.

Most organizations use a dashboard with Hospital Acquired Conditions, Core Measures and Serious Safety Event Rate included. Those that create visual bar graphs, line graphs, and other graphics can help make it easier for the board to understand and ask questions.

There are plenty more nuggets of information in “Getting the Board on Board: What Your Board Needs to Know about Quality and Patient Safety”. Order your copy today and start maximizing your board/leader efficiency.

What We Have Hereā€¦ Is a Failure to Communicate

Jan 26, 2017 | Comments (0) | 3416 Views

By Emily Aaronson, MD
Harvard Medical School
Fellowship in Patient Safety and Quality Improvement
Massachusetts General Hospital

Despite the growing emphasis on “patient-centered care,” patient safety lapses attributed to poor communication are still commonplace. Noting this, during my fellowship at The Joint Commission, we developed a Quick Safety framework on this important issue. It’s important to reflect on some of the contributing factors and key drivers to change.

Over the last decade, major communications improvements have been achieved during transitions of care and for patient populations with unique communication needs. Despite that, there is more to be done. Specifically, a focus on all provider-patient encounters.

There are some key components of effective patient-provider communication that should be a part of every encounter:

  • Clear expectation setting
  • A patient-centered approach to communication that ensures patients play an active role in the dialogue and that their values are incorporated into decision making
  • Expressions of empathy
  • A focus on clear information exchange and patient education that promotes the understanding and retention of key information

Issue Rooted in Medical Education
Certainly, no doctor sets out with intentions of leaving patients confused or unengaged in their care.  However, in speaking to patients, that is often what happens.

While we once considered communication a “soft skill” that was innate for clinicians, the literature is now suggesting otherwise. Instead, it is now understood that this is a highly trainable, essential “non technical” skill—a skill in which all providers should be trained in and have to demonstrate competency. Given the demonstrated link between poor communication and poor patient outcomes, communication should be considered a core competency.

Modern medical education incorporates some training on empathy and communications skills, but older doctors weren’t required to take these courses. Even for those who have been exposed to these communication curriculums, there’s still an opportunity for more learning surrounding communication. Although there are increasingly “alternative” modules in medical and nursing schools that often bundle ethics, empathy, communication and emotional skills in medical practice, there is rarely a comprehensive, systematic training in communication. As a result, providers may start their careers both without strong skills in this domain, and without understanding its importance.

High-Level Leadership Support
Like anything else, effective patient-provider communication within an organization needs management’s endorsement to get off the ground.

In addition to embracing an attitudinal shift that communication is not second-tier training nor inherent in an individual’s disposition, there are some concrete steps leadership can take to improve communication, including:

  • Conducting an internal assessment of your organization’s current communication training programs and explicit institutional focus on the value of patient-provider communication
  • Measuring clinicians’ communication-focused skills using, for example, patient experience and scores related to communication competency. This information can also be used as a basis for determining goals to improve performance.
  • Carving out protected, compensated time for training
  • Incentivizing staff on metrics related to provider-patient communication
  • Providing coaching for caregivers who are struggling to achieve competency
  • Perhaps most important: Speaking openly at the highest levels of leadership about the importance of communication

Patient Activation Strategies
No discussion of patient-provider communication can be complete without mentioning patient activation, which has been proven to enhance communication. More activated patients are more likely to:

  • Follow their provider’s recommendations
  • Experience better outcomes
  • Avoid unnecessary readmission

While the health and communication status of the patient usually drives the outcome improvement, it’s important to note that misdiagnoses and medications errors do occur as a result of communication breakdowns, even when the patient doesn’t have a verbal limitation.

Logically, strategies to improve engagement is a three-step process:

1. Understand the type of support your patient population needs
2. Provide it
3. Measure the results.

It’s critical that staff members fully commit to patient activation and are trained in communication skills that allow active patients to maximally participate. What we don’t want is a dichotomy between the organization’s strategy to activate patients and the front-line providers’ skills in cultivating a truly shared-care model. 

Lastly, don’t lose sight of equity in this work. This links to the measurement piece. Being sure that you understand which patient populations are using the resources provided (and which aren’t), and measuring these different populations’ overall degree of activation, ensures that we are not inadvertently creating larger disparities in care. For those groups we are not reaching, we need to think more creatively about their individual needs.

Let’s share successes. What’s worked for you in activating patients in their care?

Innovative Ways to Eliminate Health Disparities

Jan 06, 2017 | Comments (0) | 3979 Views

By Ana McKee
Executive Vice President and Chief Medical Officer

Though The Joint Commission has been leading health equity initiatives since 2002, we recognize that the real work is done by the healthcare organizations we accredit.

Health Equity ForumLast fall, we co-hosted an inaugural Health Equity Forum along with the American Hospital Association, to spark discussion about efforts several health care systems and health care professional organizations to reduce health disparities. The Joint Commission also partnered with the American Hospital Association as a supporter in the 1-2-3 for Health Equity campaign. In hosting the forum, we aimed to encourage hospitals to continue in this important endeavor. A number of health systems and organizations are making great strides in addressing equity:

  • View and purchase the moduleAmerica’s Essential Hospitals cultivated the nation’s first online module to collect race data that aligns with Joint Commission, Office of Management and Budget and meaningful use requirements. The REAL (Race, Ethnicity and Language) training module is an online course for registration staff to identify and resolve disparities.

  • Kaiser Permanente developed a holistic care coordination program that encompasses phone assessments, references to relevant community agencies and home visits. It was also lauded for eliminating disparities in cardiac risk and diabetes mellitus among black and white seniors.

  • Henry Ford Health System created a three-year campaign to address sources of inequity, which includes raising awareness and implementing tools to facilitate cross-cultural communication. Its blueprint for the Center for Health Equity includes:

    • Culturally competent care

    • language access

    • health literacy.

Henry Ford’s Kimberlydawn Wisdom, chief wellness and diversity officer, said monitoring national trends and best practices played a huge role in the creation of its Center for Health Equity. Data is a significant component as well and Henry Ford conducts needs assessments and fills its own gaps.

Sometimes, though, it’s the simple courtesies that go a long way toward eliminating disparities.
Henry Ford Health System also recognizes the importance of asking patients:

  • What is your race?

  • What is your ethnicity?

  • What is your preferred language?

Just the few extra minutes to ask and document the answers to those questions help the facility use appropriate interpretation services and patient education information, and better track data. The facility created a patient information document on the importance of these simple questions and Wisdom justified the rationale: We ask because we care.

  • The Detroit Regional Infant Mortality Reduction Program, composed of Detroit Medical Center, Henry Ford Health System, St. John Providence Health System, and Oakwood Healthcare System, formed Women-Inspired Neighborhood Network. The idea was to provide the social support to help support infant survival.

  • The Institute for Healthcare Improvement (IHI) implemented a strategic plan to incorporate quality improvement into all of its activities.

The Joint Commission’s Equity Endeavors

We at The Joint Commission are so proud of the hospitals that contributed to our Health Equity Forum and others working towards eliminating health disparities every day. Beyond supporting their mission, we are working toward the same goal.

As I mentioned, The Joint Commission began addressing disparities nearly 15 years ago. Like you, our projects have been too numerous to list but highlights include advancing patient- and family-centered care for the LGBT patient, improving linguistic services and so much more. David Baker, MD, executive vice president of healthcare quality evaluation at The Joint Commission, noted 30 years of Joint Commission research on pain control disparities.

Our full record of health equity resources are available anytime.

Staff Diversity

Bruce Siegel, MD, MPH, president and CEO of America’s Essential Hospitals organization, also observed the importance of staff—and board members—being as diverse as the communities we represent. Navicent Health promotes this philosophy by including a bonus for search firms who recruit minority candidates. Navicent also re-purposed its human resources department into a coaching department to promote integration.

Nationally, we expect discussion surrounding health equity to intensify and that’s natural. As the U.S. transitions to a new administration, the debate over reimbursement will likely gain steam and it’s important not to ignore any implications that could adversely affect health equity. One pertinent example is the Medicaid debate. At the Health Equity Forum, Sarita Mohanty, MD, executive director community-clinical care integration of Kaiser Permanente, said it’s important to support Medicaid for continuity of coverage.

With the coming of a new year, a new president and expectations of an unprecedented amount  of change,  it is important to continue to reduce disparities in health care. Disparities lead to unsafe care and unfavorable outcomes. There is no one solution for this complex problem and that is why it is critical for healthcare organizations to continue implementing strategies to reduce disparities and share their learnings with others. What is your organization doing to promote health equity?

Teaming Up Against Workplace Violence

Oct 19, 2016 | Comments (0) | 4797 Views

By Ann Scott Blouin, RN, PhD, FACHE
Executive Vice President of Customer Relations

It’s a sad reality that Americans are growing accustomed to encountering violence on the highway, at movie theaters and in schools.

Increasingly health care staff are becoming victims and observers of this growing problem while they’re working.

The Joint Commission just launched a workplace violence prevention portal to support health care organizations in preventing, preparing for and mitigating the impact of workplace violence. The violent situations occurring across our country spill over into our emergency departments (EDs), behavioral health settings and elsewhere. In a matter of seconds, your patients, staff and visitors can become victims in these frightening and often devastating situations.

In seeking submissions from colleagues and professional associations on addressing violence in healthcare settings, we wanted to provide a compendium of resources through our new portal for easy reference on this somber topic.

Nurses, Nursing Assistants at Increased Risk

Though violent incidents can affect everyone from the chair of surgery to a patient’s visiting grandmother, the nursing profession encounters these frightening situations most frequently. Alarmingly, 80% of nurses don’t feel safe in their workplace, according to a 2009 study (Peek-Asa et al, 2009)

Even when injuries aren’t fatal or very serious, these incidents can exacerbate the nursing shortage because the result can be early retirement, disability or, at the very least, missed work days.

The health care environment, especially hospitals, actually present  a risk factor. The public moves relatively unrestricted in the hospital, especially the ED. Hospitals are becoming popular “criminal hold” locations and may be targeted because of the perceived availability of drugs or money.

Code Silver

Whether urban or rural, the sad reality is that the possibility of an active shooter in the hospital is becoming more common.  Between 2010 and 2014, The Joint Commission received reports of 19 shootings in our accredited healthcare settings, resulting in 27 fatalities. It is unclear whether   those numbers are going to decrease anytime soon.

Health care organizations s have risen to the occasion and created crisis prevention and management plans. These days, it’s a must to incorporate active shooter incident planning into health care facility emergency operations plans.

Active shooter drills dominate association conferences in every specialty. In 2015, the Emergency Nurses Association orchestrated a surprise mass casualty drill (Note: This is a link to YouTube) at its annual conference. Sadly, a few attendees tested their skills several months later while treating victims of the Pulse nightclub shooting in Orlando.

Many organizations’  innovative practices and protocols can be found in our new online resource center for addressing workplace violence; however there’s no “one-size-fits-all” solution.

What we have learned is that the answer is far more complicated than just “call security.” In fact over the past 11 years of data, we’ve learned that 23% of hospital shootings (frequently in the ED) involved the perpetrator taking a security or police officer’s gun, according to internal data from The Joint Commission’s Office of Quality and Patient Safety.

Need for Collaboration

Realizing that we’re all accountable for managing—ideally, preventing—instances of workplace violence from occurring is truly the first step.

This collaboration may save our lives and those of our patients and colleagues. Please take the time to review materials from government agencies like OSHA and the  FBI, state health departments, and professional  associations like the American Nurses Association and the American Society for Healthcare Risk Management, all featured on our web resource center.

We recognize that workplace violence doesn’t occur only in the acute care setting. The Joint Commission’s workplace violence prevention resource center is very much a work in progress. We would appreciate learning  about your experiences in home care, behavioral health, nursing care centers/long term care  and  ambulatory care. Please share your ‘lessons learned’ and,   importantly, your suggested strategies for preventing future incidents.

Please submit your innovative practices to curtail workplace violence to Wpv_info@jointcommission.org

One Index to Rule Them All

Jun 07, 2016 | Comments (0) | 3389 Views

By Ann Scott Blouin, RN, PhD, FACHE
Executive Vice President of Customer Relations

We have thousands of web pages, periodical articles, books, monographs, videos, webinars, podcasts, lessons, etc. You name it, we have it. Only problem is, how do you search through it? 

Now we have an answer.  We are very pleased to announce an important and useful new resource: The Joint Commission Enterprise Content Library Index (ECL Index). 

The ECL Index is a list of Joint Commission Enterprise resources organized into 20 topics, such as Emergency Management, Infection Control, Patient Safety and High Reliability. The mission behind creating the ECL Index is to help our customers — and everyone taking the journey toward high reliability —by giving them one convenient, single source of Joint Commission Enterprise content. 

The ECL Index – which is in PDF format and will be updated on a quarterly basis –includes all clinical settings, with each resource alphabetically listed in its appropriate topic. Most of the resources are free and accessible to all, though some are only complimentary to customers or fee-based. The ECL Index also contains information like applicable settings (e.g. ambulatory), year published, and identifiers for ordering or referencing, as well as the location and links to the source where applicable.

You can find the ECL Index located on the Joint Commission website under Topics – Quick Links or here. We hope you will find the index useful within your healthcare setting. For questions about the ECL Index, please contact Customer Relations at customerrelations@jointcommission.org