Q1 Newsletter February 28, 2020
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Four Safety Trends for 2020
Patient safety has been a pressing issue in healthcare, spurred by the publication of the landmark reportTo Err Is Human: Building a Safer Health System in 1999. Anne Marie Benedicto, a vice president at healthcare accreditor The Joint Commission, recently shared her thoughts regarding the patient safety outlook for this year. She detailed four ongoing trends she feels will dominate the safety landscape in 2020.
1. Patient advocacy. In 2020, there will be two primary forces at play in patient advocacy, Benedicto says. "Healthcare providers have become more commercial in how they track patients as 'customers,' and patients are becoming more like consumers and using those skills to help navigate the healthcare system. This means more and more patients feel they have a say in what diagnoses mean for them, how they are treated and how they engage with their care teams," she explains.
Health systems and hospitals are increasingly embracing patient advocacy. For example, Benedicto's division at The Joint Commission is working with a Texas-based health system to boost quality improvement skills in neonatal intensive care units. The effort initially focused on clinicians, but the health system wanted to achieve quality and safety gains through empowering patients' families as well.
"Our biggest surprise has been that the organization not only wanted clinicians trained in improvement skills, but also the patient advisory council. We also provided training to parents of babies who were in the NICU for long periods of time. We found that the training gave parents permission to talk about quality issues with clinicians in a way that we had not seen before," Benedicto says.
2. Improving the work environment. Ensuring adequate staffing at healthcare organizations is a key element of patient safety, and health systems, hospitals and physician practices need to step up efforts to care for caregivers, Benedicto says. "This is an ongoing trend because we are already seeing clinician shortages. We are not recruiting and retaining enough medical staff members to meet the demand."
She also stressed how healthcare organization leaders must shape work environments in ways that ease stress on staff members. For example, clinicians often struggle to find equipment or supplies such as medication pumps. It may be a small inconvenience, but repeated occurrences can add frustration and danger to an already stressful day. "The solution to this challenge is to put the proper systems in place, such as supply chain management, that make it easier for staff members to do their work."
3. High reliability. Falls with injury represent an example of a persistent patient safety problem that is actually a missed high-reliability opportunity, Benedicto says. "Often, an organization will target falls every couple of years, saying that their fall rates are unacceptable. They come up with a solution, put it in place, it lasts for a few months, then the old practices creep back."
There needs to be an understanding that persistent problems in healthcare persist because they are complex, and they require structured and sustained solutions, she says. "The use of highly reliable process tools is necessary to get to zero harm. It's not just a matter of picking the easiest solution and putting it in place. It's a matter of stepping back and figuring out why the problem is happening, finding out why it is persisting, looking at the contributing factors, then developing solutions."
4. Surgery center safety
Surgery centers need to adopt patient safety protocols that have become common at hospitals. With increasing numbers of procedures shifting from the hospital setting to ambulatory surgery centers, improving safety at these centers will be a top concern in 2020, Benedicto predicts.
"If patients can get care in less complicated settings, then those options should be pursued. However, this opportunity comes with a risk. Many surgical centers do not have the same levels of protection that hospitals have. For example, more and more spine surgeries are happening in surgical centers, and those centers may not know what to do when there is a serious complication."
"Over the past decade, hospitals have been investing in process improvement and improvement methodologies, so they could make their care as safe as possible. That same type of trend needs to happen in other settings of care such as surgery centers, Benedicto says. "Achieving zero harm not only requires embracing high reliability as a goal, it means making sure that resources are in place to get to that goal—stronger improvement skills, stronger safety culture, and leadership commitment to zero harm."
—Adapted from "Four Patient Safety Trends for 2020," HealthLeaders, by Christopher Cheney, Jan. 8, 2020.
Quality Patient Outcomes Begin With Trust
The forces shaping the future of healthcare are putting increasing pressure on all players in the medical community to forge more effective partnerships and collaborations if they are to achieve quality patient outcomes at reduced cost. The foundation of these successful partnerships and collaborations is trust.
Trust can be simply defined as an outcome based on repeated interactions, characterized by specific behaviors that drive high performance. Research has shown that trust isn’t a given, but has to be earned. Further, once compromised, it is not easily restored. So, what does it take to trust and be trusted? Here’s a look at some trust-building practices.
This is saying what you mean and meaning what you say. We tend to admire people like this because they bring decisiveness and direction to situations where it’s needed. Straightforwardness is essential when, for example, clinicians are giving a diagnosis, prescribing a treatment plan or offering a team member feedback. It is a key trait whenever critical business decisions need to be made, standards upheld or policies enforced. It is essential for the governance of healthcare systems, which relies on the strength of the relationship between physicians and administrators.
Trust grows when your actions are aligned with your thoughts, values and beliefs. In other words, when you’re straightforward with people, their trust increases because they never have to guess what your intentions are.
Transitioning to a leadership role in any organization is fraught with pitfalls. This is especially true for physicians ascending to leadership in the governance of a hospital or healthcare system. The independent, authoritative approach that often works well for physician practitioners falls flat when it comes to leading organizations at a high-level. To succeed in this more complex kind of leadership, physicians need to cultivate the quality of openness.
Leaders who internalize the concept of openness have the psychological hardiness to interact with others in ways that make them want to open up too. So when problems arise in the trenches, when timelines slip or mistakes are made, the probability that their colleagues will share relevant information before it becomes a crisis is raised. Time and money are saved, objectives are met, trusting relationships are solidified and everybody wins.
Mistakes happen. People forget, drop the ball and break agreements. Leaders encounter any or all of these situations in the space of a day, sometimes within themselves. How they respond reflects their level of acceptance: the ability to attack the problem and not the person; to consciously work to uphold the dignity of others even when justifiably unhappy with them.
People who make mistakes, voice resentments, dig in their heels and otherwise make a leader’s job difficult are just that—people. Bias can be subtle and insidious, but its counterpart, acceptance, is a skill that can be learned. The payoff is psychological safety and the absence of fear, which makes it possible for people to engage in all of the other trust-building practices.
Making and keeping promises is the foundation of reliability and it is essential to good leadership and good business. The absence of reliability leads to breakdowns in the form of conflict and loss of credibility. Reliability is a practice that distinguishes the “go-to” people—those who are always busy, yet always have the energy to take on the next thing. They are counted on because they inspire confidence that they will come through again and again on the promises they make. Trust grows when you make and keep your promises.
—Adapted from "The Four Keys to Better-Performing Collaborations," O'Brien Group.