With the healthcare industry turning away from the traditional fee-for-service model to pay-for-performance and value-based purchasing, hospitals and health systems are feeling pressure now more than ever to ramp up quality and safety initiatives. Orange Regional Medical Center in Middletown, N.Y., is no exception, but accreditation and quality leaders at the hospital are confident the hospital will not just survive but thrive during such dynamic change in the healthcare industry.
Mary Ellen Crittenden, RN, director of quality support services, and Fred Conklin, manager of accreditation and clinical compliance, both agree no healthcare system will be sustainable or profitable without a robust performance improvement program and patient safety culture. Here, they share five ways ORMC maintains a pervasive culture of quality and safety.
1. Identify and focus on key organization priorities. Quality reporting programs, such as the value-based purchasing and inpatient quality reporting programs, can pose burdensome and overwhelming problems for healthcare organizations of all types and sizes. Participation in these programs involve a meticulous and enormous amount of data collection, collaboration and patience, which is why ORMC leaders agreed to choose and zero in on five priority quality areas for improvement and focus in 2012.
The process of choosing just five focus areas may seem impossible, but Ms. Crittenden said it became more manageable by asking for feedback from the governing body and the administration all the way down to the medical and frontline staff. The hospital utilizes a systematic approach, including an internal assessment of organization data (how the organization did on prior year goals), review of strategic initiatives (future organization direction) and consideration of external issues that will impact the organization such as healthcare reform. Based on a top-down and bottom-up approach, ORMC leaders have agreed upon the focus areas for this year: patients' experience, value based purchasing, patient safety, readmissions and emergency department flow.
"We need to narrow down our focus so we can be successful," she says. "Building a culture of quality and safety trickles all the way down to frontline staff level. That's our starting point for figuring out how we can improve our processes so we can hardwire safety into the healthcare delivery process and prevent adverse events from occurring. It's the frontline staff and leaders that truly own quality and safety."
2. Align quality and safety goals vertically and horizontally. Once ORMC's five goals are established, every department will create its own scorecard or dashboard of metrics to help it achieve those five overarching goals. The idea, Ms. Crittenden says, is for each department to align goals up and down and across the entire organization to ensure a systematic approach to achieving organization objectives and ensure everyone is on the same page.
For instance, ORMC will set a 2012 patient experience target based on 2011 patient satisfaction outcomes. While the hospital sets a higher target for 2012, individual nursing units also receive unit-specific results from the 2011 patient satisfaction survey. That data is used to determine the unit's 2012 patient satisfaction goals, which are tailored to each unit's unique areas of improvement. The unit-specific goals are revisited and assessed on a monthly basis to ensure progress is being made enterprise-wide.
3. Directly involve top management in patient safety efforts. A culture of patient safety can also be fostered and maintained by directly involving top management in patient safety efforts. At ORMC, several teams (comprised of both clinical staff members and administrators) are scheduled to "trace" or conduct rounds in a designated unit every Monday. The Monday tracer meetings give administrators and other top-level executives a first-hand look at how different units are maintaining patient safety and how the organization as a whole can improve.
"[The tracer methodology] is something The Joint Commission started a number of years ago. We've been doing [the tracer methodology] for a few months now, and it's working quite well," Mr. Conklin says. "It helps get everyone in the right frame of mind about patient safety."
Ms. Crittenden adds it has been beneficial for senior leaders to connect with bedside caregivers to educate each other about The Joint Commission's national patient safety goals and the daily quality of care that is provided. "That understanding and collaboration is really nice. These teams range from clinical coordinators right up to the vice presidents," she says. The tracers provide a framework in which care is assessed "through the eyes of the patient," with a focus on identifying ways to improve care processes and systems.
4. Gauge medical and frontline staff perceptions of patient safety. ORMC is joining CMS' national Partnership for Patient Safety initiative, which brings together physicians, nurses, hospitals and health systems, patient safety advocates and other stakeholders in a shared effort to make patient care safer. As part of that effort, ORMC will administer a patient safety culture survey to all staff members starting this year. Ms. Crittenden says the surveys are designed to get comprehensive feedback from staff on their perception of patient safety within the organization.
Issues in the staff perception survey run the gamut, including staff perception on inter-departmental communication and senior-level leadership engagement. Ms. Crittenden says ORMC will administer this survey in March with preliminary plans to re-measure staff members' feedback on a yearly basis.
"It's a great way to really understand how your staff feels about patient safety because they are truly on the front lines taking care of patients," she says. "All staff, from senior leaders to the front-line staff, proactively evaluate care and identify ways to prevent medical errors."
5. Go above and beyond the minimum requirement for patient safety. Compliance to patient safety standards is necessary in order to maintain both quality and reimbursement, but clinical and administrative leaders at ORMC believe that meeting the minimum requirements for patient safety is simply not enough.
Mr. Conklin explains that ORMC conducts a root cause analysis every time a serious adverse event occurs to fully understand how the event happened and what steps can be taken to prevent such an occurrence in the future. In addition, The Joint Commission requires every accredited organization, including ORMC, to perform a failure mode effect analysis for at least one high-risk process each year.
"FMEA definitely serves as a second line of defense because, as part of a risk assessment, it helps us determine whether there's any last shortfall we didn't catch [while assessing the adverse event during the root cause analysis]," Mr. Conklin says. "So we're going beyond the standard for Joint Commission and conducting an even more thorough follow-up assessment."
Mary Ellen Crittenden, RN, director of quality support services, and Fred Conklin, manager of accreditation and clinical compliance, both agree no healthcare system will be sustainable or profitable without a robust performance improvement program and patient safety culture. Here, they share five ways ORMC maintains a pervasive culture of quality and safety.
1. Identify and focus on key organization priorities. Quality reporting programs, such as the value-based purchasing and inpatient quality reporting programs, can pose burdensome and overwhelming problems for healthcare organizations of all types and sizes. Participation in these programs involve a meticulous and enormous amount of data collection, collaboration and patience, which is why ORMC leaders agreed to choose and zero in on five priority quality areas for improvement and focus in 2012.
The process of choosing just five focus areas may seem impossible, but Ms. Crittenden said it became more manageable by asking for feedback from the governing body and the administration all the way down to the medical and frontline staff. The hospital utilizes a systematic approach, including an internal assessment of organization data (how the organization did on prior year goals), review of strategic initiatives (future organization direction) and consideration of external issues that will impact the organization such as healthcare reform. Based on a top-down and bottom-up approach, ORMC leaders have agreed upon the focus areas for this year: patients' experience, value based purchasing, patient safety, readmissions and emergency department flow.
"We need to narrow down our focus so we can be successful," she says. "Building a culture of quality and safety trickles all the way down to frontline staff level. That's our starting point for figuring out how we can improve our processes so we can hardwire safety into the healthcare delivery process and prevent adverse events from occurring. It's the frontline staff and leaders that truly own quality and safety."
2. Align quality and safety goals vertically and horizontally. Once ORMC's five goals are established, every department will create its own scorecard or dashboard of metrics to help it achieve those five overarching goals. The idea, Ms. Crittenden says, is for each department to align goals up and down and across the entire organization to ensure a systematic approach to achieving organization objectives and ensure everyone is on the same page.
For instance, ORMC will set a 2012 patient experience target based on 2011 patient satisfaction outcomes. While the hospital sets a higher target for 2012, individual nursing units also receive unit-specific results from the 2011 patient satisfaction survey. That data is used to determine the unit's 2012 patient satisfaction goals, which are tailored to each unit's unique areas of improvement. The unit-specific goals are revisited and assessed on a monthly basis to ensure progress is being made enterprise-wide.
3. Directly involve top management in patient safety efforts. A culture of patient safety can also be fostered and maintained by directly involving top management in patient safety efforts. At ORMC, several teams (comprised of both clinical staff members and administrators) are scheduled to "trace" or conduct rounds in a designated unit every Monday. The Monday tracer meetings give administrators and other top-level executives a first-hand look at how different units are maintaining patient safety and how the organization as a whole can improve.
"[The tracer methodology] is something The Joint Commission started a number of years ago. We've been doing [the tracer methodology] for a few months now, and it's working quite well," Mr. Conklin says. "It helps get everyone in the right frame of mind about patient safety."
Ms. Crittenden adds it has been beneficial for senior leaders to connect with bedside caregivers to educate each other about The Joint Commission's national patient safety goals and the daily quality of care that is provided. "That understanding and collaboration is really nice. These teams range from clinical coordinators right up to the vice presidents," she says. The tracers provide a framework in which care is assessed "through the eyes of the patient," with a focus on identifying ways to improve care processes and systems.
4. Gauge medical and frontline staff perceptions of patient safety. ORMC is joining CMS' national Partnership for Patient Safety initiative, which brings together physicians, nurses, hospitals and health systems, patient safety advocates and other stakeholders in a shared effort to make patient care safer. As part of that effort, ORMC will administer a patient safety culture survey to all staff members starting this year. Ms. Crittenden says the surveys are designed to get comprehensive feedback from staff on their perception of patient safety within the organization.
Issues in the staff perception survey run the gamut, including staff perception on inter-departmental communication and senior-level leadership engagement. Ms. Crittenden says ORMC will administer this survey in March with preliminary plans to re-measure staff members' feedback on a yearly basis.
"It's a great way to really understand how your staff feels about patient safety because they are truly on the front lines taking care of patients," she says. "All staff, from senior leaders to the front-line staff, proactively evaluate care and identify ways to prevent medical errors."
5. Go above and beyond the minimum requirement for patient safety. Compliance to patient safety standards is necessary in order to maintain both quality and reimbursement, but clinical and administrative leaders at ORMC believe that meeting the minimum requirements for patient safety is simply not enough.
Mr. Conklin explains that ORMC conducts a root cause analysis every time a serious adverse event occurs to fully understand how the event happened and what steps can be taken to prevent such an occurrence in the future. In addition, The Joint Commission requires every accredited organization, including ORMC, to perform a failure mode effect analysis for at least one high-risk process each year.
"FMEA definitely serves as a second line of defense because, as part of a risk assessment, it helps us determine whether there's any last shortfall we didn't catch [while assessing the adverse event during the root cause analysis]," Mr. Conklin says. "So we're going beyond the standard for Joint Commission and conducting an even more thorough follow-up assessment."