Sociotechnical Aspects: Clinicians and Technology Lecture 2

2. The Culture of Health Care
Sociotechnical Aspects:
Clinicians and Technology
Lecture b
This material (Comp 2 Unit 10) was developed by Oregon Health & Science University, funded by the
Department of Health and Human Services, Office of the National Coordinator for Health Information
Technology under Award Number IU24OC000015. This material was updated in 2016 by Bellevue College
under Award Number 90WT0002.
This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International
License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/.

3. Sociotechnical Aspects:
Clinicians and Technology
Learning Objectives
• Describe the concepts of medical error and patient safety (Lectures
a, b).
• Discuss error as an individual problem and as a system problem
(Lecture a).
• Compare and contrast the interaction and interdependence of social
and technical “resistance to change” (Lecture c).
• Discuss the challenges inherent with adapting work processes to
new technology (Lecture c).
• Discuss the downside of adapting technology to work practices and
why this is not desirable (Lecture c).
• Discuss the impact of changing sociotechnical processes on quality,
efficiency, and safety (Lectures a, b).
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4. Patient Safety Goals
• The National Patient Safety Goals
(NPSGs)
– Promoted by The Joint Commission
– Set of regulations addressing safety issues
including:
o Infections by antibiotic-resistant microorganisms
o Catheter-related bloodstream infections (CRBSIs)
o Surgical site infections (SSIs)
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5. Improving Patient Safety by
Implementing a “Do Not Use” List
• In 2001, The Joint Commission issued a Sentinel Event
Alert on the topic of medical abbreviations
• In 2002, a National Patient Safety Goal was approved
that required accredited organizations to develop and
implement a “do not use” list of abbreviations
• In 2004, The Joint Commission created its “do not use”
list as part of the requirements
• In 2010, NPSG.02.02.01 was integrated into The Joint
Commission Information Management standards
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6. Infection Control as a Patient
Safety Measure
• Examples of methodologies used to control
infection in the inpatient setting
– Emphasis on hand hygiene
– Immunizing health care professionals to avoid the
spread of disease
– Using antibiotics appropriately to reduce antibiotic
resistance
– Identifying and appropriately isolating patients with
infectious pathogens
– Revising training and competency assessments
– Using safer medications
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7. Universal Protocol for Preventing
Patient Harm during Surgery
• In 2003, the Joint Commission approved the
Universal Protocol for Preventing Wrong Site,
Wrong Procedure and Wrong Person Surgery
• Since 2004, protocol required for all accredited
facilities
• Components of Universal Protocol:
– Conducting a pre-procedure patient/site verification
process
– Marking the procedure site prior to surgery
– Performing a pre-procedure time-out
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8. Other Promoters of Patient Safety
• Patient safety promoted by organizations
• Example: Leapfrog Group, a voluntary
program initiated by large employers and
organizations of purchasers
• Leapfrog initiatives include the Leapfrog
Hospital Survey and a number of initiatives
that improve patient safety
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9. Some Leapfrog Members
Employers
• The Boeing Company
• Chrysler
• FedEx Corporation
• General Motors Corporation
• Goodwill Industries Central IN
• IBM
• Intel Corporation
• Lockheed Martin
• Maine State Employee Health Commission
• Motorola, Inc.
• Ohio Public Employees Retirement System
• Sprint
• Toyota
• UPS
• United Technologies Corporation
Organizations of Purchasers
• Colorado Business Group on Health
• Indiana Employers Quality Health Alliance
• Iowa Buyers Health Alliance
• Lehigh Valley Business Coalition on Health
• Las Vegas Health Services Coalition
• Maine Health Management Coalition
• Massachusetts Healthcare Purchaser Group
• Nevada Healthcare Coalition
• New Hampshire Purchasers Group on
Health
• New Jersey Healthcare Quality Institute
• New York Business Group on Health
• Niagara Health Quality Coalition
• Pacific Business Group on Health
• Savannah Business Group on Health
• South Carolina Business Coalition on Health
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10. Other Promoters of Patient Safety
Continued
• Nonprofit organizations
• Example: National Quality Forum (NQF)
• Goals:
– Sets national priorities and goals
– Endorses national consensus standards
– Promotes the attainment of national goals
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11. Other Promoters of Patient Safety
Continued 2
• Consumer organizations
– Example: Consumer Reports
• Rates hospitals, cardiac surgical groups,
treatments, natural medicines
• Multiple methodologies for rating
– Performance data
– Patient ratings
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12. Patient Ratings of Hospitals
• HCAHPS questions ask about
– Communication
– Pain control
– Assistance
– Cleanliness and quietness
– Medication and discharge information
– Whether the patient would recommend the
hospital to family and friends
– The patients’ overall rating of their experience
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13. Sociotechnical Aspects:
Clinicians and Technology
Summary – Lecture b
• Patient safety is promoted by using
enhancements in technology coupled with
improvements in how people work
• This sociotechnical process is assisted by
agencies such as The Joint Commission
• Organizations such as the Leapfrog
Group, the National Quality Forum, and
consumer organizations promote patient
safety
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14. Sociotechnical Aspects:
Clinicians and Technology
References – Lecture b
References
Ebright, P. (2014). Culture of safety part one: Moving beyond blame. University of California.
MERLOT. Retrieved from https://www.merlot.org/merlot/materials.htm%3Bjsessionid=
F7A1AA5120282BC1123A261CCB3EEEDC?pageSize=&page=10&userId=19195
Fonarow, G., Abraham, W., Albert, N. M., et al. (2007). Association between performance measures
and clinical outcomes for patients hospitalized with heart failure. JAMA, 297, 61–70.
Fowles, J. B., & Commonwealth Fund. (2008). Performance measures using electronic health records:
Five case studies. Washington, DC: Commonwealth Fund. Retrieved from
http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=685103
Institute of Medicine. (2000). To err is human: Building a safer health system. National Academies
Press. Retrieved from http://books.nap.edu/openbook.php?isbn=0309068371
The Joint Commission. (n.d.). Universal protocol poster. Retrieved from
http://www.jointcommission.org/assets/1/18/UP_Poster.pdf
The Joint Commission. (2009). Measuring hand hygiene adherence: Overcoming the challenges.
Retrieved from http://www.jointcommission.org/assets/1/18/hh_monograph.pdf.
The Joint Commission. (2015). Facts about the do not use list of abbreviations. Retrieved from
http://www.jointcommission.org/facts_about_do_not_use_list/
Landon, B., Normand, S., Blumenthal, D., & Daley, J. (2003). Physician clinical performance
assessment: Prospects and barriers. JAMA, 290, 1183–1189.
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15. Sociotechnical Aspects:
Clinicians and Technology
References – Lecture b Continued
Leape, L. L. (1994). Error in medicine. JAMA, 272(23),1851–1857.
Lindenauer, P., Remus, D., Roman, S., et al. (2007). Public reporting and pay for performance in
hospital quality improvement. New England Journal of Medicine, 356, 486–496.
Lynn, J., & Baily, M., et al. (2007). The ethics of using quality improvement methods in healthcare.
Annals of Internal Medicine, 146, 666–673.
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16. The Culture of Health Care
Sociotechnical Aspects:
Clinicians and Technology
Lecture b
This material was developed by Oregon Health &
Science University, funded by the Department of
Health and Human Services, Office of the National
Coordinator for Health Information Technology
under Award Number IU24OC000015. This
material was updated in 2016 by Bellevue College
under Award Number 90WT0002.
16