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Beauvais B, Dolezel D, Ramamonjiarivelo Z. An Exploratory Analysis of the Association between Hospital Quality Measures and Financial Performance. Healthcare (Basel) 2023; 11:2758. [PMID: 37893832 PMCID: PMC10606508 DOI: 10.3390/healthcare11202758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 10/10/2023] [Accepted: 10/16/2023] [Indexed: 10/29/2023] Open
Abstract
Hospitals are perpetually challenged by concurrently improving the quality of healthcare and maintaining financial solvency. Both issues are among the top concerns for hospital executives across the United States, yet some have questioned if the efforts to enhance quality are financially sustainable. Thus, the aim of this study is to examine if efforts to improve quality in the hospital setting have a corresponding association with hospital profitability. Recent and directly relevant research on this topic is very limited, leaving practitioners uncertain about the wisdom of their investments in interventions which enhance quality and patient safety. We assessed if eight different quality measures were associated with our targeted measure of hospital profitability: the net patient revenue per adjusted discharge. Using multivariate regression, we found that improving quality was significantly associated with our targeted measure of hospital profitability: the net patient revenue per adjusted discharge. Significant findings were reported for seven of eight quality measures tested, including the HCAHPS Summary Star Rating (p < 0.001), Hospital Compare Overall Rating (p < 0.001), All-Cause Hospital-Wide Readmission Rate (p < 0.01), Total Performance Score (p < 0.001), Safety Domain Score (p < 0.01), Person and Community Engagement Domain Score (p < 0.001), and the Efficiency and Cost Reduction Score (p < 0.001). Failing to address quality and patient safety issues is costly for US hospitals. We believe our findings support the premise that increased attention to the quality of care delivered as well as patients' perceptions of care may allow hospitals to accentuate profitability and advance a hospital's financial position.
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Affiliation(s)
- Brad Beauvais
- School of Health Administration, Texas State University, Encino Hall, Room 250A, 601 University Drive, San Marcos, TX 78666, USA;
| | - Diane Dolezel
- Health Informatics & Information Management Department, Texas State University, Round Rock, TX 78665, USA;
| | - Zo Ramamonjiarivelo
- School of Health Administration, Texas State University, Encino Hall, Room 250A, 601 University Drive, San Marcos, TX 78666, USA;
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Kurihara M, Watari T, Kosaka S, Enomoto K, Kimura T, Taniguchi K, Watanuki S, Nagoshi K, Koizumi S. Root cause analysis to identify major barriers to the promotion of patient safety in Japan. JOURNAL OF PATIENT SAFETY AND RISK MANAGEMENT 2022. [DOI: 10.1177/25160435221144134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objectives Despite existing patient safety measures, both outside and inside hospitals, barriers to patient safety prevail. We aimed to identify the current contributory factors to patient safety in Japan. Methods This qualitative study included nine expert Japanese health care providers working both inside and outside hospitals. These participants, who included six physicians, one nurse, one pharmacist, and one physical therapist, work across a broad spectrum in government policy and public health, academia, and safety management. Root cause analysis using the online Kawakita Jiro method (KJ method or affinity diagram) was conducted. We labeled and summarized the classification in a fishbone diagram to elucidate barriers to patient safety in Japan. Results We identified specific factors in six main groups: the hospital system, education, law and policy, culture and society, patient centricity, and multidisciplinary cooperation. Quality of care, patient engagement, and shortage of patient safety specialists were crucial factors for multiple groups. Conclusions This study clarifies components of patient safety in Japan and provides basic data for promoting comprehensive patient safety in the future. Periodic root cause analysis of comprehensive patient safety issues can help develop strategies to promote patient safety at both the hospital and national levels.
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Affiliation(s)
- Masaru Kurihara
- Department of Patient Safety, Nagoya University Hospital, Aichi, Japan
| | - Takashi Watari
- General Medicine Center, Shimane University Hospital, Shimane, Japan
| | - Shintaro Kosaka
- Department of General Internal Medicine, Nerima Hikarigaoka Hospital, Tokyo, Japan
| | - Kiichi Enomoto
- Department of Pharmacy, Nerima Hikarigaoka Hospital, Tokyo, Japan
| | - Toru Kimura
- Department of Rehabilitation, Nerima Hikarigaoka Hospital, Tokyo, Japan
| | - Kaori Taniguchi
- Department of Environmental Medicine and Public Health, Shimane University, Shimane, Japan
| | - Satoshi Watanuki
- Department of General Internal Medicine, Tama General Hospital, Tokyo, Japan
| | - Kiwamu Nagoshi
- Department of Environmental Medicine and Public Health, Shimane University, Shimane, Japan
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Hussein M, Pavlova M, Ghalwash M, Groot W. The impact of hospital accreditation on the quality of healthcare: a systematic literature review. BMC Health Serv Res 2021; 21:1057. [PMID: 34610823 PMCID: PMC8493726 DOI: 10.1186/s12913-021-07097-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 09/23/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Accreditation is viewed as a reputable tool to evaluate and enhance the quality of health care. However, its effect on performance and outcomes remains unclear. This review aimed to identify and analyze the evidence on the impact of hospital accreditation. METHODS We systematically searched electronic databases (PubMed, CINAHL, PsycINFO, EMBASE, MEDLINE (OvidSP), CDSR, CENTRAL, ScienceDirect, SSCI, RSCI, SciELO, and KCI) and other sources using relevant subject headings. We included peer-reviewed quantitative studies published over the last two decades, irrespective of its design or language. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, two reviewers independently screened initially identified articles, reviewed the full-text of potentially relevant studies, extracted necessary data, and assessed the methodological quality of the included studies using a validated tool. The accreditation effects were synthesized and categorized thematically into six impact themes. RESULTS We screened a total of 17,830 studies, of which 76 empirical studies that examined the impact of accreditation met our inclusion criteria. These studies were methodologically heterogeneous. Apart from the effect of accreditation on healthcare workers and particularly on job stress, our results indicate a consistent positive effect of hospital accreditation on safety culture, process-related performance measures, efficiency, and the patient length of stay, whereas employee satisfaction, patient satisfaction and experience, and 30-day hospital readmission rate were found to be unrelated to accreditation. Paradoxical results regarding the impact of accreditation on mortality rate and healthcare-associated infections hampered drawing firm conclusions on these outcome measures. CONCLUSION There is reasonable evidence to support the notion that compliance with accreditation standards has multiple plausible benefits in improving the performance in the hospital setting. Despite inconclusive evidence on causality, introducing hospital accreditation schemes stimulates performance improvement and patient safety. Efforts to incentivize and modernize accreditation are recommended to move towards institutionalization and sustaining the performance gains. PROSPERO registration number CRD42020167863.
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Affiliation(s)
- Mohammed Hussein
- Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
- Department of Hospitals Accreditation, Saudi Central Board for Accreditation of Healthcare Institutions (CBAHI), Riyadh, Saudi Arabia.
| | - Milena Pavlova
- Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Mostafa Ghalwash
- Department of Hospitals Accreditation, Saudi Central Board for Accreditation of Healthcare Institutions (CBAHI), Riyadh, Saudi Arabia
| | - Wim Groot
- Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Top Institute Evidence-Based Education Research (TIER), Maastricht University, Maastricht, The Netherlands
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Association Between Hospital Accreditation and Outcomes: The Analysis of Inhospital Mortality From the National Claims Data of the Universal Coverage Scheme in Thailand. Qual Manag Health Care 2021; 29:150-157. [PMID: 32590490 DOI: 10.1097/qmh.0000000000000256] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND In Thailand, hospital accreditation (HA) is widely recognized as one of the system tools to promote effective operation of universal health coverage. This nationwide study aims to examine the relationship between accredited statuses of the provincial hospitals and their mortality outcomes. METHOD A 5-year retrospective analysis of the Universal Coverage Scheme's claim dataset was conducted, using 1 297 869 inpatient discharges from 76 provincial hospital networks under the Ministry of Public Health. Mortality outcomes of 3 major acute care conditions, including acute myocardial infarction, acute stroke, and sepsis, were selected. RESULTS Using generalized estimating equations to adjust for area-based control variables, hospital networks with HA-accredited provincial hospitals showed significant associations with lower standardized mortality ratios of acute stroke and sepsis. CONCLUSION Our findings added supportive evidence that HA, as an organizational and health system management tool, could help promote hospital quality and safety in a developing country, leading to better outcomes.
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Al-Sayedahmed H, Al-Tawfiq J, Al-Dossary B, Al-Yami S. Impact of Accreditation Certification on Improving Healthcare Quality and Patient Safety at Johns Hopkins Aramco Healthcare. GLOBAL JOURNAL ON QUALITY AND SAFETY IN HEALTHCARE 2021; 4:117-122. [PMID: 37261062 PMCID: PMC10228990 DOI: 10.36401/jqsh-21-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/18/2021] [Accepted: 06/08/2021] [Indexed: 06/02/2023]
Abstract
Introduction Accreditation gained worldwide attention as a means of increasing awareness of medical errors, improving healthcare quality, and ensuring a culture of safety. Johns Hopkins Aramco Healthcare has been accredited by Joint Commission International (JCI) since 2002. The aim of this study was to evaluate the effect of the accreditation process on healthcare quality performance by maintaining compliance with the requirements of JCI's international patient safety goals (IPSGs) over a 4-year period and how this was reflected by patient safety and satisfaction. Methods In Johns Hopkins Aramco Healthcare, the six JCI IPSGs are part of the as key performance indicators that reflect organizational performance in different services. For this study, data from January 2017 to the end of 2020 were analyzed apropos performance and correlation with patient experience. Results The IPSGs data analysis showed that general performance was maintained above the target values (> 90%-96%) in all IPSGs. This was significantly reflected in high patient satisfaction during this period, with Pearson correlation of 0.9 and p < 0.000. Conclusions Maintaining accreditation status over time enhances patients' confidence in an organization and its leadership as providers of safe, quality healthcare services. However, individual staff perception, commitment, accountability, and responsibility have an influence on performance, the organization's accreditation status, and patients' experiences.
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Affiliation(s)
- Huda Al-Sayedahmed
- Department of Quality and Patient Safety, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Jaffar Al-Tawfiq
- Department of Quality and Patient Safety, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Basma Al-Dossary
- Department of Quality and Patient Safety, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Saeed Al-Yami
- Department of Quality and Patient Safety, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
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Tedesco D, Moghavem N, Weng Y, Fantini MP, Hernandez-Boussard T. Improvement in Patient Safety May Precede Policy Changes: Trends in Patient Safety Indicators in the United States, 2000-2013. J Patient Saf 2021; 17:e327-e334. [PMID: 32217926 PMCID: PMC8194008 DOI: 10.1097/pts.0000000000000615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Quality and safety improvement are global priorities. In the last two decades, the United States has introduced several payment reforms to improve patient safety. The Agency for Healthcare Research and Quality (AHRQ) developed tools to identify preventable inpatient adverse events using administrative data, patient safety indicators (PSIs). The aim of this study was to assess changes in national patient safety trends that corresponded to U.S. pay-for-performance reforms. METHODS This is a retrospective, longitudinal analysis to estimate temporal changes in 13 AHRQ's PSIs. National inpatient sample from the AHRQ and estimates were weighted to represent a national sample. We analyzed PSI trends, Center for Medicaid and Medicare Services payment policy changes, and Inpatient Prospective Payment System regulations and notices between 2000 and 2013. RESULTS Of the 13 PSIs studied, 10 had an overall decrease in rates and 3 had an increase. Joinpoint analysis showed that 12 of 13 PSIs had decreasing or stable trends in the last 5 years of the study. Central-line blood stream infections had the greatest annual decrease (-31.1 annual percent change between 2006 and 2013), whereas postoperative respiratory failure had the smallest decrease (-3.5 annual percent change between 2005 and 2013). With the exception of postoperative hip fracture, significant decreases in trends preceded federal payment reform initiatives. CONCLUSIONS National in-hospital patient safety has significantly improved between 2000 and 2015, as measured by PSIs. In this study, improvements in PSI trends often proceeded policies targeting patient safety events, suggesting that intense public discourses targeting patient safety may drive national policy reforms and that these improved trends may be sustained by the Center for Medicare and Medicaid Services policies that followed.
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Affiliation(s)
- Dario Tedesco
- Department of Medicine, Center for Biomedical Informatics Research, Stanford University, Stanford, California
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Nuriel Moghavem
- Department of Neurology, Stanford School of Medicine, Stanford University, Palo Alto
| | - Yingjie Weng
- Department of Medicine, Center for Biomedical Informatics Research, Stanford University, Stanford, California
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Tina Hernandez-Boussard
- Department of Medicine, Center for Biomedical Informatics Research, Stanford University, Stanford, California
- Department of Surgery, Stanford University, Stanford, California
- Department of Biomedical Data Sciences, Stanford University, Stanford, California
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Liao HH, Rau HH, Hsu PC, Wang PC. Development of the Joint Commission of Taiwan's Smart Healthcare Standard. J Med Syst 2021; 45:67. [PMID: 33977381 DOI: 10.1007/s10916-021-01738-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 04/05/2021] [Indexed: 11/30/2022]
Abstract
It is well known that information technology (IT) can play a pivotal role in enhancing healthcare quality and patient safety. The use of computational science to enhance the capabilities of hospital information systems helps deliver enhanced healthcare quality. "Smart healthcare" has become a popular term, reflecting the level of IT involvement in healthcare services. However, each hospital has a different level of IT development, and no clear definition of smart healthcare exists. In this study, we aimed to develop and validate a survey standard to evaluate the level of IT involvement in hospitals. The quality improvement task force of the Joint Commission of Taiwan (QITF-JCT) conducted a systematic literature review to identify the key elements of major healthcare IT functions. The modified Delphi technique was used to review the importance and appropriateness of these elements through an expert panel, and the JCT Smart Healthcare Standard version 1.0 (JCT-SHS 1.0) was drafted. A total of 40 healthcare quality improvement campaign (HQIC) application projects in 2018 were selected for evaluating nine key dimensions of hospital functions: security, digitization, automation, interconnection, connectivity, interoperability, mobility, computation, and artificial intelligence. The standard can be used smart hospital evaluation and executed by two experts by on-site evaluation and rating as three-level scale (norm, excellent, and innovative). The internal consistency and inter-rater reliability were investigated using Cronbach's α and kappa statistics, respectively. This standard was evaluated by using 40 HQIC application projects. The Cronbach's α values were in the range of 0.74-0.92, indicating the good internal consistency of the JCT-SHS 1.0 among the nine IT dimensions. The kappa correlation coefficients were 0.68 for security (p = 0.027), 0.47 for digitization (p = 0.042), 0.21 for automation (p = 0.048), 0.82 for interconnection (p = 0.014), 0.35 for connectivity (p = 0.036), 0.28 for interoperability (p = 0.042), 0.71 for mobility (p = 0.016), 0.47 for computation (p = 0.029), and 0.34 for artificial intelligence (p = 0.033), revealing moderate inter-rater reliability. The validation data indicated that the JCT-SHS 1.0 is a consistent and reliable instrument for evaluating the levels of IT development in the hospitals. Healthcare providers, external accreditation bodies, and policymakers may use the JCT-SHS 1.0 to assess and plan their organizational and system-wise IT strategy.
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Affiliation(s)
- Hsun-Hsiang Liao
- Joint Commission Taiwan, 5F., No.31, Sec. 2, Sanmin Rd., Banqiao Dist., New Taipei City, Taiwan
| | - Hsiao-Hsien Rau
- Joint Commission Taiwan, 5F., No.31, Sec. 2, Sanmin Rd., Banqiao Dist., New Taipei City, Taiwan
| | - Pei-Chia Hsu
- Joint Commission Taiwan, 5F., No.31, Sec. 2, Sanmin Rd., Banqiao Dist., New Taipei City, Taiwan
| | - Pa-Chun Wang
- Joint Commission Taiwan, 5F., No.31, Sec. 2, Sanmin Rd., Banqiao Dist., New Taipei City, Taiwan. .,Quality Management Center, Cathay General Hospital, Taipei, Taiwan. .,Fu-Jen Catholic University School of Medicine, New Taipei City, Taiwan. .,Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
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Hincapie AL, Alyami F, Alrasheed M, Hegener M, Beaton C, O'Brien L, MacKinnon NJ. Continuous quality improvement regulations for community pharmacy practice in the United States. J Am Pharm Assoc (2003) 2021; 61:470-475.e2. [PMID: 33722542 DOI: 10.1016/j.japh.2021.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 02/05/2021] [Accepted: 02/12/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES In the United States, medication errors are considered to be the cause of 7000 deaths annually. Continuous quality improvement (CQI) is a management process that focuses on continually and systematically evaluating the organization's work process. In community pharmacy, CQI leads to enhanced patient safety through a reduction in medication errors and quality-related events (QREs). There is limited information about the variations in CQI regulations required by State Boards of Pharmacy (SBPs) for community pharmacy across the country. The objective of this study is to comprehensively describe CQI regulations required by SBPs for community pharmacy practice in the United States. METHODS This was a cross-sectional study. Information regarding SBPs community pharmacy CQI regulations was collected electronically by surveying a representative of each SBP. In addition, a review of State Pharmacy Laws published online complemented the survey data. The percentage of states with CQI regulations for community pharmacy was estimated. RESULTS Of the 50 Boards, 16 require pharmacies to maintain CQI programs to monitor and prevent QREs in community pharmacy. The most common elements of CQI programs include the management of known, alleged, and suspected medication errors that reach the patient (73%) and regular reviews of the pharmacy's aggregate data of medication errors or incidents (73%). The North Dakota SBP regulation is the most comprehensive, followed by that of Iowa, Maryland, Massachusetts, and Montana. CONCLUSION There is wide variation among SBP CQI regulations for community pharmacy practice. Standardization of CQI programs across Boards, including a national database for reporting medication errors and QREs would enhance patient safety.
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Shaw J, Bastawrous M, Burns S, McKay S. System Issues Leading to "Found-on-Floor" Incidents: A Multi-Incident Analysis. J Patient Saf 2021; 17:30-35. [PMID: 27811588 DOI: 10.1097/pts.0000000000000294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Although attention to patient safety issues in the home care setting is growing, few studies have highlighted health system-level concerns that contribute to patient safety incidents in the home. Found-on-floor (FOF) incidents are a key patient safety issue that is unique to the home care setting and highlights a number of opportunities for system-level improvements to drive enhanced patient safety. METHODS We completed a multi-incident analysis of FOF incidents documented in the electronic record system of a home health care agency in Toronto, Canada, for the course of 1 year between January 2012 and February 2013. RESULTS Length of stay (LOS) was identified as the cross-cutting theme, illustrating the following 3 key issues: (1) in the short LOS group, a lack of information continuity led to missed fall risk information by home care professionals; (2) in the medium LOS group, a lack of personal support worker/carer training in fall prevention led to inadequate fall prevention activity; and (3) in the long LOS group, a lack of accountability policy at a system level led to a lack of fall risk assessment follow-up. CONCLUSIONS Our study suggests that considering LOS in the home care sector helps expose key system-level issues enabling safety incidents such as FOF to occur. Our multi-incident analysis identified a number of opportunities for system-level changes that might improve fall prevention practice and reduce the likelihood of FOF incidents in the home. Specifically, investment in electronic health records that are functional across the continuum of care, further research and understanding of the training and skills of personal support workers, and enhanced incentives or more punitive approaches (depending on the circumstances) to ensure accountability in home safety will strengthen the home care sector and help prevent FOF incidents among older people.
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Affiliation(s)
- James Shaw
- From the Institute for Health System Solutions and Virtual Care, Women's College Hospital
| | | | - Susan Burns
- VHA Home Health Care, Toronto, Ontario, Canada
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Yuce TK, Chung JW, Barnard C, Bilimoria KY. Association of State Certificate of Need Regulation With Procedural Volume, Market Share, and Outcomes Among Medicare Beneficiaries. JAMA 2020; 324:2058-2068. [PMID: 33231664 PMCID: PMC7686860 DOI: 10.1001/jama.2020.21115] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
IMPORTANCE Certificate of need laws provide state-level regulation of health system expenditure. These laws are intended to limit spending and control hospital expansion in order to prevent excess capacity and improve quality of care. Several states have recently introduced legislation to modify or repeal these regulations, as encouraged by executive order 13813, issued in October 2017 by the Trump administration. OBJECTIVE To evaluate the difference in markers of hospital activity and quality by state certificate of need status. These markers include hospital procedural volume, hospital market share, county-level procedures per 10 000 persons, and patient-level postoperative outcomes. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional study involving Medicare beneficiaries aged 65 years or older who underwent 1 of the following 10 procedures from January 1, 2016, through November 30, 2018: total knee or hip arthroplasty, coronary artery bypass grafting, colectomy, ventral hernia repair, lower extremity vascular bypass, lung resection, pancreatic resection, cystectomy, or esophagectomy. EXPOSURES State certificate of need regulation status as determined by data from the National Conference of State Legislatures. MAIN OUTCOMES AND MEASURES Outcomes of interest included hospital procedural volume; hospital market share (range, 0-1; reflecting 0%-100% of market share); county-level procedures per 10 000 persons; and patient-level postoperative 30-day mortality, surgical site infection, and readmission. RESULTS A total of 1 545 952 patients (58.0% women; median age 72 years; interquartile range, 68-77 years) at 3631 hospitals underwent 1 of the 10 operations. Of these patients, 468 236 (30.3%) underwent procedures in the 15 states without certificate of need regulations and 1 077 716 (69.7%) in the 35 states with certificate of need regulations. The total number of procedures ranged between 729 855 total knee arthroplasties (47.21%) and 4558 esophagectomies (0.29%). When comparing states without vs with certificate of need regulations, there were no significant differences in overall hospital procedural volume (median hospital procedure volume, 241 vs 272 operations per hospital for 3 years; absolute difference, 31; 95% CI, -27.64 to 89.64; P = .30). There were no statistically significant differences between states without vs with certificate of need regulations for median hospital market share (median, 28% vs 52%; absolute difference, 24%; 95% CI, -5% to 55%; P = .11); procedure rates per 10 000 Medicare-eligible population (median, 239.23 vs 205.41 operations per Medicare-eligible population in 3 years; absolute difference, 33.82; 95% CI, -84.08 to 16.43; P = .19); or 30-day mortality (1.17% vs 1.33%, odds ratio [OR], 1.04; 95% CI, 0.93 to 1.16; P = .52), surgical site infection (1.24% vs 1.25%; OR, 0.93; 95% CI, 0.83 to 1.04; P = .21), or readmission rate (9.69% vs 8.40%; OR, 0.80; 95% CI, 0.57 to 1.12; P = .19). CONCLUSIONS AND RELEVANCE Among Medicare beneficiaries who underwent a range of surgical procedures from 2016 through 2018, there were no significant differences in markers of hospital volume or quality between states without vs with certificate of need laws. Policy makers should consider reevaluating whether the current approach to certificate of need regulation is achieving the intended objectives and whether those objectives should be updated.
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Affiliation(s)
- Tarik K. Yuce
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Jeanette W. Chung
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Cynthia Barnard
- Department of Quality Strategies, Northwestern Memorial Hospital, Chicago, Illinois
| | - Karl Y. Bilimoria
- Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery and Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Department of Quality Strategies, Northwestern Memorial Hospital, Chicago, Illinois
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Does Patient Safety Pay? Evaluating the Association Between Surgical Care Improvement Project Performance and Hospital Profitability. J Healthc Manag 2020; 64:142-154. [PMID: 31999263 DOI: 10.1097/jhm-d-17-00208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
EXECUTIVE SUMMARY Financial issues are top concerns for hospital executives. Evolving reimbursement structures focused on value provide an incentive to fully understand how patient safety performance and financial outcomes are connected. To that end, this study examines the relationships between Surgical Care Improvement Project (SCIP) measurements and hospital financial performance.Using multinomial logistic regression, we determined the association between hospital patient safety performances via analysis of eight prophylaxis data elements drawn from the archived Hospital Compare data. The measures are SCIP-Inf-1 (prophylactic antibiotic prophylaxis received within 1 hr prior to surgical incision), SCIP-Inf-2 (prophylactic antibiotic selection for surgical patients), SCIP-Inf-3 (prophylactic antibiotics discontinued within 24 hr after surgery end time), SCIP-Inf-4 (cardiac surgery patients with controlled 6 A.M. postoperative serum glucose management), SCIP-Inf-9 (urinary catheter removal postsurgery), SCIP-Inf-Card-2 (beta-blocker during the perioperative period), and SCIP-Inf-VTE-2 (venous thromboembolism prophylaxis). Data from the American Hospital Association provided two dimensions of organizational profitability: operating margin and net patient revenue. Our results indicate that improved hospital safety performance is associated with a relative risk of higher operating margin and net patient revenue, with some variation noted among the measures of patient safety. Our findings suggest that targeted improvement in patient safety performance, as evaluated in the Hospital Compare data, is associated with improved financial performance at the hospital level. Increased attention to safe care delivery may allow hospitals to generate additional patent care earnings, improve margins, and create capital to advance hospital financial position.
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Doing well by doing good: Evaluating the influence of patient safety performance on hospital financial outcomes. Health Care Manage Rev 2020; 44:2-9. [PMID: 28445325 DOI: 10.1097/hmr.0000000000000163] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND As financial pressures on hospitals increase because of changing reimbursement structures and heightened focus on quality and value, the association between patient safety performance and financial outcomes remains unclear. PURPOSE The purpose of this study is to investigate if hospitals with higher patient safety performance are associated with higher levels of profitability than those with lower safety performance. METHODOLOGY/APPROACH Using multinomial logistic regression, we analyzed data from the spring 2014 Leapfrog Hospital Safety Score and the 2014 American Hospital Association to determine the association between Leapfrog Hospital Safety Score performance and three dimensions of organizational profitability: operating margin, net patient revenue, and operating income. RESULTS Our findings suggest that improved hospital safety scores are associated with a relative risk of being in the top versus bottom quartile of financial performance: 5.41 times greater (p < .001) for operating margin, 10.98 times greater (p < .001) for net patient revenue, and 4.03 times greater (p < .001) for operating income. PRACTICE IMPLICATIONS Our findings suggest that improved patient safety performance, as evaluated within the Leapfrog Hospital Safety Score, is associated with improved financial performance at the hospital level. Targeted focus on patient safety may allow hospitals to improve financial performance, maximize scarce resources, and generate additional capital to continue to positively evolve care.
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How hospitals select their patient safety priorities: An exploratory study of four Veterans Health Administration hospitals. Health Care Manage Rev 2019; 45:E56-E67. [PMID: 31498164 DOI: 10.1097/hmr.0000000000000260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hospitals face ongoing pressure to reduce patient safety events. However, given resource constraints, hospitals must prioritize their safety improvements. There is limited literature on how hospitals select their safety priorities. PURPOSE The aim of this research was to describe and compare the approaches used by Veterans Health Administration (VA) hospitals to select their safety priorities. METHODOLOGY Semistructured telephone interviews with key informants (n = 16) were used to collect data on safety priorities in four VA hospitals from May to December 2016. We conducted a directed content analysis of the interview notes using an organizational learning perspective. We coded for descriptive data on the approaches (e.g., set of cues, circumstances, and activities) used to select safety priorities, a priori organizational learning capabilities (learning processes, learning environment, and learning-oriented leadership), and emergent domains. For cross-site comparisons, we examined the coded data for patterns. RESULTS All hospitals used multiple approaches to select their safety priorities; these approaches used varied across hospitals. Although no single approach was reported as particularly influential, all hospitals used approaches that addressed system level or national requirements (i.e., externally required activities). Additional approaches used by hospitals (e.g., responding to staff concerns of patient safety issues, conducting a multidisciplinary team investigation) were less connected to externally required activities and demonstrated organizational learning capabilities in learning processes (e.g., performance monitoring), learning environment (e.g., staff's psychological safety), and learning-oriented leadership (e.g., establishing a nonpunitive culture). PRACTICE IMPLICATIONS Leaders should examine the approaches used to select safety priorities and the role of organizational learning in these selection approaches. Exclusively relying on approaches focused on externally required activities may fail to identify safety priorities that are locally relevant but not established as significant at the system or national levels. Organizational learning may promote hospitals' use of varied approaches to guide their selection of safety priorities and thereby benefit hospital safety improvement efforts.
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Kapoor R, Moghanaki D, Rexrode S, Monzon B, Ray M, Hulick PR, Albuquerque K, Rosenthal SA, Palta JR, Hagan MP. Quality Improvements of Veterans Health Administration Radiation Oncology Services Through Partnership for Accreditation With the ACR. J Am Coll Radiol 2018; 15:1732-1737. [DOI: 10.1016/j.jacr.2018.06.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 06/29/2018] [Indexed: 10/28/2022]
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Alshyyab MA, FitzGerald G, Dingle K, Ting J, Bowman P, Kinnear FB, Borkoles E. Developing a conceptual framework for patient safety culture in emergency department: A review of the literature. Int J Health Plann Manage 2018; 34:42-55. [PMID: 30187536 DOI: 10.1002/hpm.2640] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 08/01/2018] [Indexed: 11/08/2022] Open
Abstract
Patient safety culture is a critical component of modern health care. However, the high-paced, unpredictable nature of the emergency department (ED) environment may impact adversely on it. The aim of this paper is to explore the concept of patient safety culture as it may apply to emergency health care, and to propose a conceptual framework that could form the basis for interventions designed to improve it. This is a systematic review of the literature. A search was undertaken of common electronic bibliographic databases using key words such as safety culture, safety climate, and Emergency Department. Articles were analysed for consistent themes with the aim to construct a conceptual framework. Ten articles met the inclusion criteria that specifically examined safety culture in the ED. Synthesis of the literature resulted in the emergence of three overarching themes of ED practice found to impact on safety culture in the ED. These were the dimensions of patient safety culture, the factors influencing it, and the interventions for improving it. A conceptual framework was constructed that identifies elements that significantly impact the patient safety culture in the ED. This framework may assist managers and researchers to take a comprehensive approach to build an effective safety culture in ED setting.
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Affiliation(s)
- Muhammad Ahmed Alshyyab
- School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Gerard FitzGerald
- School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Kaeleen Dingle
- School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Joseph Ting
- School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia.,Department of Emergency Medicine, Mater Health Services, Brisbane, QLD, Australia
| | - Paula Bowman
- School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
| | - Frances B Kinnear
- School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia.,Department of Emergency Medicine, The Prince Charles Hospital, Brisbane, QLD, Australia
| | - Erika Borkoles
- School of Public Health and Social Work and Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, QLD, Australia
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Organizational, Cultural, and Psychological Determinants of Smart Infusion Pump Work Arounds: A Study of 3 U.S. Health Systems. J Patient Saf 2017; 13:162-168. [DOI: 10.1097/pts.0000000000000137] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Melo S. The impact of accreditation on healthcare quality improvement: a qualitative case study. J Health Organ Manag 2017; 30:1242-1258. [PMID: 27834605 DOI: 10.1108/jhom-01-2016-0021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose Research on accreditation has mostly focused on assessing its impact using large scale quantitative studies, yet little is known on how quality is improved in practice through an accreditation process. Using a case study of an acute teaching hospital in Portugal, the purpose of this paper is to explore the dynamics through which accreditation can lead to an improvement in the quality of healthcare services provided. Design/methodology/approach Data for the case study was collected through 46 in-depth semi-structured interviews with 49 clinical and non-clinical members of staff. Data were analyzed using a framework thematic analysis. Findings Interviewees felt that hospital accreditation contributed to the improvement of healthcare quality in general, and more specifically to patient safety, as it fostered staff reflection, a higher standardization of practices, and a greater focus on quality improvement. However, findings also suggest that the positive impact of accreditation resulted from the approach the hospital adopted in its implementation as well as the fact that several of the procedures and practices required by accreditation were already in place at the hospital, albeit often in an informal way. Research limitations/implications The study was conducted in only one hospital. The design of an accreditation implementation plan tailored to the hospital's context can significantly contribute to positive outcomes in terms of quality and patient safety improvements. Originality/value This study provides a better understanding of how accreditation can contribute to healthcare quality improvement. It offers important lessons on the factors and processes that potentiate quality improvements through accreditation.
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Affiliation(s)
- Sara Melo
- Queen's Management School, Queen's University Belfast , Belfast, UK
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White DE, Norris JM, Jackson K, Khandwala F. Barriers and facilitators of Canadian quality and safety teams: a mixed-methods study exploring the views of health care leaders. J Healthc Leadersh 2016; 8:127-137. [PMID: 29355203 PMCID: PMC5741004 DOI: 10.2147/jhl.s116477] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Health care organizations are utilizing quality and safety (QS) teams as a mechanism to optimize care. However, there is a lack of evidence-informed best practices for creating and sustaining successful QS teams. This study aimed to understand what health care leaders viewed as barriers and facilitators to establishing/implementing and measuring the impact of Canadian acute care QS teams. METHODS Organizational senior leaders (SLs) and QS team leaders (TLs) participated. A mixed-methods sequential explanatory design included surveys (n=249) and interviews (n=89). Chi-squared and Fisher's exact tests were used to compare categorical variables for region, organization size, and leader position. Interviews were digitally recorded and transcribed for constant comparison analysis. RESULTS Five qualitative themes overlapped with quantitative data: (1) resources, time, and capacity; (2) data availability and information technology; (3) leadership; (4) organizational plan and culture; and (5) team composition and processes. Leaders from larger organizations more often reported that clear objectives and physician champions facilitated QS teams (p<0.01). Fewer Eastern respondents viewed board/senior leadership as a facilitator (p<0.001), and fewer Ontario respondents viewed geography as a barrier to measurement (p<0.001). TLs and SLs differed on several factors, including time to meet with the team, data availability, leadership, and culture. CONCLUSION QS teams need strong, committed leaders who align initiatives to strategic directions of the organization, foster a quality culture, and provide tools teams require for their work. There are excellent opportunities to create synergy across the country to address each organization's quality agenda.
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Affiliation(s)
| | | | - Karen Jackson
- Workforce Research and Evaluation, Alberta Health Services
| | - Farah Khandwala
- Cancer Care Services, Alberta Health Services, Calgary, AB, Canada
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Benchmarking operating room departments in the Netherlands. BENCHMARKING-AN INTERNATIONAL JOURNAL 2016. [DOI: 10.1108/bij-04-2014-0035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– Benchmarking is increasingly considered a useful management instrument to improve performance in healthcare. The purpose of this paper is to assess if a nationwide long-term benchmarking collaborative between operating room (OR) departments of university medical centres in the Netherlands leads to benefits in OR management and to evaluate if the initiative meets the requirements of the 4P-model.
Design/methodology/approach
– The evaluation was based on the 4P-model (purposes, performance indicators, participating organisations, performance management system), developed in former studies. A mixed-methods design was applied, consisting of document study, observations, interviews as well as analysing OR performance data using SPSS statistics.
Findings
– Collaborative benchmarking has benefits different from mainly performance improvement and identification of performance gaps. It is interesting that, since 2004, the OR benchmarking initiative still endures after already existing for ten years. A key benefit was pointed out by all respondents as “the purpose of networking”, on top of the purposes recognised in the 4P-model. The networking events were found to make it easier for participants to contact and also visit one another. Apparently, such informal contacts were helpful in spreading knowledge, sharing policy documents and initiating improvement. This benchmark largely met all key conditions of the 4P-model.
Research limitations/implications
– The current study has the limitations accompanied with any qualitative research and particularly related to interviewing. Qualitative research findings must be viewed within the context of the conducted case study. The experiences in this university hospital context in the Netherlands might not be transferable to other (general) hospital settings or other countries. The number of conducted interviews is restricted; nevertheless, all other data sources are extensive.
Originality/value
– A collaborative approach in benchmarking can be effective because participants use its knowledge-sharing infrastructure which enables operational, tactical and strategic learning. Organisational learning is to the advantage of overall OR management. Benchmarking seems a useful instrument in enabling hospitals to learn from each other, to initiate performance improvements and catalyse knowledge-sharing.
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Abstract
OBJECTIVES An estimated 7.4% of patients admitted to acute care facilities in Canada experience injury or death due to health care mishaps, and 38% of these events are deemed preventable. Commitment of executive leaders to a culture of safety is important for the reduction of risk to Canadian patients. The purpose of this study was to examine the safety climate from a leader's perspective in 2 Canadian acute care settings, with attention paid to high reliability organization (HRO) principles. METHODS The Patient Safety Culture in Healthcare Organizations questionnaire was administered to leaders in 2 acute care hospitals in Ontario between June and January 2009. The primary outcome measures were senior leadership support for safety and supervisory leadership support for safety. Misalignment between the safety climate and HRO principles was defined as greater than 10% of respondents reporting problematic or neutral leadership support for safety. RESULTS Of the 142 respondents (67% response rate), both medical/nursing leaders and tertiary care clinical leaders were significantly more likely than board/administrative leaders to report problematic/neutral responses. Overall, executive leadership perceptions of the safety climate were not aligned with HRO principles. CONCLUSIONS The significant differences in response between board/administrative leaders and those involved in frontline patient care suggest that a weak safety culture exists in these 2 health care organizations. The cultivation of a stronger organizational safety culture, in alignment with HRO principles, could lead to lower rates of preventable mishaps and support risk identification and mitigation in perioperative settings.
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Abstract
BACKGROUND Acute care physical therapists are at risk for developing work-related musculoskeletal disorders (WMSDs) due to manual patient handling. Safe patient handling (SPH) reduces WMSDs caused by manual handling. OBJECTIVE The purpose of this study was to describe the patient handling practices of acute care physical therapists and their perceptions regarding SPH. Additionally, this study determined whether an SPH program influences the patient handling practices and perceptions regarding SPH of acute care physical therapists. METHODS Subscribers to the electronic discussion board of American Physical Therapy Association's Acute Care Section were invited to complete a survey questionnaire. RESULTS The majority of respondents used SPH equipment and practices (91.1%), were confident using SPH equipment and practices (93.8%), agreed that evidence supports the use of SPH equipment and practices (87.0%), and reported the use of SPH equipment and practices is feasible (92.2%). Respondents at a facility with an SPH program were more likely to use SPH equipment and practices, have received training in the use of SPH equipment and practices, agree that the use of SPH equipment and practices is feasible, and feel confident using SPH equipment and practices. LIMITATIONS The study might not reflect the perceptions and practices of the population of acute care physical therapists. CONCLUSION Acute care physical therapists are trained to use SPH equipment and practices, use SPH equipment and practices, and have positive perceptions regarding SPH. Acute care physical therapists in a facility with an SPH program are more likely to use SPH equipment and practices, receive training in SPH equipment and practices, and have positive perceptions regarding SPH. Quasi-regulatory organizations should incorporate SPH programs into their evaluative standards.
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Weng RH, Chen JC, Pong LJ, Chen LM, Lin TC. The Impact of Market Orientation on Patient Safety Climate Among Hospital Nurses. Eval Health Prof 2014; 39:65-86. [PMID: 24492246 DOI: 10.1177/0163278714521811] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Improving market orientation and patient safety have become the key concerns of nursing management. For nurses, establishing a patient safety climate is the key to enhancing nursing quality. This study explores how market orientation affects the climate of patient safety among hospital nurses. We proposed adopting a cross-sectional research design and using questionnaires to collect responses from nurses working in two Taiwanese hospitals. Three-hundred and forty-three valid samples were obtained. Multiple regression and path analyses were conducted to test the study. Market orientation was defined as the combination of customer orientation, competitor orientation, and interfunctional coordination. Customer orientation directly affects the climate of patient safety. Although the findings only supported Hypothesis 1, competitor orientation and interfunctional coordination positively affected the patient safety climate through the mediating effects of hospital support for staff. Health care managers could encourage nurses to adopt customer-oriented perspectives to enhance their nursing care. In addition, to enhance competitor orientation, interfunctional coordination, and the patient safety climate, hospital managers could strengthen their support for staff members.
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Affiliation(s)
- Rhay-Hung Weng
- Department of Long Term Care, National Quemoy University, Kinmen, Taiwan, Republic of China
| | - Jung-Chien Chen
- Department of Nursing, Chest Hospital, Tainan, Taiwan, Republic of China
| | - Li-Jung Pong
- Office of Deputy Superintendent, Tainan Municipal Hospital, Tainan, Taiwan, Republic of China
| | - Li-Mei Chen
- Department of Nursing, Tainan Municipal Hospital, Tainan, Taiwan, Republic of China
| | - Tzu-Chi Lin
- Department of Nursing, Chi Mei Medical Center, Tainan, Taiwan, Republic of China
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Moldenhauer KL, Alder P. Compliance to Patient Safety Culture. Patient Saf Surg 2014. [DOI: 10.1007/978-1-4471-4369-7_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Affiliation(s)
- Sara J. Singer
- Department of Health Policy and Management, Harvard School of Public Health, Boston, Massachusetts 02115;
| | - Timothy J. Vogus
- Owen Graduate School of Management, Vanderbilt University, Nashville, Tennessee 37203;
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Using an Objective Structured Clinical Examination to test adherence to Joint Commission National Patient Safety Goal--associated behaviors. Jt Comm J Qual Patient Saf 2012; 38:414-8. [PMID: 23002494 DOI: 10.1016/s1553-7250(12)38053-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND A study was conducted at a tertiary care academic medical center to assess a simulation-based, single-station Objective Structured Clinical Examination (OSCE) designed to evaluate intern trainees' familiarity with and adherence to behaviors associated with Joint Commission National Patient Safety Goals and The Joint Commission Universal Protocol for Preventing Wrong Site, Wrong Procedure, Wrong Person Surgery. METHOD Subjects were interns, from all disciplines, completing basic skills training during intern orientation. The OSCE scenario was designed to assess 13 behaviors associated with four National Patient Safety Goals (1, 2, 3, and 7) from 2009 and 2010 and the Universal Protocol. Sessions were digitally recorded and independently reviewed by two observers, who scored behaviors using a standardized score sheet. Behaviors were assigned point values and tabulated for all trainees. Kappa coefficient was calculated to assess interrater reliability. RESULTS One-hundred eleven (74.5%) of 149 interns completed the station. The average time to completion was 6.9 minutes (standard deviation [SD] 1.8; range, 3.5-12.6). Interns scored an average of 9.5 points (SD, 4.7; range, 2-20; mode, 8) of 26. The interrater reliability for the two reviewers was 0.9. Interns most frequently requested chlorhexidine to sterilize the patient's skin (98.2% of interns demonstrated); identifying an unlabeled medication vial as inappropriate for use was the most frequently missed item (8.1% of interns demonstrated). CONCLUSIONS Behaviors related to tenets of patient safety and quality care can be assessed using a simple to design and execute OSCE. Using simulation to test behaviors associated with the National Patient Safety Goals may be a desirable adjunct to traditional simple knowledge-based tests.
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Greenfield D, Pawsey M, Hinchcliff R, Moldovan M, Braithwaite J. The standard of healthcare accreditation standards: a review of empirical research underpinning their development and impact. BMC Health Serv Res 2012; 12:329. [PMID: 22995152 PMCID: PMC3520756 DOI: 10.1186/1472-6963-12-329] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Accepted: 09/18/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Healthcare accreditation standards are advocated as an important means of improving clinical practice and organisational performance. Standard development agencies have documented methodologies to promote open, transparent, inclusive development processes where standards are developed by members. They assert that their methodologies are effective and efficient at producing standards appropriate for the health industry. However, the evidence to support these claims requires scrutiny. The study's purpose was to examine the empirical research that grounds the development methods and application of healthcare accreditation standards. METHODS A multi-method strategy was employed over the period March 2010 to August 2011. Five academic health research databases (Medline, Psych INFO, Embase, Social work abstracts, and CINAHL) were interrogated, the websites of 36 agencies associated with the study topic were investigated, and a snowball search was undertaken. Search criteria included accreditation research studies, in English, addressing standards and their impact. Searching in stage 1 initially selected 9386 abstracts. In stage 2, this selection was refined against the inclusion criteria; empirical studies (n = 2111) were identified and refined to a selection of 140 papers with the exclusion of clinical or biomedical and commentary pieces. These were independently reviewed by two researchers and reduced to 13 articles that met the study criteria. RESULTS The 13 articles were analysed according to four categories: overall findings; standards development; implementation issues; and impact of standards. Studies have only occurred in the acute care setting, predominately in 2003 (n = 5) and 2009 (n = 4), and in the United States (n = 8). A multidisciplinary focus (n = 9) and mixed method approach (n = 11) are common characteristics. Three interventional studies were identified, with the remaining 10 studies having research designs to investigate clinical or organisational impacts. No study directly examined standards development or other issues associated with their progression. Only one study noted implementation issues, identifying several enablers and barriers. Standards were reported to improve organisational efficiency and staff circumstances. However, the impact on clinical quality was mixed, with both improvements and a lack of measurable effects recorded. CONCLUSION Standards are ubiquitous within healthcare and are generally considered to be an important means by which to improve clinical practice and organisational performance. However, there is a lack of robust empirical evidence examining the development, writing, implementation and impacts of healthcare accreditation standards.
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Affiliation(s)
- David Greenfield
- Centre for Clinical Governance Research, Australian Institute of Health Innovation, University of New South Wales, Sydney, New South Wales 2052, Australia.
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Alkhenizan A, Shaw C. The attitude of health care professionals towards accreditation: A systematic review of the literature. J Family Community Med 2012; 19:74-80. [PMID: 22870409 PMCID: PMC3410183 DOI: 10.4103/2230-8229.98281] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Accreditation is usually a voluntary program, in which authorized external peer reviewers evaluate the compliance of a health care organization with pre-established performance standards. The aim of this study was to systematically review the literature of the attitude of health care professionals towards professional accreditation. A systematic search of four databases including Medline, Embase, Healthstar, and Cinhal presented seventeen studies that had evaluated the attitudes of health care professionals towards accreditation. Health care professionals had a skeptical attitude towards accreditation. Owners of hospitals indicated that accreditation had the potential of being used as a marketing tool. Health care professionals viewed accreditation programs as bureaucratic and demanding. There was consistent concern, especially in developing countries, about the cost of accreditation programs and their impact on the quality of health care services.
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Affiliation(s)
- Abdullah Alkhenizan
- Department of Family Medicine and Polyclinic, King Faisal Specialist Hospital and Research Center, Saudi Arabia.
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Rossy KM, Lawrence N. Difficulty with surgical site identification: What role does it play in dermatology? J Am Acad Dermatol 2012; 67:257-61. [DOI: 10.1016/j.jaad.2012.02.034] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2010] [Revised: 02/21/2012] [Accepted: 02/25/2012] [Indexed: 10/28/2022]
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Relationship Between Nursing Home Safety Culture and Joint Commission Accreditation. Jt Comm J Qual Patient Saf 2012; 38:207-15. [DOI: 10.1016/s1553-7250(12)38026-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Chung E, Horwitz JR, Pottow JAE, Jagsi R. Malpractice suits and physician apologies in cancer care. J Oncol Pract 2012; 7:389-93. [PMID: 22379423 DOI: 10.1200/jop.2011.000264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2011] [Indexed: 11/20/2022] Open
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Abstract
BACKGROUND Optimal inpatient pain management remains a major institutional and therapeutic challenge. Nontoxic, nonpharmacological approaches to treating pain show promise but have not been widely implemented, nor has their effectiveness been evaluated. AIMS To evaluate the effectiveness of an inpatient integrative medicine consult service for pain management in 6 settings across an entire tertiary care hospital. DESIGN Retrospective, observational study. SETTING Abbott Northwestern Hospital, a 629-bed tertiary-care hospital in Minneapolis, Minn, that is part of Allina Hospitals & Clinics. PARTICIPANTS Approximately 1837 patients hospitalized between January 1, 2008, and June 30, 2009. MEASUREMENTS Pretreatment and posttreatment pain scores on a verbal scale of 0 to 10. RESULTS Most patients (66%) had never previously received integrative services. Provision of integrative services had immediate and beneficial effects on pain scores. The average reduction in pain scores was 1.9 points (on a 10-point scale), and the average percentage in pain reduction was approximately 55%. CONCLUSIONS The formal provision of inpatient integrative medicine had a significant impact on pain scores for hospitalized patients, reducing self-reported pain by more than 50%, without placing patients at increased risk of adverse effects. This was true in all 6 settings. Age, previous use of complementary therapies, and sex did not affect results. Future research must define the appropriate dose of the intervention, the duration of the relief, and the identification of patients most likely to respond to these nonpharmacological treatments. Additionally, future research using the electronic health record will allow quantification of any reduction in total costs, pain medication usage, and adverse events.
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Wisdom JP, Cavaleri MA, Onwuegbuzie AJ, Green CA. Methodological reporting in qualitative, quantitative, and mixed methods health services research articles. Health Serv Res 2011; 47:721-45. [PMID: 22092040 DOI: 10.1111/j.1475-6773.2011.01344.x] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Methodologically sound mixed methods research can improve our understanding of health services by providing a more comprehensive picture of health services than either method can alone. This study describes the frequency of mixed methods in published health services research and compares the presence of methodological components indicative of rigorous approaches across mixed methods, qualitative, and quantitative articles. DATA SOURCES All empirical articles (n = 1,651) published between 2003 and 2007 from four top-ranked health services journals. STUDY DESIGN All mixed methods articles (n = 47) and random samples of qualitative and quantitative articles were evaluated to identify reporting of key components indicating rigor for each method, based on accepted standards for evaluating the quality of research reports (e.g., use of p-values in quantitative reports, description of context in qualitative reports, and integration in mixed method reports). We used chi-square tests to evaluate differences between article types for each component. PRINCIPAL FINDINGS Mixed methods articles comprised 2.85 percent (n = 47) of empirical articles, quantitative articles 90.98 percent (n = 1,502), and qualitative articles 6.18 percent (n = 102). There was a statistically significant difference (χ(2) (1) = 12.20, p = .0005, Cramer's V = 0.09, odds ratio = 1.49 [95% confidence interval = 1,27, 1.74]) in the proportion of quantitative methodological components present in mixed methods compared to quantitative papers (21.94 versus 47.07 percent, respectively) but no statistically significant difference (χ(2) (1) = 0.02, p = .89, Cramer's V = 0.01) in the proportion of qualitative methodological components in mixed methods compared to qualitative papers (21.34 versus 25.47 percent, respectively). CONCLUSION Few published health services research articles use mixed methods. The frequency of key methodological components is variable. Suggestions are provided to increase the transparency of mixed methods studies and the presence of key methodological components in published reports.
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Affiliation(s)
- Jennifer P Wisdom
- Psychiatry Department, Columbia University, New York State Psychiatric Institute, New York, NY 10032, USA.
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Schmaltz SP, Williams SC, Chassin MR, Loeb JM, Wachter RM. Hospital performance trends on national quality measures and the association with Joint Commission accreditation. J Hosp Med 2011; 6:454-61. [PMID: 21990175 PMCID: PMC3265714 DOI: 10.1002/jhm.905] [Citation(s) in RCA: 93] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Evaluations of the impact of hospital accreditation have been previously hampered by the lack of nationally standardized data. One way to assess this impact is to compare accreditation status with other evidence-based measures of quality, such as the process measures now publicly reported by The Joint Commission and the Centers for Medicare and Medicaid Services (CMS). OBJECTIVES To examine the association between Joint Commission accreditation status and both absolute measures of, and trends in, hospital performance on publicly reported quality measures for common diseases. DESIGN, SETTING, AND PATIENTS Performance data for 2004 and 2008 from U.S. acute care and critical access hospitals were obtained using publicly available CMS Hospital Compare data augmented with Joint Commission performance data. MEASUREMENTS Changes in hospital performance between 2004 and 2008, and percent of hospitals with 2008 performance exceeding 90% for 16 measures of quality-of-care and 4 summary scores. RESULTS Hospitals accredited by The Joint Commission tended to have better baseline performance in 2004 than non-accredited hospitals. Accredited hospitals had larger gains over time, and were significantly more likely to have high performance in 2008 on 13 out of 16 standardized clinical performance measures and all summary scores. CONCLUSIONS While Joint Commission-accredited hospitals already outperformed non-accredited hospitals on publicly reported quality measures in the early days of public reporting, these differences became significantly more pronounced over 5 years of observation. Future research should examine whether accreditation actually promotes improved performance or is a marker for other hospital characteristics associated with such performance. Journal of Hospital Medicine 2011;6:458-465. © 2011 Society of Hospital Medicine.
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Jaafaripooyan E, Agrizzi D, Akbari-Haghighi F. Healthcare accreditation systems: further perspectives on performance measures. Int J Qual Health Care 2011; 23:645-56. [PMID: 21954282 DOI: 10.1093/intqhc/mzr063] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The purpose of this paper is to identify and suggest a number of performance measures to facilitate the evaluation of accreditation programs in healthcare. METHODS The paper is based on an exploratory research which has used qualitative methods, including snowball sampling technique, email interview and thematic content analysis. PARTICIPANTS Respondents (experts and professionals) were selected from a diverse spectrum ranging from healthcare organizations, universities and accreditation-associated institutions. RESULTS The analysis of the data provided key measures to be considered in the evaluation of accreditation programs' impact at macro and micro levels as well as their nature and operations. The measures can be used to, for example, assess the degree of stakeholders' reliance on accreditation results, measure the cost of accreditation for participating organizations and serve as a formal mechanism for accredited organizations to appeal accreditation decisions. CONCLUSIONS This paper has brought together a number of generic, yet influential and workable, measures which could be utilized for assessing the overall performance of an accreditation program in healthcare. The application of these measures depends on the features of given accreditation program and the context in which the program operates. Therefore, the next step/steps in the assessment of an accreditation program might be choosing the measures suiting that program.
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Affiliation(s)
- Debora Simmons
- Texas Woman’s University, Houston, Texas
- National Center for Cognitive Informatics and Decision Making in Healthcare, School of Health Information Sciences, University of Texas Health Science Center at Houston, and The Patient Safety Education Project (PSEP), Buehler Center on Aging, Health & Society, Northwestern University
| | - Lene Symes
- Texas Woman’s University, Houston, Texas
| | - Peggi Guenter
- Clinical Practice, Advocacy, and Research Affairs, American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.), Silver Spring, Maryland
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Ross JS, Sheth S, Krumholz HM. State-sponsored public reporting of hospital quality: results are hard to find and lack uniformity. Health Aff (Millwood) 2011; 29:2317-22. [PMID: 21134936 DOI: 10.1377/hlthaff.2010.0564] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The prevalence of state public reporting initiatives that focus on hospital quality is not known. We systematically reviewed state-sponsored public reporting programs that focused on clinical aspects of hospital quality and performance for adults, by surveying the fifty US states and the District of Columbia. We found that although identifying information about programs was frequently a challenge, twenty-five states had programs that reported about hospital quality. Information varied considerably from state to state, by health condition and by process and outcome measures reported. We examine the implications of these findings for future state initiatives.
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Affiliation(s)
- Joseph S Ross
- Yale University School, Medicine, New Haven, Connecticut, USA.
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A Critical Evaluation of the Impact of Leapfrog's Evidence-Based Hospital Referral. J Am Coll Surg 2011; 212:150-159.e1. [DOI: 10.1016/j.jamcollsurg.2010.09.027] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2010] [Revised: 09/14/2010] [Accepted: 09/29/2010] [Indexed: 12/17/2022]
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Ginsburg LR, Chuang YT, Berta WB, Norton PG, Ng P, Tregunno D, Richardson J. The relationship between organizational leadership for safety and learning from patient safety events. Health Serv Res 2010; 45:607-32. [PMID: 20337737 PMCID: PMC2875751 DOI: 10.1111/j.1475-6773.2010.01102.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To examine the relationship between organizational leadership for patient safety and five types of learning from patient safety events (PSEs). STUDY SETTING Forty-nine general acute care hospitals in Ontario, Canada. STUDY DESIGN A nonexperimental design using cross-sectional surveys of hospital patient safety officers (PSOs) and patient care managers (PCMs). PSOs provided data on organization-level learning from (a) minor events, (b) moderate events, (c) major near misses, (d) major event analysis, and (e) major event dissemination/communication. PCMs provided data on organizational leadership (formal and informal) for patient safety. EXTRACTION METHODS Hospitals were the unit of analysis. Seemingly unrelated regression was used to examine the influence of formal and informal leadership for safety on the five types of learning from PSEs. The interaction between leadership and hospital size was also examined. PRINCIPAL FINDINGS Formal organizational leadership for patient safety is an important predictor of learning from minor, moderate, and major near-miss events, and major event dissemination. This relationship is significantly stronger for small hospitals (<100 beds). CONCLUSIONS We find support for the relationship between patient safety leadership and patient safety behaviors such as learning from safety events. Formal leadership support for safety is of particular importance in small organizations where the economic burden of safety programs is disproportionately large and formal leadership is closer to the front lines.
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Affiliation(s)
- Liane R Ginsburg
- School of Health Policy & Management, Faculty of Health, HNES Bldg., 413, York University, 4700 Keele Street, Toronto, ON M3J 1P3, Canada.
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Kessels-Habraken M, De Jonge J, Van der Schaaf T, Rutte C. Prospective risk analysis prior to retrospective incident reporting and analysis as a means to enhance incident reporting behaviour: A quasi-experimental field study. Soc Sci Med 2010; 70:1309-16. [DOI: 10.1016/j.socscimed.2010.01.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2009] [Revised: 12/05/2009] [Accepted: 01/25/2010] [Indexed: 10/19/2022]
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Ross JS, Chen J, Lin Z, Bueno H, Curtis JP, Keenan PS, Normand SLT, Schreiner G, Spertus JA, Vidán MT, Wang Y, Wang Y, Krumholz HM. Recent national trends in readmission rates after heart failure hospitalization. Circ Heart Fail 2009; 3:97-103. [PMID: 19903931 DOI: 10.1161/circheartfailure.109.885210] [Citation(s) in RCA: 323] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND In July 2009, Medicare began publicly reporting hospitals' risk-standardized 30-day all-cause readmission rates (RSRRs) among fee-for-service beneficiaries discharged after hospitalization for heart failure from all the US acute care nonfederal hospitals. No recent national trends in RSRRs have been reported, and it is not known whether hospital-specific performance is improving or variation in performance is decreasing. METHODS AND RESULTS We used 2004-2006 Medicare administrative data to identify all fee-for-service beneficiaries admitted to a US acute care hospital for heart failure and discharged alive. We estimated mean annual RSRRs, a National Quality Forum-endorsed metric for quality, using 2-level hierarchical models that accounted for age, sex, and multiple comorbidities; variation in quality was estimated by the SD of the RSRRs. There were 570 996 distinct hospitalizations for heart failure in which the patient was discharged alive in 4728 hospitals in 2004, 544 550 in 4694 hospitals in 2005, and 501 234 in 4674 hospitals in 2006. Unadjusted 30-day all-cause readmission rates were virtually identical over this period: 23.0% in 2004, 23.3% in 2005, and 22.9% in 2006. The mean and SD of RSRRs were also similar: mean (SD) of 23.7% (1.3) in 2004, 23.9% (1.4) in 2005, and 23.8% (1.4) in 2006, suggesting similar hospital variation throughout the study period. CONCLUSIONS National mean and RSRR distributions among Medicare beneficiaries discharged after hospitalization for heart failure have not changed in recent years, indicating that there was neither improvement in hospital readmission rates nor in hospital variations in rates over this time period.
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Affiliation(s)
- Joseph S Ross
- Department of Geriatrics, Mount Sinai School of Medicine, New York, NY 10029, USA.
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Abstract
BACKGROUND Patient safety issues are the forefront of delivering effective quality healthcare. The fast pace and high volume of dermatology practice presents an opportunity for new research on error prevention and patient safety. OBJECTIVE To identify areas of concern in patient safety to introduce starting points for new improvement projects in dermatology. METHODS Aliterature search was performed using the PubMed database with the search terms 'patient safety' and 'quality of care'. The articles were categorized into three topics concerning patient safety research: safety in treatment and procedures received; safety issues related to facility infrastructure; and human resource management. RESULTS Many issues identified as healthcare shortcomings such as wrong site surgery, patient misidentification, specimen errors, medication errors, communication failure, poor teamwork, healthcare worker management defects, and facility safety design problems were discussed in the literature. Each of these requires exploration with new safety initiatives for resolution. Alimitation included omitting pieces on occupational health and safety that could contribute to overall patient safety. Our search also included only data from one database. CONCLUSIONS Patient safety is an ever-evolving process requiring continuous attention by practicing physicians including dermatologists, healthcare staff, patients, and research scholars to discover and implement new safety initiatives for overall healthcare improvement.
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Affiliation(s)
- Elizabeth Uhlenhake
- Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine, Winston-Salem, North Carolina 22157-1071, USA.
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Mamaril M, Ross J, Poole EL, Brady JM, Clifford T. ASPAN's Delphi study on national research: priorities for perianesthesia nurses in the United States. J Perianesth Nurs 2009; 24:4-13. [PMID: 19185816 DOI: 10.1016/j.jopan.2008.11.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Revised: 10/31/2008] [Accepted: 11/03/2008] [Indexed: 10/21/2022]
Abstract
Prudent nursing practice mandates the best, scientific evidence available. The complexity of perianesthesia practice, management, and education, coupled with required competencies within these domains, generate problems demanding answers. ASPAN's financial and human resources, however, are limited. Therefore, ASPAN must be able to articulate research priorities. The purpose of this study was to identify and prioritize the research questions related to perianesthesia practice, management, and education. A three-round Delphi study conducted with perianesthesia nursing experts determined research priorities for perianesthesia nursing practice. Research problems were identified and refined into research questions. Questions were ranked for their priority. Research priorities focused on the following themes: evidence supporting ASPAN standards, staffing ratios, nurse fatigue, adverse patient outcomes, patient care issues related to intensive care unit (ICU) overflow, obstructive sleep apnea, pain management, glycemic control, and clinical critical care competencies. This study advances the mission of ASPAN by identifying the top national perianesthesia research priorities related to practice, management, and education, and should guide researchers in their continued exploration of the science of perianesthesia nursing.
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Wachter RM, Foster NE, Dudley RA. Medicare’s Decision to Withhold Payment for Hospital Errors: The Devil Is in the Details. Jt Comm J Qual Patient Saf 2008; 34:116-23. [DOI: 10.1016/s1553-7250(08)34014-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Scanlon DP, Christianson JB, Ford EW. Hospital Responses to the Leapfrog Group in Local Markets. Med Care Res Rev 2007; 65:207-31. [DOI: 10.1177/1077558707312499] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Leapfrog (LF) initiative, directed at improving patient safety in hospitals, may be the most ambitious, coordinated attempt to date on the part of large employers to shape the delivery of health care in America. This article assesses the role of market conditions and other factors in influencing hospital responses to LF activities at the community level. Community characteristics were found to be important in explaining hospital participation in a LF safety standards survey at the study sites. However, characteristics of the individual hospitals, and of the LF goals themselves, were more important in explaining the relatively limited progress by hospitals across all sites in achieving those goals over a 5-year period.
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Schutz AL, Counte MA, Meurer S. Assessment of patient safety research from an organizational ergonomics and structural perspective. ERGONOMICS 2007; 50:1451-84. [PMID: 17654036 DOI: 10.1080/00140130701346765] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The aim of this study is to review patient safety improvement initiatives within a conceptual framework that builds upon principles of organizational ergonomics and emphasizes structural factors that influence patient safety. The literature review included 131 English language published studies of patient safety improvement strategies extracted using Medline, Ovid Healthstar, PubMed and CINAHL searches. Keywords for the search included: 'patient safety'; 'medical errors'; 'adverse event'; 'iatrogenic'; and truncated options for 'improve'. The multilevel, hierarchical framework offered in this paper integrates quality management principles and organizational ergonomics theory and organizes patient safety initiatives according to sociotechnical system elements within three structural levels: health policies and associated health care organizations; health care delivery organizations; and health care microsystems. Utilizing the conceptual framework, this review of patient safety improvement initiatives highlights the need for consideration of the impact of all improvement proposals on each structural component within health care systems. The review also supports the need for patient safety research to evolve from exploratory, 1-D reporting to multi-level, integrated research.
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Affiliation(s)
- A L Schutz
- Saint Louis University, School of Public Health, Salus Center, Saint Louis, MO, USA.
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Casey MM, Moscovice IS, Davidson G. Pharmacist staffing, technology use, and implementation of medication safety practices in rural hospitals. J Rural Health 2007; 22:321-30. [PMID: 17010029 DOI: 10.1111/j.1748-0361.2006.00053.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
CONTEXT Medication safety is clearly an important quality issue for rural hospitals. However, rural hospitals face special challenges implementing medication safety practices in terms of their staffing and financial and technical resources. PURPOSE This study assessed the capacity of small rural hospitals to implement medication safety practices, with particular focus on pharmacist staffing and the availability of technology. METHODS A telephone survey of a national random sample of small rural hospitals was conducted from March to May 2005 (N = 387 hospitals, 94.6% response rate). Survey respondents included pharmacists (89%) and directors of nursing (11%). Multivariate analyses examined the relationships between hospital organizational and financial variables and (1) the amount of pharmacist staffing; (2) use of pharmacy computers for medication safety activities; and (3) implementation of medication safety practices. FINDINGS Many small rural hospitals have limited hours of on-site pharmacist coverage. Almost one quarter of hospitals either do not have a pharmacy computer or are not using it for clinical purposes. Half of the hospitals have implemented 4 key medication safety practices. Level of pharmacist staffing, use of technology, and implementation of medication safety practices are significantly related to hospital financial status and accreditation. CONCLUSIONS Implementation of protocols related to medication use and key medication safety practices are areas where small rural hospitals could improve. The study results support a continuation of Medicare cost-based reimbursement policies to help ensure financial stability and support quality and patient safety activities in small rural hospitals.
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Affiliation(s)
- Michelle M Casey
- Rural Health Research Center, Division of Health Services Research and Policy, School of Public Health, University of Minnesota, Minneapolis, MN, USA.
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Wang MC, Hyun JK, Harrison M, Shortell SM, Fraser I. Redesigning health systems for quality: Lessons from emerging practices. Jt Comm J Qual Patient Saf 2007; 32:599-611. [PMID: 17120919 DOI: 10.1016/s1553-7250(06)32078-8] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND It has been five years since the Institute of Medicine (IOM) report, Crossing the Quality Chasm, proposed systemwide changes to transform our health care system. What progress has been made? What lessons have been learned? How should we move forward? METHODS Semistructured telephone interviews were conducted with 16 health care providers and researchers at organizations involved in system redesign. The findings were supplemented with a focused literature review and discussions from a national expert meeting. RESULTS Many promising and innovative examples of redesign were identified. However, even delivery systems that are redesigning care in pursuit of the six IOM aims face daunting challenges, reflecting the need to align system changes across multiple levels and to integrate redesign efforts with ongoing system features. Four success factors were reported by providers as crucial in overcoming redesign barriers: (1) directly involving top and middle-level leaders, (2) strategically aligning and integrating improvement efforts with organizational priorities, (3) systematically establishing infrastructure, process, and performance appraisal systems for continuous improvement, and (4) actively developing champions, teams, and staff. A framework that integrates these success factors to facilitate a systems approach to redesigning health care organizations and delivery systems for improved performance is provided. CONCLUSIONS Successful system redesign requires coordinating and managing a complex set of changes across multiple levels rather than isolated projects.
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Frølich A, Talavera JA, Broadhead P, Dudley RA. A behavioral model of clinician responses to incentives to improve quality. Health Policy 2007; 80:179-93. [PMID: 16624440 DOI: 10.1016/j.healthpol.2006.03.001] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2005] [Accepted: 03/06/2006] [Indexed: 10/24/2022]
Abstract
The use of pay for performance (P4P) and public reporting of performance (PR) in health care is increasing rapidly worldwide. The rationale for P4P and PR comes from experience in other industries and from theories about incentive use from psychology, economics, and organizational behavior. This paper reviews the major themes from this prior research and considers how they might be applied to health care. The resulting conceptual model addresses the dual nature (combining direct financial and reputational incentives) of the initiatives many policymakers are pursuing. It also includes explicit recognition of the key contextual factors (at the levels of the markets and the provider organization) and provider and patient characteristics that can enhance or mitigate response to incentives. Evaluation of the existing literature (through June 2005) about incentive use in health care in light of the conceptual model highlights important weaknesses in the way that trials have been reported to date and suggests future research topics.
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Affiliation(s)
- Anne Frølich
- Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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