This document discusses reliability in healthcare and strategies to improve it. It defines reliability as the consistency of achieving intended outcomes. Processes can be measured on a scale of reliability from 10-1 to 10-6. Strategies to improve reliability include preventing failures through standardization, identifying and mitigating failures through redundancy and decision aids, and redesigning systems based on understanding failure modes. Bundles, or groups of interventions that improve outcomes when implemented together, can also enhance reliability. The example of a diabetes care bundle includes various tests and education.
5 Reasons the Practice of Evidence-Based Medicine Is a Hot TopicHealth Catalyst
Evidence-based medicine is an important model of care because it offers health systems a way to achieve the goals of the Triple Aim. It also offers health systems an opportunity to thrive in this era of value-based care. In specific, there are five reasons the industry is interested in the practice of evidence-based medicine: (1) With the explosion of scientific knowledge being published, it’s difficult for clinicians to stay current on the latest best practices. (2) Improved technology enables healthcare workers to have better access to data and knowledge. (3) Payers, employers, and patients are driving the need for the industry to show transparency, accountability, and value. (4) There is broad evidence that Americans often do not get the care they need. (5) Evidence-based medicine works. While the practice of evidence-based medicine is growing in popularity, moving an entire organization to a new model of care presents challenges. First, clinicians need to change how they were taught to practice. Second, providers are already busy with increasingly larger and larger workloads. Using a five-step framework, though, enables clinicians to begin to incorporate evidence-based medicine into their practices. The five steps include (1) Asking a clinical question to identify a key problem. (2) Acquiring the best evidence possible. (3) Appraising the evidence and making sure it’s applicable to the population and the question being asked. (4) Applying the evidence to daily clinical practice. (5) Assessing performance.
From Installed to Stalled: Why Sustaining Outcomes Improvement Requires More ...Health Catalyst
The big first step toward building an outcomes improvement program is installing the analytics platform. But it’s certainly not the only step. Sustaining healthcare outcomes improvement is a triathlon, and the three legs are:
Installing an analytics platform
Gaining adoption
Implementing best practices
The program requires buy-in, enthusiasm, even evangelizing of analytics and its tools throughout the organization. It also requires that learnings from analysis translate into best practices, otherwise the program fails to produce results and will eventually fade away. Equally important is that top-level leadership across the organization, not just IT, supports and promotes the program ongoing. We explore each of the elements and how they come together to create successful and sustainable outcomes improvement that defines leading healthcare organizations.
This is the presentation I gave to the HIMSS Management Engineering and Process Improvement (ME-PI) Community on predictive analytics healthcare usage.
Quality improvement is integral to the practice of medicine. Sometimes, QI strays over into clinical research. This presentation provides an overview of the intersection between QI and research
Improving Patient Safety and Quality Through Culture, Clinical Analytics, Evi...Health Catalyst
According to the Centers of Disease Control (CDC), an estimated 70,000 patients die each year from hospital-associated infections (HAIs): contrast the CDC statistic with the fact that only 35,000 people die each year in the U.S. from motor vehicle accidents. Learn key best practices in patient safety and quality including: patient safety as a team sport, the added challenges of healthcare being the most complex, adaptive system, and how culture, analytics, and content contribute to improve outcomes and lower costs.
5 Reasons the Practice of Evidence-Based Medicine Is a Hot TopicHealth Catalyst
Evidence-based medicine is an important model of care because it offers health systems a way to achieve the goals of the Triple Aim. It also offers health systems an opportunity to thrive in this era of value-based care. In specific, there are five reasons the industry is interested in the practice of evidence-based medicine: (1) With the explosion of scientific knowledge being published, it’s difficult for clinicians to stay current on the latest best practices. (2) Improved technology enables healthcare workers to have better access to data and knowledge. (3) Payers, employers, and patients are driving the need for the industry to show transparency, accountability, and value. (4) There is broad evidence that Americans often do not get the care they need. (5) Evidence-based medicine works. While the practice of evidence-based medicine is growing in popularity, moving an entire organization to a new model of care presents challenges. First, clinicians need to change how they were taught to practice. Second, providers are already busy with increasingly larger and larger workloads. Using a five-step framework, though, enables clinicians to begin to incorporate evidence-based medicine into their practices. The five steps include (1) Asking a clinical question to identify a key problem. (2) Acquiring the best evidence possible. (3) Appraising the evidence and making sure it’s applicable to the population and the question being asked. (4) Applying the evidence to daily clinical practice. (5) Assessing performance.
From Installed to Stalled: Why Sustaining Outcomes Improvement Requires More ...Health Catalyst
The big first step toward building an outcomes improvement program is installing the analytics platform. But it’s certainly not the only step. Sustaining healthcare outcomes improvement is a triathlon, and the three legs are:
Installing an analytics platform
Gaining adoption
Implementing best practices
The program requires buy-in, enthusiasm, even evangelizing of analytics and its tools throughout the organization. It also requires that learnings from analysis translate into best practices, otherwise the program fails to produce results and will eventually fade away. Equally important is that top-level leadership across the organization, not just IT, supports and promotes the program ongoing. We explore each of the elements and how they come together to create successful and sustainable outcomes improvement that defines leading healthcare organizations.
This is the presentation I gave to the HIMSS Management Engineering and Process Improvement (ME-PI) Community on predictive analytics healthcare usage.
Quality improvement is integral to the practice of medicine. Sometimes, QI strays over into clinical research. This presentation provides an overview of the intersection between QI and research
Improving Patient Safety and Quality Through Culture, Clinical Analytics, Evi...Health Catalyst
According to the Centers of Disease Control (CDC), an estimated 70,000 patients die each year from hospital-associated infections (HAIs): contrast the CDC statistic with the fact that only 35,000 people die each year in the U.S. from motor vehicle accidents. Learn key best practices in patient safety and quality including: patient safety as a team sport, the added challenges of healthcare being the most complex, adaptive system, and how culture, analytics, and content contribute to improve outcomes and lower costs.
We are defining the problem too narrowly. Our paradigm of pharmaceutical quality sifted long-ago. We have harmonized on a regulatory methodology for QbD (e.g., ICH Q8). However, with the prevailing ontological gaps (for example as illustrated in the continuing challenges posed with the current FDA’s Inactive Ingredient Database) - How good are the scientific explanations in regulatory submissions? Is quality risk-assessment - metaphysical or an epistemological category?
IGPA Building a Culture of Quality Ajaz Hussain_5 Sept 2015_Rferences minAjaz Hussain
Improving Confidence in Quality of Medicines . We make two products – medicine and evidence (documents) but many forget this and do not pay attention to documentation.
Level of attention to documentation is a “canary in a coal mine”
Breaches are irrational –”System 1 thinking” and cognitive biases.
Culture of Quality is familiar to all of us – a framework proposed
Quality Metrics – great idea – very much needed; but we are not yet ready for an FDA Guidance.
We must first address our collective blind spots; be confident that process validation truly ensures complexity is sufficiently reduced and that outcomes are predictable.
Leverage near real-time data with risk-based, adaptive site monitoring to identify issues and trigger targeted actions that proactively mitigate threats to a clinical trial's success.
The Changing Role of Healthcare Data AnalystsHealth Catalyst
The healthcare industry is undergoing a sea change, and healthcare data analysts will play a central role in this transformation. This report explores how the evolution to value-based care is changing the role of healthcare data analysts, how data analysts’ skills can best be applied to achieve value-based objectives and, finally, how Health Catalyst’s most successful health system clients are making this cultural transformation happen in the real world.
Good Regulators of Pharmaceuticals (GRP) 22 October 2014Ajaz Hussain
Sharing thoughts on what makes a Good Regulator of Pharmaceuticals with pharmacy students at the Universities of Minnesota and Iowa. A point of emphasis on "we all are regulators" is explained and three areas for learning - (a) Systems and Integrative Thinking, (b) Argumentation and (c) Behavioral Economics described.
I hope you, the viewers, will also find some value in reviewing these slides. If you are a student and have some questions please feel free to drop me a email (a2zpharmsci@msn.com).
We are on a journey to make quality medicines affordable to all. In the 21st Century, this journey will be successful to the extent we recognize that quality has to be built-in by design and that it cannot be tested into products, utilize and improve a global Quality Management System (QMS), and implement science based risk assessment in our decision making. Pharmacopoeias are an integral part of this global QMS and have been setting public or market standards for medical products for many centuries. In the 21st Century, Pharmacopoeias can and should be a champion for the practice of quality by design. To do so most effectively it would be useful to recognize how, in the 21st Century, human factors help and hinder optimal development, and correct interpretation, of public or market standards in design, development, control and manufacturing decisions. To explore this aspect in this presentation, cognitive biases – blind spots or alleys – are collected and organized on topics relevant to this workshop: (a) Impurities & Contaminants, (b) Analytical Method Validation, and (c) Public/market standards and Release Testing. How to confront these biases will be discussed. Steps to help in maximally leveraging the Pharmacopoeias on the 21st Century journey will be highlighted.
On FDA’s Guidance on Pharmaceutical Process Validation (2011)lAjaz Hussain
Connectors between Culture – Metrics – Continued Process Verification in Process Validation?
Confidence is a critical quality attribute. CGMP violations erode confidence and increase nocebo effects. Currently – “breaches in assurance of data integrity” is a global concern. Have exposed the prevailing ‘regulator heterogeneity’. Re-building ‘epistemic trust” is difficult generally; more so with US FDA. Some thoughts on how to ....
Question Based Development to Quality by Design to Continued Process Verification
Does your QbD program delivery confidence in CQA’s?
Does it reduce the risk of development failure?
Does it provide a process which is stable and ‘in control’?
Does it reduce risk of GMP noncompliance?
Are we asking the right question and at the right time?
The study explores major factors that contribute to hospital readmissions via various analysis algorithms, including decision tree, neutral network and Bayesian network.
Chemometrics, Pharmacometrics and Econometrics Dimensions_of_QualityAjaz Hussain
25 May 2012 Basel, Switzerland. A philosophical exploration - Scientific understanding and risk-based regulatory decisions on Quality by Design. How good are the scientific explanations in regulatory submissions? Scientific explanations yield understanding; quality of explanations differ.What role can Chemometrics, Pharmacometics and Econometrics play? Understanding multidisciplinary (cGMP, CMC, Clin. Pharm., Tox., Clinical, Public Health) perspectives on risk is important. Opportunities; only when the disciplinary divides are bridged. Within the regulatory realm how we set specifications and assess risk have progressed incrementally; at this rate the Vision 2020 may be expected to be visible broadly over time, by 2020?
Most organizations are wondering how to utilize data science to improve decision making and business intelligence. What holds up this process is lack of data for analytics teams. To some extent this dilemma has been resolved by the Open Data initiative publishing large datasets in the cloud and making it freely available.
This session covers on how to access, re-organize and load useful data from the Linked Open Data Cloud in your environment to enable Big Data analytics.
Problems such as inaccurate diagnoses and poor drug-adherence pose challenges to individual health and safety. These challenges are now being alleviated with big data analytics using personalized drug regimes, follow-up alerts and real-time diagnosis monitoring.
In this paper, learn how predictive analytics is helping healthcare industry with technologies such as Clinical Decision Support, Medical Text Analysis and Electronic Health Record (EHR).
As the Chief Medical Officer of North Memorial Health Care, Dr. Kevin Croston’s ultimate objective is to improve healthcare by driving variation out and improving cost efficiencies at North Memorial Healthcare. Core to his success has been a fundamental culture shift with physicians who are now using data to drive care optimization.
During this webinar, you’ll learn: 1) how to shift to a data-driven decision making culture, 2) how to make the data meaningful so providers can make better decisions, and 3) examples of successes and challenges, including how North Memorial has reduced unnecessary pre-39 week inductions, improved cardiovascular care and uncovered a substantial revenue cycle process issue.
Insights on Culture of Quality What have I Learned 22 September 2015Ajaz Hussain
Why criticality of CGMPs not widely appreciated as expected by the customer (US FDA)?
What “norms” provide reasons to rationalize cGMP deviations?
How a company can re-build lost credibility? Better option improve credibility?
How To Drive Clinical Improvement Programs That Get Results - HAS Session 20Health Catalyst
Getting accurate data does not improve care unless empowered teams are created with knowledge of how to apply the data. This was the highest-rated breakout session, and the second-highest rated session overall. This was a very hands-on session, using four different “ah ha” experiences to demonstrate key principles for getting clinical improvement results. These experiences included a deal or no deal re-enactment, a popsicle bomb exercise, a water stopping contest, and Paul Revere exercise. Key principles included how to prioritize your clinical improvement programs and cohorts, defining and selecting the most impactful AIM statements, fixing data quality, and defining and rolling out interventions throughout the system.
PREPARATIONConsider the hospital-acquired conditions that ar.docxkeilenettie
PREPARATION
Consider the hospital-acquired conditions that are not reimbursed for under Medicare/Medicaid. Among these conditions are specific safety issues such as infections, falls, medication errors, and other safety concerns that could have been prevented or alleviated with the use of evidence-based guidelines. Hospital Safety Score, an independent nonprofit organization, uses national performance measures to determine the safety score for hospitals in the United States. The Hospital Safety Score Web site and other online resources provide hospital safety scores to the public.
Read the scenario below:
Scenario
As the manager of a unit, you have been advised by the patient safety office of an alarming increase in the hospital safety score for your unit. This is a very serious public relations matter because patient safety data is public information. It is also a financial crisis because the organization stands to lose a significant amount of reimbursement money from Medicare and Medicaid unless the source of the problem can be identified and corrected. You are required to submit a safety score improvement plan to the organization's leadership and the patient safety office.
Select a specific patient safety goal that has been identified by an organization, or one that is widely regarded in the nursing profession as relevant to quality patient care delivery, such as patient falls, infection rates, catheter-induced urinary infections, IV infections, et cetera.
DELIVERABLE: SAFETY SCORE IMPROVEMENT PLAN
Develop a 3–5 page safety score improvement plan.
Identify the health care setting and nursing unit of your choice
in the title of the mitigation plan. For example, "Safety Score Improvement Plan for XYZ Rehabilitation Center."
You may choose to use information on a patient safety issue for the organization in which you currently work, or search for information from a setting you are familiar with, perhaps from your clinical work.
Demonstrate systems theory and systems thinking as you develop your recommendations.
Organize your report with these headings:
Study of Factors
Identify a patient safety issue.
Describe the influence of nursing leadership in driving the needed changes.
Apply systems thinking to explain how current policies and procedures may affect a safety issue.
Recommendations
Recommend an evidence-based strategy to improve the safety issue.
Explain a strategy to collect information about the safety concern.
How would you determine the sources of the problem?
Explain a plan to implement a recommendation and monitor outcomes.
What quality indicators will you use?
How will you monitor outcomes?
Will policies or procedures need to be changed?
Will nursing staff need training?
What tools will you need to do this?
Additional Requirements
Written communication: Written communication should be free of errors that detract from the overall message.
APA formatting: Resources and in-te ...
We are defining the problem too narrowly. Our paradigm of pharmaceutical quality sifted long-ago. We have harmonized on a regulatory methodology for QbD (e.g., ICH Q8). However, with the prevailing ontological gaps (for example as illustrated in the continuing challenges posed with the current FDA’s Inactive Ingredient Database) - How good are the scientific explanations in regulatory submissions? Is quality risk-assessment - metaphysical or an epistemological category?
IGPA Building a Culture of Quality Ajaz Hussain_5 Sept 2015_Rferences minAjaz Hussain
Improving Confidence in Quality of Medicines . We make two products – medicine and evidence (documents) but many forget this and do not pay attention to documentation.
Level of attention to documentation is a “canary in a coal mine”
Breaches are irrational –”System 1 thinking” and cognitive biases.
Culture of Quality is familiar to all of us – a framework proposed
Quality Metrics – great idea – very much needed; but we are not yet ready for an FDA Guidance.
We must first address our collective blind spots; be confident that process validation truly ensures complexity is sufficiently reduced and that outcomes are predictable.
Leverage near real-time data with risk-based, adaptive site monitoring to identify issues and trigger targeted actions that proactively mitigate threats to a clinical trial's success.
The Changing Role of Healthcare Data AnalystsHealth Catalyst
The healthcare industry is undergoing a sea change, and healthcare data analysts will play a central role in this transformation. This report explores how the evolution to value-based care is changing the role of healthcare data analysts, how data analysts’ skills can best be applied to achieve value-based objectives and, finally, how Health Catalyst’s most successful health system clients are making this cultural transformation happen in the real world.
Good Regulators of Pharmaceuticals (GRP) 22 October 2014Ajaz Hussain
Sharing thoughts on what makes a Good Regulator of Pharmaceuticals with pharmacy students at the Universities of Minnesota and Iowa. A point of emphasis on "we all are regulators" is explained and three areas for learning - (a) Systems and Integrative Thinking, (b) Argumentation and (c) Behavioral Economics described.
I hope you, the viewers, will also find some value in reviewing these slides. If you are a student and have some questions please feel free to drop me a email (a2zpharmsci@msn.com).
We are on a journey to make quality medicines affordable to all. In the 21st Century, this journey will be successful to the extent we recognize that quality has to be built-in by design and that it cannot be tested into products, utilize and improve a global Quality Management System (QMS), and implement science based risk assessment in our decision making. Pharmacopoeias are an integral part of this global QMS and have been setting public or market standards for medical products for many centuries. In the 21st Century, Pharmacopoeias can and should be a champion for the practice of quality by design. To do so most effectively it would be useful to recognize how, in the 21st Century, human factors help and hinder optimal development, and correct interpretation, of public or market standards in design, development, control and manufacturing decisions. To explore this aspect in this presentation, cognitive biases – blind spots or alleys – are collected and organized on topics relevant to this workshop: (a) Impurities & Contaminants, (b) Analytical Method Validation, and (c) Public/market standards and Release Testing. How to confront these biases will be discussed. Steps to help in maximally leveraging the Pharmacopoeias on the 21st Century journey will be highlighted.
On FDA’s Guidance on Pharmaceutical Process Validation (2011)lAjaz Hussain
Connectors between Culture – Metrics – Continued Process Verification in Process Validation?
Confidence is a critical quality attribute. CGMP violations erode confidence and increase nocebo effects. Currently – “breaches in assurance of data integrity” is a global concern. Have exposed the prevailing ‘regulator heterogeneity’. Re-building ‘epistemic trust” is difficult generally; more so with US FDA. Some thoughts on how to ....
Question Based Development to Quality by Design to Continued Process Verification
Does your QbD program delivery confidence in CQA’s?
Does it reduce the risk of development failure?
Does it provide a process which is stable and ‘in control’?
Does it reduce risk of GMP noncompliance?
Are we asking the right question and at the right time?
The study explores major factors that contribute to hospital readmissions via various analysis algorithms, including decision tree, neutral network and Bayesian network.
Chemometrics, Pharmacometrics and Econometrics Dimensions_of_QualityAjaz Hussain
25 May 2012 Basel, Switzerland. A philosophical exploration - Scientific understanding and risk-based regulatory decisions on Quality by Design. How good are the scientific explanations in regulatory submissions? Scientific explanations yield understanding; quality of explanations differ.What role can Chemometrics, Pharmacometics and Econometrics play? Understanding multidisciplinary (cGMP, CMC, Clin. Pharm., Tox., Clinical, Public Health) perspectives on risk is important. Opportunities; only when the disciplinary divides are bridged. Within the regulatory realm how we set specifications and assess risk have progressed incrementally; at this rate the Vision 2020 may be expected to be visible broadly over time, by 2020?
Most organizations are wondering how to utilize data science to improve decision making and business intelligence. What holds up this process is lack of data for analytics teams. To some extent this dilemma has been resolved by the Open Data initiative publishing large datasets in the cloud and making it freely available.
This session covers on how to access, re-organize and load useful data from the Linked Open Data Cloud in your environment to enable Big Data analytics.
Problems such as inaccurate diagnoses and poor drug-adherence pose challenges to individual health and safety. These challenges are now being alleviated with big data analytics using personalized drug regimes, follow-up alerts and real-time diagnosis monitoring.
In this paper, learn how predictive analytics is helping healthcare industry with technologies such as Clinical Decision Support, Medical Text Analysis and Electronic Health Record (EHR).
As the Chief Medical Officer of North Memorial Health Care, Dr. Kevin Croston’s ultimate objective is to improve healthcare by driving variation out and improving cost efficiencies at North Memorial Healthcare. Core to his success has been a fundamental culture shift with physicians who are now using data to drive care optimization.
During this webinar, you’ll learn: 1) how to shift to a data-driven decision making culture, 2) how to make the data meaningful so providers can make better decisions, and 3) examples of successes and challenges, including how North Memorial has reduced unnecessary pre-39 week inductions, improved cardiovascular care and uncovered a substantial revenue cycle process issue.
Insights on Culture of Quality What have I Learned 22 September 2015Ajaz Hussain
Why criticality of CGMPs not widely appreciated as expected by the customer (US FDA)?
What “norms” provide reasons to rationalize cGMP deviations?
How a company can re-build lost credibility? Better option improve credibility?
How To Drive Clinical Improvement Programs That Get Results - HAS Session 20Health Catalyst
Getting accurate data does not improve care unless empowered teams are created with knowledge of how to apply the data. This was the highest-rated breakout session, and the second-highest rated session overall. This was a very hands-on session, using four different “ah ha” experiences to demonstrate key principles for getting clinical improvement results. These experiences included a deal or no deal re-enactment, a popsicle bomb exercise, a water stopping contest, and Paul Revere exercise. Key principles included how to prioritize your clinical improvement programs and cohorts, defining and selecting the most impactful AIM statements, fixing data quality, and defining and rolling out interventions throughout the system.
PREPARATIONConsider the hospital-acquired conditions that ar.docxkeilenettie
PREPARATION
Consider the hospital-acquired conditions that are not reimbursed for under Medicare/Medicaid. Among these conditions are specific safety issues such as infections, falls, medication errors, and other safety concerns that could have been prevented or alleviated with the use of evidence-based guidelines. Hospital Safety Score, an independent nonprofit organization, uses national performance measures to determine the safety score for hospitals in the United States. The Hospital Safety Score Web site and other online resources provide hospital safety scores to the public.
Read the scenario below:
Scenario
As the manager of a unit, you have been advised by the patient safety office of an alarming increase in the hospital safety score for your unit. This is a very serious public relations matter because patient safety data is public information. It is also a financial crisis because the organization stands to lose a significant amount of reimbursement money from Medicare and Medicaid unless the source of the problem can be identified and corrected. You are required to submit a safety score improvement plan to the organization's leadership and the patient safety office.
Select a specific patient safety goal that has been identified by an organization, or one that is widely regarded in the nursing profession as relevant to quality patient care delivery, such as patient falls, infection rates, catheter-induced urinary infections, IV infections, et cetera.
DELIVERABLE: SAFETY SCORE IMPROVEMENT PLAN
Develop a 3–5 page safety score improvement plan.
Identify the health care setting and nursing unit of your choice
in the title of the mitigation plan. For example, "Safety Score Improvement Plan for XYZ Rehabilitation Center."
You may choose to use information on a patient safety issue for the organization in which you currently work, or search for information from a setting you are familiar with, perhaps from your clinical work.
Demonstrate systems theory and systems thinking as you develop your recommendations.
Organize your report with these headings:
Study of Factors
Identify a patient safety issue.
Describe the influence of nursing leadership in driving the needed changes.
Apply systems thinking to explain how current policies and procedures may affect a safety issue.
Recommendations
Recommend an evidence-based strategy to improve the safety issue.
Explain a strategy to collect information about the safety concern.
How would you determine the sources of the problem?
Explain a plan to implement a recommendation and monitor outcomes.
What quality indicators will you use?
How will you monitor outcomes?
Will policies or procedures need to be changed?
Will nursing staff need training?
What tools will you need to do this?
Additional Requirements
Written communication: Written communication should be free of errors that detract from the overall message.
APA formatting: Resources and in-te ...
Patient safety is the cornerstone of high-quality healthcare services. In the presentation, A summary of the frameworks & practical approaches to improve safety of patient care.
Realizing the Promise of Patient-Reported Outcomes MeasuresHealth Catalyst
Dr. Rachel Clark Sisodia, a champion of the system-wide adoption of Patient Reported Outcomes Measures at Partners HealthcCare, will share her experience and perspective on the relevance and necessity of Patient-Reported Outcomes Measures (PROMs). In this webinar, Dr. Sisodia will highlight how the PROMs ideas have been put into practice at Partners HealthCare.
Join us and learn:
Strategies and tactics for overcoming potential barriers to collecting and effectively using PROMs.
Through specific examples, how to demonstrate that PROMs can help deliver faster, more personalized care for individual patients.
How to collect and use advanced analytics to leverage aggregate PROMs data to inform clinical patient and provider decisions.
How to use outcomes metrics for quality improvement and comparative effectiveness.
Quality Improvement and Professional Nursing Practice Chapte.docxmakdul
Quality Improvement
and Professional Nursing Practice
Chapter 9
1
Healthcare Quality (1 of 2)
Quality is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge
Healthcare Quality (2 of 2)
Quality improvement refers to the use of data to monitor the outcomes of care processes, and uses improvement methods to design and test changes to continuously improve the quality and safety of healthcare systems
Crossing the Quality Chasm (IOM, 2001)
Safe, timely, effective, efficient, equitable, and patient-centered (STEEEP)
10 rules for redesign to move the healthcare system toward the identified performance expectations
10 Rules for Redesign (1 of 3)
Care is based on continuous healing relationships with patients receiving care whenever and wherever it is needed
Care can be customized according to the patient’s needs and preferences even though the system is designed to meet the most common types of needs
The patient is the source of control and as such, should be given enough information and opportunity to exercise the degree of control he or she chooses regarding decisions that affect him or her
10 Rules for Redesign (2 of 3)
Knowledge is shared and information flows freely so that patients have access to their own medical information
Decision making is evidence based; that is, it is based on the best available scientific knowledge and should not vary illogically between clinicians or locations
Safety is a system property and patients should be safe from harm caused by the healthcare system
10 Rules for Redesign (3 of 3)
Transparency is necessary where systems make information available to patients and families that enable them to make informed decisions when selecting a health plan, hospital, or clinic, or when choosing alternative treatments.
Patient needs are anticipated rather reacted to
Waste of resources and patient time is continuously decreased
Cooperation among clinicians is a priority to ensure appropriate exchange of information and coordination of care
Healthcare Transparency (1 of 2)
Medicare’s Hospital Compare at: www.hospitalcompare.hhs.gov
Medicare’s Home Health Compare at: https://www.medicare.gov/homehealthcompare/
Quality Check’s Find a Health Care Organization at: http://www.qualitycheck.org/
consumer/searchQCR.aspx
The Leapfrog Group’s Hospital Safety Score at: http://www.hospitalsafetyscore.org
Healthcare Transparency (2 of 2)
America’s Health Rankings by the United Health Foundation at: http://www.americashealthrankings.org
Improving Healthcare for the Common Good (IPRO) at: http://ipro.org/for-consumers
IPRO’s Why Not the Best? at: http://www.whynotthebest.org
The Commonwealth Fund at: http://www.commonwealthfund.org
Measures of Quality
Benchmarking
Core measures
Accountability
Composite measures
Measures of Nursing Care
Consumer Assessment of Healthcare Providers and Systems (CAHP ...
Out-Patient Physical therapy risk management
Grand Canyon University
Joshua Garcia
1
Objectives
Risk management rationale
Risk management support
Risk management implementation
Risk management challenges
Risk management evaluation
Risk management opportunities
2
Risk management goals
Improve quality care and safety
Identify risks that affect the business and care.
Practice within the scope of practice
Implement risk management strategy
Review
Risk management role is to improve quality care, safety and identify risks that affect the business such as scope of practice, documentation, patient relationship, and interventions, and malpractice.
“A situation involving exposure to danger where a probability or threat of damage, injury, liability, loss, or any other negative occurrence that is caused by external or internal vulnerabilities exist and that may be avoided through preemptive action.” (Chugh, 2015).
“Work within the physical therapist scope of practice and professional competence; Document only the intervention and avoid comments related to "secondary gain" or its origin. Avoid expansion of services at the individual patient's/client's request unless approved by appropriate referral sources and an additional examination/evaluation is performed.” (Anonymous, 2011)
Implement strategies in areas that are prone to non compliance, safety and care that will affect the patient, health care professional and the business.
3
Rationale
Health care professional competence
Continuing education
Competence with care
Competence with practice standards
It is important to perform continuing education in or to maintain your licensure.
The accrediting body of CMS is important in maintaining compliance especially with documentation, safety, accreditation of a therapist, medical records and practicing of a therapist .
4
Support
Standard practice in Physical Therapy
Continuing education
Inservice training
Physical therapy plan to risk management is “According to the Guide to Physical Therapist Practice, the elements of patient/client management include examination, evaluation, diagnosis, prognosis, and intervention.” (Anonymous, 2011).
“Identifying the most efficient and effective learning activities is essential to enable the profession to assimilate research findings and enhance clinical expertise to maximize patient outcomes.” (Leahy, Chipchase, & Blackstock, 2017).
Inservice training is imperative to identify the most effective and safest approach.
5
Professional negligence
Improper management of treatment
Improper use of physical agents
Improper therapeutic exercise
Improper manual therapy
Inservice training will decrease the chances of malpractice in the most common types of interventions listed above.
Many different types of injuries can occur from improper training such as: falls, burns, improper assessments, ligament/tendon damage, dislocation etc.
Continuing education and practici ...
Presentation for the School of Dentistry Bootcamp series on April 23, 2008. Uploaded originally at that time, but Slideshare for some inexplicable reason deleted the file. Hope it sticks this time. The Chain of Trust / Levels of Evidence tool was originally developed for use by college undergraduate students, shown adapted here for use in healthcare. It is appropriate for a wide variety of audiences.
Jeanette Ives Erickson: Influencing professional nursing practiceThe King's Fund
Jeanette Ives Erickson, Senior Vice President for Patient Care and Chief Nurse, Massachusetts General Hospital and Instructor, Harvard Medical School articulates the importance of a structure for clearly understanding fundamental standards that is accepted and embraced by both the public and health care professionals.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...
Introduction to Reliability
1. Quality Improvement
Introduction to Reliability
This material (Comp 12 Unit 3) was developed by Johns Hopkins University, funded by the Department of Health
and Human Services, Office of the National Coordinator for Health Information Technology under Award
Number IU24OC000013. This material was updated in 2016 by Johns Hopkins University under Award
Number 90WT0005.
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/
2. Introduction to Reliability
Learning Objectives
• Discuss the basic concepts of reliability.
• Understand what makes organizations
highly reliable.
2
3. What Is Reliability?
• “The extent to which an experiment, test, or
measuring procedure yields the same results
on repeated trials.” (Webster’s Dictionary)
• “Reliability principles, used to design systems
that compensate for the limits of human
ability, can improve safety and the rate at
which a system consistently produces
desired outcomes.” (Nolan, T., Resar, R.,
Haraden, C., Griffin, F.A.)
3
4. Which Clinic Would You Prefer?
3.01 Chart. Courtesy of Dr. Anna Maria Izquierdo-Porrera.
4
5. How Do We Measure Reliability?
• Reliability = # of actions that achieve the intended result
÷ total # of actions taken
• Reliability is expressed as an order of magnitude.
– Unstable process:
more than 1–2 defects
per 10 attempts.
– 10-1: 1–2 defects per
10 attempts.
– 10-2: 1–2 defects per
100 attempts.
– 10-3: 1–2 defects per
1000.
– 10-4: 1–2 defects per
10,000.
– 10-5: 1–2 defects per
100,000.
– 10-6: 1–2 defects per
1,000,000.
– And so on.
5
8. Example: Improvement of
Diabetes Care
• Guideline recommendation: >3
Hemoglobin A1c every 2 years.
• You are tasked with improving the rate of
patients being tested appropriately.
• Because you are in the HIT department,
you will use HIT tools to improve the
reliability of the process.
8
9. Prevention of Failure
• Strategies:
– Using intent and
standardization.
– Segmentation.
• Tools:
– Basic standardization.
– Best practice guidelines,
tools, and techniques.
– Memory aids, such as
checklists.
– Feedback mechanisms
regarding compliance
with standards.
– Awareness campaigns.
9
10. Identification and Mitigation
• Strategies
– Human factor changes.
• Redundancy
– Independent double
checks.
• Tools
– Reduce fatigue and
distraction.
– Schedule key tasks.
– Take advantage of habits
and patterns.
– Decision aids and
reminders built into the
system.
– Differentiation.
– Constraints.
– Affordances.
10
11. Redesign for Success
• Understand where the failure is occurring.
• Determine the remedy.
– Failure modes:
o What could go wrong?
– Failure causes:
o Why would the failure happen?
– Failure effects:
o What would be the consequences of each failure?
11
12. Bundles
• A “bundle” is a group of interventions
related to a disease process that, when
executed together, result in better
outcomes than when implemented
individually.
• Providing each element of care within a
bundle leads to more reliable care for
patients.
12
13. Example: Diabetes Care Bundles
• What would you include in a diabetic
bundle?
• The example of a good diabetic bundle is
that used to enhance reliability at
CareSouth Carolina.
• It includes: BMI, education, 2 HgbA1c
tests, LDL test, use of statin.
13
14. Introduction to Reliability
Summary
• Designing a reliable system is a stepwise
process that requires the incorporation of
prevention of failure, identification and
mitigation of failure, and system redesign
from failure.
• Different processes require different levels
of reliability.
14
15. Introduction to Reliability
References — 1
References
Elgert, S. Reliability Science: Reducing the Error Rate in Your Practice. These seven
principles can help ensure that your patients receive the right care at the right time
every time. Fam Pract Manag. 2005 Oct;12(9):59-63.
Merriam-Webster’s Dictionary. Available from: http://www.merriam-
webster.com/dictionary/reliability
Nolan, T., Resar, R., Haraden, C., Griffin, F.A. Improving the Reliability of Health Care. IHI
Innovation Series white paper. Boston: Institute for Healthcare Improvement; 2004.
Available from: www.IHI.org
Reliability: Sepsis Management Bundle. Available from:
http://www.ihi.org/knowledge/Pages/Measures/ReliabilitySepsisManagementBundle.a
spx
When Good Enough Isn’t … Good Enough: The Case for Reliability. Institute for
Healthcare Improvement. Available
from:http://www.ihi.org/resources/Pages/ImprovementStories/WhenGoodEnoughIsnt
GoodEnoughTheCaseforReliability.aspx
15
16. Introduction to Reliability
References — 2
Charts, Tables, Figures
3.01 Chart: Which Clinic Would You Prefer? Courtesy Dr. Anna Maria Izquierdo-Porrera.
3.02 Table: Examples of Reliability in Health Care. Courtesy Dr. Anna Maria Izquierdo-
Porrera.
Images
Slide 7: Strategies to Improve Reliability. Adapted from Nolan, T., Resar, R., Haraden, C.,
Griffin, F.A. Improving the Reliability of Health Care. IHI Innovation Series white
paper. Boston: Institute for Healthcare Improvement; 2004. Available from:
www.IHI.org
16
17. Quality Improvement
Introduction to Reliability
This material (Comp 12 Unit 3) was developed by
Johns Hopkins University, funded by the
Department of Health and Human Services, Office
of the National Coordinator for Health Information
Technology under Award Number IU24OC000013.
This material was updated in 2016 by Johns
Hopkins University under Award Number
90WT0005.
17
Editor's Notes
Welcome to Quality Improvement: Introduction to Reliability.
The Objectives for Introduction to Reliability are to:
Discuss the basic concepts of reliability.
Understand what makes organizations highly reliable.
In its most basic definition, reliability is the ability to get the same result when you repeat a test or process. However, when applied to health care, it includes a number of additional factors. Reliability in health care is a tool to design a safe and consistent system. It also tackles one of health care’s fallibilities: the limits of human ability.
Consider these two hypothetical clinics. They are working on improving their patient care. Although the average is exactly the same for both clinics, Clinic 1 has a wider range. This means that although one month they do well, the following month they do much worse. Clinic 2’s range of outcomes is smaller.
The graph shows the progression of the two clinics. Clinic 1 has a wide range of outcomes (from 1 to 3), and the other, Clinic 2, has a narrow range of outcomes (from 1.9 to 2.1).
To measure reliability, divide the number of actions that achieved the intended result by the total number of actions taken. Reliability measures are presented as an order of magnitude. An unstable process is defined as a process with more than one to two defects per 10 attempts. 10-1 describes a process with one to two defects per 10 attempts and so on.
Measuring reliability is also useful to describe the design of the system. The characteristics of systems that perform at 10-1, for instance, are different from those that perform at 10-3.
The use of beta blockers for patients with acute myocardial infarction and the testing of hemoglobin A1c in diabetic patients are some of the least reliable processes. Reliability of the system improves when considering outcomes such as deaths in risky surgery, neonatal mortality, and deaths in routine anesthesia. The most reliable processes underline outcomes such as deaths from major radiotherapy machine failures or from seismic noncompliance.
To compensate for human limitations, the IHI framework employs a three-tiered strategy. The first line of defense is to prevent the failure from occurring in the first place. The second is to identify and mitigate failure. The last step is to redesign the system.
The guidelines for the care of diabetes recommends that all diabetic patients have their blood tested at least three times every two years for the levels of hemoglobin A1c. You work in a clinic where the rate of testing is between 70 percent and 80 percent. You are in the HIT department and have become part of the team tasked with improving the reliability of diabetes care. Although you can suggest any strategy to improve, you will be expected to focus in HIT solutions.
Given the rate provided, what is the reliability of the current process? If you said “unstable process” you are correct. Why? Because if there are 10 tests with only a 70 to 80 percent reliability measurement — that means there are between two and three errors per 10 tests. Recall that we said (on slide 6) that an unstable process is defined as a process with more than one to two defects per 10 attempts.
There’s a growing body of evidence that clinicians are distracted and interrupted constantly during the course of care, and that they can grow fatigued during prolonged shifts. Fatigue and distraction can impede them from preventing failures. There are two major strategies to prevent failure: use of intent and standardization and segmentation.
There are several tools that can be used to support standardization. Basic standardization — such as using preconfigured order sheets, guidelines, and practice standards — can assist in this regard. Other tools can include techniques that support human memory such as checklists, additional training and education, and feedback mechanisms that support standards compliance. Finally, awareness campaigns can be very effective in bringing nonstandard practices to light. As an IT professional, you will be asked to assist in these efforts using technology, strategies, and tools to support prevention of failure.
During the prevention of failure phase, you can also consider segmentation. A segmentation approach involves selecting a portion of the population, which can be clearly defined (e.g., disease, admission routes, physician, language, etc.) and identifying it as the target of change.
The use of tools such as these can take you from an unstable process to a process that performs at 10-1 reliability — recalling that 10-1 reliability means one to two defects per 10 attempts. In order to further improve reliability, you will need to turn to identification and mitigation strategies.
HIT offers a variety of options for identifying failure and reducing its impact. These options are aimed at changing the human factors and introducing a degree of redundancy. As we discussed previously, clinicians are distracted and interrupted constantly during the course of care. They also can grow fatigued during prolonged shifts.
There is a growing body of research evidence that provides estimates of an error rate of 10-2 when people are performing under duress — even as they self-report that they believe that they are doing their best work. To be highly reliable, systems must be designed to compensate for the limits of human ability.
An obvious first step to identify and mitigate is the reduction of fatigue and distraction in all individuals involved in care. The limit of the number of continuous hours a provider can work or the limitation of interruptions during decision-making moments, such as during rounds. The scheduling of key tasks is another tool to change the human factor. Meetings at the beginning of every shift or clinic day help plan for specific activities and increases reliability.
Also consider taking advantage of habits and patterns. Decision aids and reminders built into the system are another tool to be used. Examples of very effective decision aids are standing orders.
Differentiation of information, such as changing the color of overdue items to red, help change human factors. Finally, constraints and affordances, when built into the system, are an important aspect of identification and mitigation. Constraints make it difficult to do the wrong thing, such as alarms. Consider a system that will not allow you to prescribe a drug that is marked as a patient’s allergy until you fill two screens of information with reasons and rechecks. Affordances make the desired action the default. It is easier to do the right thing because there are clear visual and other sensory clues or electronic flags.
Finally, you will add some redundancy to the system. However, redundancy needs to be added with care. You do not want to overburden your staff with repeated tasks. Examples of redundancy are independent double-checks. They are used for processes that represent a higher risk, such as transfusions or amputations, and thus require a higher reliability.
Finally, high-reliability organizations redesign for success. They understand where the failure in the system is occurring (through analytic methods such as root cause analyses) and determine the remedy. It’s absolutely critical that we understand where the failure is occurring so that we can figure out the remedy. You may have heard early reports of a particular brand of automobile that was accelerating suddenly when their drivers insisted that they were in parking gear. Some of these runaway cars killed or injured people, so the manufacturers redesigned their gearboxes so that the cars couldn’t be taken out of park unless the driver’s foot is on the brake. Even if the driver is confused, the car will not let him make a mistake. Just think how many more people would have been injured or killed if the company had decided to argue incessantly about who or what was at fault!
For example, you might be asked to recommend IT solutions to prompt clinicians to ensure that they implement the ventilator bundle for all mechanically ventilated patients. A “bundle” is a group of interventions for particular patient populations that, when executed together, result in better outcomes than when implemented individually. The ventilator bundle requires that we elevate the head of the bed of the patient 30 degrees, that we have daily vacations from sedation and assessment of the patient’s readiness to extubate, measures to prevent stomach ulcers and blood clots, and daily mouth care. Providing each element of care within a bundle leads to more reliable care for patients. Your assistance in finding the best ways to remind clinicians of these measures within the electronic health record will be invaluable.
You could truly incorporate a number of measures into a bundle for diabetic care. A good example is the work of CareSouth Carolina. CareSouth Carolina is a private, nonprofit health and human services provider located in the Pee Dee region of South Carolina. They have conducted transformational work ensuring reliability of a significant amount of their processes. Their diabetic bundle includes: recording body-mass index (BMI), diabetes mellitus (DM) education, two hemoglobin A1c (HbA1c) measures in past year, LDL cholesterol measure in last year, and patients on statin (if over 40).
Essentially, in building a bundle, you should ask yourself, “I know checking two hemoglobin A1c will help me meet guidelines, but which changes will help me improve their morbidity and mortality when used in combination?”
This concludes Introduction to Reliability. In summary, designing a reliable system is a stepwise process that requires the incorporation of prevention of failure, identification and mitigation of failure, and system redesign from failure. We have also learned that different processes require different levels of reliability.
