The recent decision by CMS to not reimburse for medical services related to certain preventable healthcare-acquired conditions has led many hospitals to try to implement effective patient safety programs as quickly as possible. However, most successful programs require time and careful planning. Winthrop-University Hospital in Mineola, N.Y., for example, has been working to implement automation systems to improve patient safety since 2000. John F. Collins, the hospital's president and CEO, suggests key steps and strategies healthcare leaders should use to implement patient safety initiatives, including computerized provider order entry.
1. Focus on safety, not quality. Mr. Collins makes a distinction between safety, which should be a priority, and quality, a "broad catch phrase" that tends to prioritize cost savings. In addition, people define quality in different ways, which may result in misunderstanding between hospital staff, physicians and executives about what the specific goals of the organization are. "The focus today of quality is back to value-based purchasing, which maintains a focus on cost, which is problematic because each institution should be focused on what can save one person's life," he says.
Mr. Collins recognizes, however, often hospital boards and finance executives will not approve a patient safety initiative without a demonstration of potential savings. Hospital leaders can overcome this challenge by getting the board and finance executives to support their vision. He suggests CEOs can get boards' and executives' buy-in by asking "Would you spend x amount of money to save one life?" By framing the choice as a comparison of people to money, hospital boards and financial leaders may be more likely to take a risk on a new safety initiative such as provider order entry systems.
2. Create a culture that encourages self-reporting. A culture that encourages staff to self-report errors can improve patient safety, Mr. Collins says. "Put a culture in place that says, 'We will protect you if you report yourself.' There shouldn't be a punitive feeling in the staff." He suggests that a zero-tolerance policy would discourage reporting and thus not improve people's practices. In contrast, reporting medical errors may help staff learn from their mistakes. To help create a culture of honesty, Mr. Collins publicly congratulates staff members who had the courage to come forward with a mistake.
3. Survey employees to gauge hospital's level of patient safety. Before Winthrop-University Hospital implemented provider order entry systems, the employees were surveyed to identify the greatest challenges for patient safety. "The first thing you need to do is have the survey to see the results. You can't improve unless you find out where you're starting from," Mr. Collins says. The hospital then hired a company to determine the prevalence of the issues noted in the survey. The results revealed that communication between nurses and clinicians was a major problem, particularly concerning prescriptions. The process of rewriting illegible prescription notes, faxing or hand-delivering the orders to the pharmacy and sending the prescriptions back to the bedside without systems to cross-check presented many opportunities for error. Once the problem was identified, however, the hospital could work to eliminate it.
4. Update infrastructure. Hospitals need to update their infrastructure to successfully implement automation. Mr. Collins says it took Winthrop-University Hospital from 2000-2006 to fully modernize their infrastructure. These updates not only enable the technology to work properly, but also facilitate physicians' use of the systems and thus ensure participation.
5. Transition systems slowly. Winthrop-University Hospital implemented the provider order entry system over a long period of time to create a smooth transition. "We went very slowly and carefully and painstakingly made sure that what was going through was accurate and fully automated," Mr. Collins says. He compares this slow, methodical pace to the "mad rush of hospitals looking to automate" by the 2015 deadline for electronic medical record implementation. He says that this rush creates a potential for error and harm.
Learn more about Winthrop-University Hospital.
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1. Focus on safety, not quality. Mr. Collins makes a distinction between safety, which should be a priority, and quality, a "broad catch phrase" that tends to prioritize cost savings. In addition, people define quality in different ways, which may result in misunderstanding between hospital staff, physicians and executives about what the specific goals of the organization are. "The focus today of quality is back to value-based purchasing, which maintains a focus on cost, which is problematic because each institution should be focused on what can save one person's life," he says.
Mr. Collins recognizes, however, often hospital boards and finance executives will not approve a patient safety initiative without a demonstration of potential savings. Hospital leaders can overcome this challenge by getting the board and finance executives to support their vision. He suggests CEOs can get boards' and executives' buy-in by asking "Would you spend x amount of money to save one life?" By framing the choice as a comparison of people to money, hospital boards and financial leaders may be more likely to take a risk on a new safety initiative such as provider order entry systems.
2. Create a culture that encourages self-reporting. A culture that encourages staff to self-report errors can improve patient safety, Mr. Collins says. "Put a culture in place that says, 'We will protect you if you report yourself.' There shouldn't be a punitive feeling in the staff." He suggests that a zero-tolerance policy would discourage reporting and thus not improve people's practices. In contrast, reporting medical errors may help staff learn from their mistakes. To help create a culture of honesty, Mr. Collins publicly congratulates staff members who had the courage to come forward with a mistake.
3. Survey employees to gauge hospital's level of patient safety. Before Winthrop-University Hospital implemented provider order entry systems, the employees were surveyed to identify the greatest challenges for patient safety. "The first thing you need to do is have the survey to see the results. You can't improve unless you find out where you're starting from," Mr. Collins says. The hospital then hired a company to determine the prevalence of the issues noted in the survey. The results revealed that communication between nurses and clinicians was a major problem, particularly concerning prescriptions. The process of rewriting illegible prescription notes, faxing or hand-delivering the orders to the pharmacy and sending the prescriptions back to the bedside without systems to cross-check presented many opportunities for error. Once the problem was identified, however, the hospital could work to eliminate it.
4. Update infrastructure. Hospitals need to update their infrastructure to successfully implement automation. Mr. Collins says it took Winthrop-University Hospital from 2000-2006 to fully modernize their infrastructure. These updates not only enable the technology to work properly, but also facilitate physicians' use of the systems and thus ensure participation.
5. Transition systems slowly. Winthrop-University Hospital implemented the provider order entry system over a long period of time to create a smooth transition. "We went very slowly and carefully and painstakingly made sure that what was going through was accurate and fully automated," Mr. Collins says. He compares this slow, methodical pace to the "mad rush of hospitals looking to automate" by the 2015 deadline for electronic medical record implementation. He says that this rush creates a potential for error and harm.
Learn more about Winthrop-University Hospital.
Related Articles on Patient Safety:
4 Principles to Guide Effective Chronic Care Management
Struggling California Hospital to Improve Quality by Better Addressing Patient Complaints
Study: Home Healthcare Could Help Reduce Readmissions, Increase Cost-Savings