Quality and Patient Safety Newsletter, May 31, 2012

In this issue: 
RWJ Foundation poll, what hospitals can learn from the Penn State scandal, Partnership for Patients national conference, IHI's free audio program, Dr. House retires

top stories

Nearly nine in 10 call cost of care a serious problem

New Poll Measures Americans’ Views on Costs and Quality of Medical Care

Many Americans who have experienced a serious illness or injury within the past 12 months are concerned about the financial costs of medical care, and struggle to ensure that their care is appropriate, according to a new poll by the Robert Wood Johnson Foundation, NPR and Harvard School of Public Health. In addition, the poll found a large majority of the general public (87%) thinks the cost of care is a serious problem for the country and two-thirds of the general public (65%) believes the cost of care has gotten worse over the last five years.

The poll also examined sick Americans’ experiences and perceptions of the costs and quality of medical care over the last year. More than 40 percent say that the cost of their medical care has caused a “very serious” (20%) or “somewhat serious” (23%) problem for their or their family’s finances. They also reported that high health care costs affected their ability to access care, with one in six sick Americans saying that there was a time in the past 12 months when they could not get the medical care they needed. The financial barriers to accessing care were more pronounced for sick people who were uninsured at some point in the last year.

Read the survey results: Sick in America.

Cardinal rules for crisis response

Health care organizations can learn valuable lessons from the recent Penn State scandal.

What happens when something goes horribly wrong at an organization that has been entrusted with the care and safety of a vulnerable population? When Penn State was accused of failing to protect children, the way its leaders handled the crisis had a profound and potentially lasting impact. The well-known case study contains invaluable lessons for hospital leaders, as a hospital has a similar responsibility toward its patients.  Read more

south carolina news

Medicaid bulletin

Effective June 1, 2012, KePRO will begin operations as the QIO for the South Carolina Department of Health and Human Services (SCDHHS), Medicaid. KePRO will be responsible for prior authorization (PA) of services as well as pre-payment and/or medical record review of select services.

Please see the May 15 Medicaid Bulletin for more information.

Hospital will be paid more next year for satisfied customers

Six years ago, the Laurens County Health Care System began a renewed emphasis on customer service and it's paid off with the hospital's ranking in annual customer service surveys soaring. Beginning next year, the payoff will be real.

CEO Rich D'Alberto told the hospital board last week that, starting in 2013, CMS (the federal Center for Medicare and Medicaid Services) will withhold a portion of every hospital's Medicare reimbursement payment and hospitals will earn the money back based on scored given for customer service and patient outcomes.

If a hospital does poorly, they won't receive any of the money back. If they do well, they can earn all their money back and even part of the money withheld from a hospital that does poorly, the CEO said. Read more


partnership for patients news

National PFP face-to-face meeting: taking action to achieve transformation

Nashville, TN
June 4 – Noon-8 p.m.
June 5 – 8 a.m.-4 p.m.
Join us at the first national face-to-face meeting for Partnership for Patients participants set to take place in early June in Nashville, TN, prior to Premier's annual Breakthroughs Conference and Exhibition. This newly designed combined national meeting will allow participants to share best practices and organizational successes with other members in the QUEST® and/or PFP collaborative through structured networking and knowledge sharing sessions.

Join us as we take action to achieve transformation with concurrent tracks addressing all six domains of QUEST and specific PFP hospital-acquired conditions. Sessions will feature renowned healthcare experts, top performers and member successes with the "practical" and "tactical" in mind.

Don't miss the trade show featuring tools, resources and shared successes to help you in your performance improvement efforts. Also, plan to take advantage of the speed networking event, which will help you connect at even deeper levels with your peers.
This two-day interactive meeting will provide education sessions on all 10 HACs, as well as leadership and safety culture workshops and plenary sessions with insights from guest speakers such as Harlan Krumholz, MD, SM, who will address hospital readmissions, and E. Patchen Dellinger, MD, who will address reducing SSIs.

Other guest speakers include: Michael Bell, MD, associate director for infection control at CDC's division of healthcare quality promotion, and Dale Bratzler, DO, MPH, chief quality officer, OU Physicians Group, University of Oklahoma Health Sciences Center.

This national face-to-face meeting precedes Premier's annual Breakthroughs Conference and Exhibition. Learn more and register. (Note: Use the following passcode to register – Partnership for Patients national meeting only – PASSCODE = PFP12.)

Premier's breakthroughs conference and exhibition

June 5-8 – Nashville, TN

Innovation. Collaboration. Transformation. These are the tools of future-proofing. Is your organization ready for tomorrow's challenges? It's time to find out. Experience a knowledge-sharing event devoted to bringing people, ideas and innovations together to transform healthcare. Great knowledge sharing is one of the cornerstones of the Breakthroughs Conference. After just a few days, you'll leave the conference chock full of invaluable learning and best practices that you can infuse into your own organization.

Make the most of your Breakthroughs experience by customizing the conference to suit your needs. Explore the 21 tracks of educational content, and choose what's best for you. From practical approaches to clinical improvement, supply chain strategies, healthcare reform, leadership, labor management and more.

We want to point out a Partnership for Patients track at the Breakthroughs Conference. It's designed for clinical, operational and quality leaders dedicated to eliminating healthcare-associated harm, reducing readmissions and responding to the Partnership for Patients initiative. Learn more about it.

Use these resources to make the conference your own:

  • Overview of Breakthroughs offerings
  • Week-at-a-glance grid
  • Clinical Innovation Series
  • Premier Academy
  • Continuing education credits
  • Networking and special events

Focused on the theme, "Future-proofing: Transformation in Action," the conference will be held at the Opryland Hotel and Convention Center in Nashville. Learn more and register. (Note: Use the following passcode to register – Combined QUEST national meeting and PFP national meeting – QNMPFP12.)

For more information, contact Jeff Vawter, director, collaborative execution, at 704.816.5605 or jeff_vawter@premierinc.com


ihi news

Free audio program: situational awareness and patient safety

June 7, 2012  2:00 – 3:00 PM Eastern Time
Guests: Stephen Muething, MD, Vice President for Safety, James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center
Anne Lyren, MD, Co-Leader, OCHSPS National Children’s Network; Strategic Advisor for Quality and Safety, Rainbow Babies & Children’s Hospital
Carol Haraden, PhD, Vice President, Institute for Healthcare Improvement
It may seem obvious that anticipating problems makes a whole lot more sense than dealing with things after the fact – especially if the problems could have been prevented. When it comes to patient care, this can of course mean the difference between life and death but, more often, the lack of attention to complexities that could arise leads to a lot of unnecessary complications and suffering and costs. But what exactly do the systems look like that focus ahead of time on risky situations and high-risk patients with the same degree of science and scrutiny as we’ve come to associate with studying failures, after the fact? Indeed, what if the entire emphasis shifted to doing everything possible to predict problems as a means of preventing failures in the first place? WIHI explored the road to becoming a “high reliability organization” with the Joint Commission’s Dr. Mark Chassin on the March 8, 2012, program, and we’re now returning to the issue based on the groundbreaking work going on at Cincinnati Children’s Hospital Medical Center.

We’re going to zero in on “situational awareness” and our guide will be Dr. Stephen Muething, who enjoys a well-deserved reputation for making the principles and practices understandable and within reach. To prepare for the WIHI, we invite you to check out the resources at the James M. Anderson Center for Health Systems Excellence at CCHMC. Dr. Muething will be joined by Dr. Anne Lyren, who’s part of a children’s hospital network in Ohio and nationally, committed to sharing data and best practices. Dr. Lyren will explain the critical role that daily huddles play with getting everyone on the same page and capable of responding to problems and crises as they’re developing, in real time.  IHI’s Carol Haraden has been leading patient safety improvement initiatives all across the globe and, despite the progress, she’s the first to admit how much work still lies ahead. That’s one of the reasons Carol Haraden is so excited about the work at CCHMC, and in Ohio, where leaders have decided safety on any given day is not only job number one, it’s the product of the vigilance and preparation from the day before... and the day before that.

What does your organization’s commitment to high reliability and situational awareness look like? Please bring your stories and examples to the discussion so we can get a good picture of the work that’s emerging and help spread some of the new habits and designs. To enroll, please click here.

About WIHI
WIHI is an exciting "talk show" program from IHI, connecting you to the cutting edge of health care improvement. It’s free, it’s timely, and it’s designed to help dedicated legions of health care improvers worldwide keep up with some of the freshest and most robust thinking and strategies for improving patient care. A 60-minute program is offered live every other week, or you can listen to recordings of the broadcast later at your convenience. WIHI is your opportunity to meet up with colleagues who want to improve patient care and shape a true health reform agenda.

aha news

Federal agencies issue recommendation to prevent needlestick injuries

The Food and Drug Administration, National Institute for Occupational Safety and Health, and Occupational Safety and Health Administration today recommended health care professionals in surgical settings use blunt-tip needles when clinically appropriate to suture muscle and fibrous tissue to help prevent needlestick injuries. "Published studies show that using blunt-tip suture needles reduces the risk of needlestick injuries from suture needles by 69%," the notice states. "Although blunt-tip suture needles currently cost some 70 cents more than their standard suture needle counterparts, the benefits of reducing the risk of serious and potentially fatal bloodborne infections for health care personnel support their use when clinically appropriate."

About one in four needlestick injuries occur in surgical settings. "Published literature indicates that while needlestick injury rates have been decreasing among non-surgical health care providers, this has not been the case among those who work in surgical settings," the notice states.

IOM issues recommendations to speed obesity prevention

A new Institute of Medicine report recommends strategies for the nation to accelerate obesity prevention, which include expanding the role of health care providers, insurers and employers in obesity prevention.

Among other actions, the report recommends health care providers adopt evidence-based or consensus guidelines for prevention, screening, diagnosis and treatment of overweight and obesity; encourage healthy weight gain during pregnancy and breastfeeding; and provide leadership for obesity prevention efforts in their communities. It also calls for public and private health insurance coverage and access provisions to address obesity prevention, screening, diagnosis and treatment.

Other strategies include requiring at least 60-minutes per day of physical education and activity in schools; industry-wide guidelines on which foods and beverages can be marketed to children; and expansion of workplace wellness programs. The report was sponsored by the Robert Wood Johnson Foundation.


AONE, ANA issue principles for collaborative nursing relationships

The American Organization of Nurse Executives and the American Nurses Association last week issued principles for enhancing collaborative relationships between clinical nurses and nurse managers.

The principles focus on three themes: effective communication, authentic relationships, and learning environment and culture. “With the ever-evolving nature of health care delivery, there is a strong need for increased synergies between clinical nurses and nurses in more formal leadership positions,” said AONE President Laura Caramanica. “These newly outlined principles provide a framework to positively impact collaboration.” AONE is an AHA subsidiary.

NJHA project helps reduce non-emergency ED cases

A New Jersey demonstration project helped reduce non-emergency visits at two hospital emergency department by 22%, the New Jersey Hospital Association reports. Supported by a $4.8 million grant from the Centers for Medicare & Medicaid Services and co-led by the NJHA’s Health Research and Educational Trust, the project tested a model for providing alternate non-emergency services to patients who presented to the ED with non-urgent primary care needs.

After being assessed and provided appropriate services, patients with a regular physician were referred to their primary care provider for a follow-up visit, while others were immediately scheduled an appointment at a partnering federally qualified health center. ED staff educated the patients on the appropriate site of care for various health care needs, while case managers stationed at the ED and health centers arranged transportation and support services; identified repeat ED users; tracked compliance with follow-up care; and assisted with referrals for specialty care. The initiative was supported by electronic systems that could schedule appointments and coordinate care.

CMS releases final CoP, regulatory burden reduction rules

The Centers for Medicare & Medicaid Services today released a final regulation to revise the existing Conditions of Participation for hospitals and critical access hospitals, as well as a final rule that addresses more than two dozen regulatory requirements for a broader range of providers, including hospitals, ambulatory surgical centers, end-stage renal disease facilities and durable medical equipment suppliers.

Together, CMS says the rules aim to promote efficiency and transparency, and to reduce health care providers' overall regulatory burden. CMS estimates the rules will save $5 billion over five years. In the CoP rule, CMS finalized its proposal to recognize a single governing body over multiple hospitals within a health system. However, the rule does not allow a multi-hospital system to elect to have a single organized medical staff.

CMS also finalized its proposal to allow CAHs to provide certain services (diagnostic, therapeutic, laboratory, radiology and emergency services) under service arrangements. Previously, CAHs were required to provide these services directly. "Today's announcement provides some much-needed regulatory relief for an overburdened health care system," said AHA President and CEO Rich Umbdenstock. "But CMS misses some important opportunities to further modernize the rules to better reflect how care is organized and delivered today." He noted that AHA is pleased that CMS will allow multi-hospital systems to have one governing board, but expressed disappointment that CMS "did not allow hospitals in such systems to have single integrated medical staff structures if that's how those providers choose to be organized. Hospitals and medical staff members across the country are working together to streamline all areas of operation and CMS should not let antiquated organizational structures stand in the way."

The final rules will be published in the May 16 Federal Register.


Patient Safety Learning Network quality information available online

Slides from the recent AHRQ/HRET South Carolina Workshop have now been posted to the PSLN website. You may access this website by:
1)    Going to http://www.psl-network.org/
2)    Select ‘Quality Indicators’ on right side of page
3)    Select ‘Resources’ tab at the top of the page
4)    Login with the username: quality, password: psln (case sensitive)

About the PSLN: The Agency for Healthcare Research and Quality (AHRQ) and the Health Research & Educational Trust (HRET) are working with state hospital associations and other provider and practitioner organizations to participate in Patient Safety Learning Networks (PSLNs). Learning Network (LN) members will share and learn patient safety best practices—which can inform AHRQ’s research agenda—as well as receive implementation technical assistance over the course of several months from both hospital peers and tool experts. For more information, please contact Jennifer Shaw at jshaw@aha.org.


Health forum webinar on cultural transformation

On Tuesday, June 12 at 12:00 EST, Values Coach Joe Tye will conduct a 90-minute webinar for the American Hospital Association/Health Forum on The Physics of Cultural Transformation. Applying the laws of physics to cultural change in organizations is a light-hearted, and highly illuminating way, to think about building a more positive and productive culture in your organization. Click here for more information or to register.

articles of note

Florence Nightingale's Lessons for Cultural Transformation

By Joe Tye

We remember Florence Nightingale as "the Lady with the Lamp" who founded the profession of nursing. She was also a visionary health care leader who created a blueprint for the hospital as we know it. Nightingale was inspired by a purpose that defines health care as it should be, and her legacy has much to offer as we face the challenges of the early 21st century.

On Nov. 4, 1854, Nightingale led a band of 38 nurses into the Scutari Barrack Hospital in Turkey and into the history books. She'd been called to duty in response to public outcry over the deplorable care being given British casualties of the Crimean War. It was especially galling to the British ego that reporters were making invidious comparisons with superior conditions in French military infirmaries. At Scutari, thousands of sick and wounded soldiers were packed into barren corridors, lying on blood-soaked straw mats. Most of them were still in clothes they’d worn on the battlefield, crawling with lice and vermin. One eyewitness called it "a vast field of suffering and misery."

Infection was rampant, and rats ran wild. There was no ventilation or fresh water, the food was inedible, and there were virtually no drugs or medical supplies. Amputations were performed without anesthesia in full view of other patients, and most amputees quickly succumbed to gangrene. The orderlies were often drunk and refused to empty chamber pots or go near the sickest patients. There was no money for even the most basic essentials. The chief medical officer made it clear that Nightingale was not welcome and did everything he could to undermine her authority. And we think we have a health care crisis!  Read more

Joe Tye is the author of The Florence Prescription. For resources and more information, click here.

10 Assumptions to share with patients to stimulate participation in their care

Zen and the Art of Not Thinking Magically
By Rob Lamberts, MD

Don’t assume anything.

Assumptions can kill.  Assuming something regarding your own health care can cost you money, cause you pain, and yes, even kill you.  Here’s my list of potentially harmful assumptions:

1.  No news is good news
If you have a test done and don’t hear anything about the result, do not assume it is fine.  This assumption kills people.  I have too many patients with too much information flying at me every day for me to catch every important detail.  Sometimes things are missed, but sometimes the results don’t come to our office.   We have trained our patients to expect an email or letter with their results within a certain amount of time, so they sometimes call when the test results don’t come in.  I tell them to do so in the clinical summary sheet I hand out at the end of each visit, but the assumption remains.
Always know what tests are being run, and always get the results of those tests (in writing, if possible).

2.  The doctor will think I am stupid
I often have patients apologizing to me.  They apologize when they have a “weird” symptom, when they “ask too many questions,” when they stop taking a medication due to side-effects, and when they are really, really worried about something.  They seem afraid that I am going to roll my eyes and think of them as “one of those patients” – the kind that I complain about to my office staff.  Read more

Gregory House, MD, RIP

By Robert Wachter, MD

Dr. Gregory House hung up his stethoscope and cane for the last time last night and shuffled off into eternal life in the Land of Reruns. House — the brilliant, misanthropic, drug addicted, my-way-or-the-highway physician — has been an entertaining presence on FOX television for the past eight years. I enjoyed the series and even learned a little medicine. I also took some pride in the show, since House was television’s first “hospitalist”, a term I helped coin and now the fastest-growing specialty in modern medicine.

But as entertaining as he was, House was a throwback to an era in which the antisocial tendencies of some physicians were seen as irrelevant to their doctoring. As medical leaders strive to redefine “the great doctor” of today, House’s departure is both timely and welcome. Read more

calendar of events

June 4-8, 2012    

Premier Breakthroughs Conference, Nashville, TN.  Use this link to register.

June 13, 2012

IHI Expedition: Preventing Obstetrical Adverse Events
Session 2: Structure and Process for System Redesign: 1:30 PM - 2:30 PM
Click here for more information

June 30-31, 2012

IHI Innovation College begins in Cambridge, MA
Learn more or enroll

September 6-12, 2012

IHI Patient Safety Development Program, Cambridge, Massachusetts
Visit the IHI website for program details and enrollment.

Please contact The SCHA Quality and Patient Safety Team if you have questions regarding this newsletter (803.744.3545) or to schedule a Site Visit with our team, please complete the form, located under Tools and Resources.


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