When we talk of improvements in the safety of our healthcare delivery system, we simply look at the annual numbers we see in official reports such as the decreasing number of readmissions and reductions in hospital-acquired conditions (HACs). But can we really rely on these numbers? Apparently not.
In a recent report of The Wall Street Journal, it was discovered that some hospitals in Arizona reported a decrease in the number of readmissions. This could very well have been good news for everyone except that there was also a significant increase in the number of patients put under special observation areas. Seemingly, patients who return after discharge are put into these observation units even though the care they need are considered to be readmissions. This only means that the lower number of readmissions does not necessarily accurately reflect improvements in healthcare delivery.
In a similar report furnished by the Agency for Healthcare Research and Quality, the results of their study indicated a 17% decline in HACs since 2010 and that close to 20 billion dollars was saved as a result of this reduction. At first glance, this data can be quite reassuring. However, the 2014 rate of hospital-acquired conditions has not improved significantly from the rate in 2013 (121 HACs per thousand discharges). With 12% of patients having HACs, the rate is still too high for us in the healthcare sector to be complacent. In addition, the exact reasons for the reduction of patient harm in hospitals are not fully understood.
These facts are grim. It makes us think and ask if indeed there are real success stories in healthcare delivery. For those whose health outcomes have been followed extensively, yes, there is a lot of good news after all. However for surgery operations done in the US, for example, how many patients are actually tracked after discharge? Sadly, only 1%, for the 99% whose surgeries or health outcome has not been tracked, we are in the dark. We need more specialty-specific clinical registries with publicly available data.
Even the quality measures used in healthcare have pitfalls. In a brief issued by FamiliesUSA.org, quality measures come in four major categories 1) structure, 2) process, 3) outcome, and 4) patient experience.
- Structure measures determine if health institutions or providers have the necessary tools (equipment, manpower and skills) to deliver quality care. While these methods are indeed significant, they fail to measure the actual quality of care patients receive and they do not give any indications of how health improvements are made.
- Process measures, on the other hand, provide feedback to providers that are clear, precise and specific. However, they fail to provide data on significant areas that affect healthcare delivery such as teamwork and organizational culture.
- Outcome measures can be costly and difficult to achieve due to diversity of the population whose health outcomes are to be measured.
- Patient experience, on the other hand, captures satisfaction but does not give an indication on the appropriateness of treatment received.
These pitfalls in quality measures only mean that there is large room for improvement waiting to be filled.
Transparency and Gamification a Way to Address Patient Safety Deficits
Our innovative ways to improve patient safety and quality is a lifetime endeavor that will involve both human and organizational factors. Fortunately, there are existing ways that are already proven to positively influence people and the organization, more specifically the organizational culture, as a whole.
- Transparency is a method that can improve interpersonal working relationships and interprofessional collaborations which create positive organizational culture. Transparency involves more pertinent information being shared either verbally or electronically among people who work together across or vertically down the hierarchy. It also sees actions in real time. Transparency encourages job-related questions to be asked without fear of being rejected or criticized. It also allows for feedback to happen. It clarifies roles and tasks which help define responsibilities and accountability. In essence, transparency is about information disclosure, clarity and accuracy.
Common scenarios of a work environment with transparency are the following:
- A nurse sees a new medication order. The order is not legible enough although the client has taken the same drug a week before. The nurse is not sure of the medication and decides to verify the order without fear of consulting the physician.
- Staff nurses and the head nurse convene to begin endorsements. The nurse from the morning shift shows the other nurse a checklist of important details of the patient’s care, what has been completed, and what is imminent and overdue. The other nurse verifies the information in the presence of the head nurse. Before endorsement was over, the head nurse briefly reminds the staff about the recent changes in protocol. The staff nurses are all in agreement that the new protocol is understood and will be carried out accordingly.
- Patients are tracked from discharge, with clear-cut information given to them about self management and a means of ensuring that patients are sticking to the treatment at home. There is also a way of keeping an accurate and unbiased record of the patient data in clinical registries that can be used in improving quality measures.
- Gamification is another method that can help bring about safe healthcare delivery. It works via the premise that happy and recognized employees provide better patient care. Gamification is taking the essence out of games and applying the gaming concept in real life situations to produce the desired results. It addresses human factors, specifically employee engagement and values individual efforts by providing recognition in real time.
Imagine a timid employee receiving 5-stars for bringing a safety or quality problem to the attention of his or her team, management sees the rewards and congratulates the employee. The assertive power of speaking up is positively reinforced while the informal power that can arise from staying silent or influencing others to stay silent is slowly and surely eroded.
In summary, health delivery does not have to cause unnecessary patient harm and huge financial losses. Transparency and gamification can go a long way to provide organizational efficiency and employee engagement. All in all, they help the health force do what they do best: care for patients in the best and safest way.
ManageUP utilizes transparency to increase success stories in your organization
ManageUP is a company whose main vision is to significantly contribute to a better and safer healthcare delivery through proven strategies that aim to bridge the gaps within organizations as well as in quality measures. These strategies are summed up in these three E’s:
ManageUP ensures that individual and team tasks are clear and understood through utilization of automated workflows. It ensures clarity of the ‘what’ ‘whom’ and ‘when’ of every task that increasesaccountability and shared leadership.
ManageUP empowers health workers by making important information (policies, procedures, and training materials) readily available through a centralized knowledge hub. When information is available to workers, they work with more confidence knowing that their actions are in line with safety and quality protocols and checklists.
ManageUP energizes your teams through gamification that rewards workers when completing tasks in a timely manner.
With real time performance tracking, gamification, and automated rewards and recognition, employee engagement is increased and true improvement in patient safety can be realized.