Wow! Today is a big day for me, and I want to share it with you. The Quality Playbook has been released!
What Makes This Book So Different?
Unlike many authors, I’m not an armchair sort of guy – I’ve been on the front lines just like you.
I’ve taken everything I know about making quality & safety programs work and created a Playbook for nailing it.
It doesn’t matter if you’re in a hospital, medical group, or even the system office – the tools, tactics, and plays in The Quality Playbook can be used everywhere.
If I Can Do It, You Can Too!
Here’s what no one else is telling you about implementing a quality program like the one I’m describing…
Quality improvement programs often fail simply because they are poorly focused. Many QI programs try to do too much; they try to work on too many small, low-impact, department-level QI projects.
Avoid The 1,001 Quality Improvement Project Trap
The 1,001 QI project trap happens when your organization charters improvement QI projects using a bottom-up approach—essentially allowing departments to charter any QI project they feel is important.
This approach results in hundreds of small, low-impact projects. They bring little improvement value to the organization, take up a lot of energy, and stretch quality department resources past their limits.
Quality leaders feel like they’re doing everything they can to improve quality, but are overwhelmed by so many QI projects, and see little improvement for all of their effort.
You might think it would be just the opposite, but time and time again, we’ve run the numbers—and when there are too many QI projects to support, they fail to achieve results.
So, your first step is to keep the number of QI projects manageable, while at the same time you need to achieve your goal to improve care for as many patients as possible. I know this sounds like a no-win situation, but there is a way to manage a reasonable number of projects while improving care for the majority of your patients.
Here are two ways to focus your improvement efforts that get HUGE RESULTS.
Medication errors continue to be the most common errors in medicine. And this is after decades of work trying to fix this problem. We’ve used bar coding, double checks, triple checks, and no interruption zones, just to name a few. And they all help. But the problem of medical errors still continues.
I taught a one day workshop on Implementing Quality Programs for the Fall Institute of the American Association of Physician Leaders, formerly the American College of Physician Executives (ACPE) this past weekend.
We spent part of the day reviewing the major components in an Annual Quality & Safety Plan. We put the redesign of the medication administration process as a priority both within the Safety section and the Process Improvement section.
We did this because of the frequency of medication errors that persists in our hospitals – on average a hospitalized patient encounters one or more medication errors per day.
We also reviewed a template for a Medication Safety Dashboard. You know my favorite line by now: The only way to manage quality is to measure and report on quality. So here is a template for doing just that. It can be used throughout any organization, from the front line to the board room, to report and manage medication related errors. It’s also a great tool for physician engagement.
I’ve used some version of this Medication Safety Dashboard in many organizations. Click here to download an excel file and of course, feel free to customize as needed.
I would love to here from you. Do you have a medication safety dashboard you would like to share? If you do, just send me an email and I’ll set up a special page for sharing.
My Grandpa was one of my heroes. He had survived WWI, the Great Depression, and WWII, and yet, he still wore a smile on his face everyday. And he loved his grandkids, and his great grandkids.
I was taking the second part of the boards one day when the dean came into the auditorium and pulled me outside.
She said, “your grandpa has been in an accident. He’s over at St. Mary’s. Go to him and we’ll worry about this test later.”
I had just finished a cardiology rotation at this hospital and one of my professors was Grandpa’s cardiologist. This gave me a sense of hope that Grandpa would be OK.
My professor said, “your Grandpa has a pneumothorax (a collapsed lung); they put in a chest tube to reinflate it; his heart failure is stable; we fully expect that he will make a full recovery.”
I was so grateful my Grandpa had a good prognosis.
The next several days went off without a hitch, but then … three days later my professor called me aside, and he had a grave look on his face.
At no other time in our careers has healthcare felt this tumultuous. Any position in the C-Suite seems to come with sleepless nights, constant challenges, a shifting landscape, hundreds of priorities, and too many questions that don’t seem to have answers. And like you, I’ve always benefited from the advice and counsel of my colleagues.
This is why I’ve created Healthcare’s INNER CIRCLE. The INNER CIRCLE is a group of peers – senior healthcare executives – who meet regularly to discuss pressing issues – advise one another – brainstorm solutions together – and share innovations and best practices.
The INNER CIRCLE is more than just meetings; it is an opportunity to network and develop deep professional relationships with colleagues throughout the country. You will also have the chance to share information with one another in between meetings. And to ensure group members are comfortable discussing any and all issues, your competitors will not be allowed to join once your registration is received. But, that also means that if one of your competitors joins first, you will be unable to join.
I’ve prepared a brochure that explains everything. Access your copy online or download a pdf here. All INNER CIRCLE groups are limited in size so don’t delay. Registration opens on Monday, November 2 and closes at midnight December 15. I hope you’ll join us!
John Byrnes MD
President & CEO, HCIC
PS: Have you ever gone to a meeting and been bombarded by consultant’s sales pitches? That won’t happen at INNER CIRCLE meetings. That’s my personal promise to you.
Registration opens Monday, November 2, 2015
Healthcare’s INNER CIRCLE
The controversy about healthcare’s rating agencies continues. Whether it’s that we don’t like their choice of measures, or how the data is risk adjusted, the most recent complaints are that there are too many of them and they all measure different things.
Regardless, rating agencies aren’t going away. Their measures and methods are becoming more sophisticated, and patient interest in hospital quality information continue to increase. And frankly, many quality leaders find their information useful and informative – some such as myself will use this information to help develop our quality and safety priorities for the near term. One such source is Leapfrog’s Hospital Safety Score.
Why You Should Follow Your Hospital Safety Score
First, Leapfrog’s Hospital Safety Score is targeted at consumers and is intended to help them “select a hospital that is prepared to protect them from harm and error.” This is reason enough to follow your score. It seems that anything less than an A, and possibly a B would be embarrassing. It’s also hard to explain when asked why your organization has a C, D, or F by the media, your board, your community leaders, your employers, and your health plan partners.
We have a healthcare crisis of epic proportions – a patient safety crisis. It only came to light in the 1990’s, but its likely existed in all of our healthcare organizations for our entire careers. But so far, we have only made a dent in the problem. Our patients know this and they are afraid, their families are afraid, and when we’re honest with ourselves, many of us worry about being hospitalized in our own organizations.
Here are the sobering statistics:
- 210,000 to 440,000 people lose their lives each year to medical errors in hospitals, according to research conducted by J. James and published in the Journal of Patient Safety.
- Medical errors may now rank as the third leading cause of death in the United States; only cardiovascular disease and cancer takes more lives each year.
- Preventable Adverse Events (PAEs) account for “roughly one-sixth of all deaths that occur in the U.S. each year.
- More than 1,000 people die every day from preventable accidents in hospitals.
- Preventable medical errors, in the form of “oops”, errors of omission, complications, readmissions, and avoidable mortality cost the US economy untold billions each year.
- The average hospitalized patient experiences 1.5 medication errors daily and medication errors are the most common form of error.
- There are more than 6 million patient injuries per year due to errors.
- 40 percent of hospitals received a C, D, or F on Leapfrog’s Safety Score.
- According to the Leapfrog Group, “since Fall 2014, (hospital) performance on safety outcomes – including preventing errors, accidents, and infections – has not significantly improved.”
Here’s the first of more than a dozen clinical dashboards that I’ll share in the coming weeks. Why? Because the pressure on physicians and hospitals to manage clinical outcomes increased exponentially when ProPublica published surgeon complication rates on the web in July.
This dashboard is for total knee replacement (click here to download an excel file). It’s one of eight surgical procedures reported on the Surgeon Scorecard and is also a high volume procedure in many hospitals. It’s also included in your hospital’s Healthgrades ratings and Truven 100 Top Hospital profiles.
I’ve used this dashboard for over 15 years. It has always been a critical part of my quality programs because it provides all of the important information needed to manage the quality of care for total knee replacement patients. Just as administrators use a monthly financial report to manage their budgets, the total knee replacement dashboard becomes the monthly report to manage quality and safety for these patients.
The Total Knee Dashboard contains several important sections:
- Process measures. These represent treatments recommended by evidence based medicine guidelines and order sets.
- Outcome measures. These are patient outcomes such as complications, readmission rates, mortality and LOS. In this example, only rates for “not present on admission” are included, because we only want to know what occurred during the hospital stay.
- Core measures.
- Comprehensive rates for Healthgrades complications and the HealthGrades star rating.
- Direct costs divided into the usual cost buckets. Implant costs could also be included here.
- Estimates for the cost of complications based on the complication rates reflected in the dashboard.
Where You Can Get The Data for The Dashboard
Most of the dashboard data comes directly out of your finance, coding, and/or cost accounting systems. This is one of the best kept secrets in healthcare. Frankly, there is enough data in these systems, (that can be converted into clinical dashboards), to keep you busy for the next 10 years. I’ve used this type of administrative data for the past 20 years and it’s been key to all of the 100 Top Hospital, 15 Top Health System, and Healthgrades designations.
I’ll post a second dashboard next week. Until then, if you have any questions about this dashboard feel free to email me at firstname.lastname@example.org and I’ll get back to you as quickly as possible.
PS: The data contained in the dashboard is for demonstration purposes only.
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