fay rozovsky, jd, mph, dfashrm marsh health care practice richmond, va the business case for patient...
TRANSCRIPT
Fay Rozovsky, JD, MPH, DFASHRMMarsh Health Care Practice
Richmond, VA
THE BUSINESS CASE FOR PATIENT SAFETY
April, 2003
Michigan Presentation 2
THE DRIVING INFLUENCES
CONSUMERS PAYERS
STATESFEDs
ACCREDITATION TRADE ASSNs
PROFESSIONALGROUPS
MEDIA
UNIONS
It is allabout
patient safety
“THE COMBO”
Michigan Presentation 3
MULTIPLE PLAYERS SETTING STANDARDS AND EXPECTATIONS
STATES ENACTING “REFORMS” GEARED TO PATIENT SAFETY
JCAHO
– PATIENT SAFETY ACCREDITATION STANDARDS
– “PERFORMANCE REPORTS”
– LINK ERROR TO STAFFING
THE STATE OFPATIENT SAFETY
Michigan Presentation 4
THE PAYER PERSPECTIVE
HEALTH INSURANCE PREMIUMS INCREASING
DISSATISFACTION ABOUT OUTCOMES OF CARE
FRUSTRATION WITH “NO ONE” DOING ANYTHING TO FIX THE SYSTEM
Michigan Presentation 5
THE PATIENT
FEAR, DISTRUST, LACK OF CONFIDENCE
MORE ASSERTIVE IN MANY INSTANCES
RECEIVING NEW “DATA” ON HOW HEALTHCARE ENTITIES “MEASURE UP”
BEING TOLD TO “SPEAK UP” AND ASK QUESTIONS
Michigan Presentation 6
PROFESSIONAL LIABIILTY
WHAT “FIRST DOLLAR” COVERAGE?
WHAT INSURANCE?
LARGE PREMIUM INCREASES, LOWER LIMITS
SOME CANNOT PURCHASEPROFESSIONAL
LIABILITY INSURANCE
Michigan Presentation 7
THE INSURANCE CONUNDRUM
ESSENTIAL: THE ABILITY TO SHOW “HOW” PATIENT SAFETY STRATEGIES ARE WORKING JUST TO GET IN THE DOOR
A NEED FOR ALTERNATE
RISK FINANCING
Michigan Presentation 8
THE STATES
MORE “REFORMS” GEARED TO REPORTING
INCREASE IN JUAs
CAPS ON MED MAL
Michigan Presentation 9
THE FEDs
GREATER USE OF “QUALITY OF CARE” ENFORCEMENT
CHALLENGING CONGRESS TO ENACT REFORMS
PUT INTO A “RESPONSE MODE” BY IOM
TRYING TO ENACT REFORM LEGISLATION THIS YEAR, BUT…….
Michigan Presentation 10
AS CONSUMERS
AS HEALTHCARE PROFESSIONALS
PATIENTSAFETY
QUALITYSAFECARE
STAFFING EFFECTIVENESS
COMPETENCY TRAINING
UNIONS
Michigan Presentation 11
SYSTEM STRESS
INCREASED SCRUTINY FROM ALL QUARTERS
MORE UNFUNDED MANDATES
STAFFING SHORTAGES
LACK OF “EVIDENCE BASED” STUDIES TO JUSTIFY MAJOR SYSTEMIC CHANGES
TOO MANY CHEFS IN THE KITCHEN: NQF, CMS, JCAHO, NADER GROUP. ETC.,ETC.
Michigan Presentation 12
THE SYSTEM IS IN TRAUMA AND NEEDS AN OVERHAUL
WHAT’S MISSING?
COMPREHENSIVE SYSTEMTIC CHANGES COST-EFFECTIVE, EVIDENCE BASED SOLUTIONS FUNDING TO DRIVE CHANGE
Michigan Presentation 13
PREVENTIVE HEALTHCARE
COMMUNITY HEALTHCARE “GROUP”
HEALTHCARE
MANAGE “AT RISK”
EVIDENCE BASED ACUTE CARE
SERVICES
COMPREHENSIVESOLUTION
THE COMPREHENSIVESOLUTION - I
A PUBLIC HEALTH REPONSE FROM RM
ELIMINATE, CONTROL, MITIGATE PRECUSORS TO HIGH ACUITY - HIGH RISK SITUATIONS
Michigan Presentation 14
INFRASTRUCTURECHANGE
THE COMPREHENSIVESOLUTION - II
COMMUNICATIONS CONSENT AS A PATIENT
SAFETY TOOL PATIENTS & FAMILY AS THE
“PRIMARY” PATIENT SAFETY OFFICER
CLINICAL COMPETENCY CREDENTIALING
EVIDENCE BASED CLINICAL CARE SOLUTIONS
Michigan Presentation 15
FAILURE MODE ANALYSIS
ROOT CAUSE ANALYSIS
SYSTEM CHANGES TIED TO MEASURABLE QUALITY, CLINICAL OUTCOMES
METRICS THAT DEMONSTRATE THE “RETURN ON INVESTMENT” IN PATIENT SAFETY
THE COMPREHENSIVESOLUTION - III
UTILIZING A BUSINESS MODEL FOR CHANGE
Michigan Presentation 16
CREDENTIALING COMPETENCYPREP
EVISICUOPEN
DISCLOSURE
“SPEAK UP”
PENMANSHIP 101
MHAUS CONSENT AS PT SAFETY TOOL
QUALITY OUTCOMES FROM INFRASTRUCTURE CHANGE
PT/FAMILY AS “SAFETY OFFICER”
COMMUNICATIONS
EXAMPLES OF CHANGE
Michigan Presentation 17
TECHNOLOGICALSAFETY
PUBLIC HEALTHRISK MANAGEMENT
EXAMPLES OF CHANGE - II
TIME INSENSITIVE PREDICTIVE INSTRUMENT ECG
ORANGE JUICE STUDY - LOWER MORBIDITY-MORTALITY IN MFM
Michigan Presentation 18
DOING THE BUSINESSCASE FOR CHANGE
BUSINESS NEEDS RISK ASSESSMENT
STRATEGIC PLAN FOR CLINICAL RM - TIED TO HCO STRATEGIC PLAN
USING FMEA - RCA BUSINESS TOOLS TO IDENTIFY NEEDED PROCESS CHANGES
SHOW THE ROI IN PATIENT SAFETY
Michigan Presentation 19
HCO
• Cash flow problems• Adjusting to
capitation payments
• New competitors• Management succession• New technology• New government regulations
• Fire, flood, windstorm• General liability• Medical malpractice
• HIPAA Compliance: Privacy
• Workers Compensation• Unionization• Employment practices• Recruitment of nurses or
systems analysts
Financial Risk: CFO
Strategic Risk: CEO
Operational Risk: COO
• Access to capital markets
• Achieving net income targets
Hazard Risk: RM
Business Needs Risk Assessment
Michigan Presentation 20
THE ROI OF PATIENT SAFETY
FMEA RCA ROI
IDENTIFY
SIGNIFICANT FEW THAT
MERIT FAILURE MODE EFFECT
ANALYSIS
DO A ROOT CAUSE
ANALYSIS, TRACKING
BEFORE AND AFTER COSTS
AND PROJECTED
SAVINGS
DEVELOP A BUSINESS CASE FOR
“WHY” CHANGE IS NEEDED AND “HOW”
TO DO IT
Michigan Presentation 21
BUILD A LOGIC TREE WITH VALIDATION OF HYPOTHESES
TRACK VALIDATION COSTS
ANALYZE THE EVENT
Michigan Presentation 23
THE BOTTOM LINE
PROVIDES A BUSINESS CASE FOR CHANGE DEMONSTRATE THE VALUE PROPOSITION FOR
KEYSTAKEHOLDERS FOCUS ON MEANINGFUL CHANGE RETURN THE MONEY SAVED TO THE SYSTEM REFLECTS AN ACCOUNTABLE
ORGANIZATION IN PATIENT SAFETY
Michigan Presentation 24
WHAT IT MEANS TO THE ACCOUNTABLE ORGANIZATION
A BUSINESS MODEL TO SHARE WITH THE MARKETS TO SHOW YOU ARE MAKING A DIFFERENCE
A SOLID, EVIDENCE-BASED APPROACH TO SHOW PAYERS AND THE PUBLIC YOU ARE SPENDING MONEY WISELY TO PROMOTE QUALITY, PATIENT SAFE CARE
AND….YOU CAN SLEEP AT NIGHT KNOWING YOU DID THE RIGHT THING