By Greg Hunter, RT (R) (T)
Beth Boynton, RN, MS
When we talk of improvements in the safety of our healthcare delivery system, we simply look at annual numbers we see in the official reports such as 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 Wallstreet Journal, it has been found out 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 under these observation units although the care they need are highly considered to be readmissions. This only means that the lower number of readmissions does not 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 impression, these data can be quite reassuring. However, 2013 HAC rate of 121 HACs per thousand discharges has not improved the following year (2014). At 12% of patients having HACs, the rate is still too high for us in the healthcare sector to be complacent. The exact reasons for the reduction of patient harm that are hospital-acquired are also not known.
These facts are grim. It makes us think and ask if indeed there are real success stories of healthcare delivery at all. For those whose health outcomes have been followed through thoroughly, yes, there is a lot of good news after all. But in all surgery operations done in the US, for example, how many patients are indeed tracked after discharge? Sadly, only 1% shares this good news. 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 the brief issued by FamiliesUSA.org, quality measures come in four major categories namely 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 those have resulted to health improvements.
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, says a lot about satisfaction but less on appropriateness of treatment received.
These pitfalls in quality measures only mean that there is a very big room for improvement waiting to be filled.
Transparency and gamification as part of the solution to address deficits in patient safety
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 relationship 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 responsibility 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 the week before. She felt unsure 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, like what have been completed, and those that are imminent and overdue. The other nurse verifies 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 to be carried out accordingly.
Patients are tracked from discharge, with clear-cut information given to patients about self management and a means of ensuring that patients are sticking to treatment at home. There is also a means of keeping accurate and unbiased record of patient data in clinical registries that can be used in improving quality measures.
Another method that can help bring about safe healthcare delivery is gamification. It works in the premise that happy and duly recognized employees care for patients better. Gamification is in fact taking the essence out of games and applying the concept of gaming in real life situations to produce desired results. It addresses human factors specifically employee engagement. It values individual efforts by providing recognition in real time. Imagine a timid employee receiving 5-stars on his tasks and the management is made aware of it. 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.
How ManageUP utilizes transparency and 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 and puts into right perspective accountability and shared leadership. These strategies open up channels and enforce transparency that helps improve quality measures.
ManageUP empowers health workers by making available to them important information (policies, procedures, and training materials) through a readily accessible centralized knowledge hub. When information is available to workers, they work with more confidence knowing that their actions are in line with protocols and patient safety checklists.
ManageUP energizes your teams through gamification that rewards workers on completed tasks done in a timely manner. Having a platform that track task status and reminds workers of which task is complete, imminent or overdue also ensures that no important intervention is missed. With real time performance tracking, gamification, and automation of rewards and recognition, employee engagement that improves healthcare delivery becomes at hand.
Contact us for more information about how ManageUP can help transform your organization.