partnership for patient safety: influencing and integrating health policy within an organization...

Partnership for Patient Safety: Influencing and Integrating Health Policy

within an OrganizationTuesday, September 16th, 2008

Driving Patient Safety Through Transformation

Background

Institute of Medicine Reports:

• To Err Is Human: Building a Safer Health System (1999)

• Crossing the Quality Chasm (2001)

• Keeping Patients Safe: Transforming the Work Environment of Nurses (2004)


“Never Events”

The Eight “never events” will cost hospitals at least $91 million less annually in Medicare reimbursement

Modern Healthcare,2008


Key Agencies: Safety Initiatives


National Quality Forum: Performance Measures

• Timeliness

• Efficiency

• Coordination of care

• Patient safety

• Prevention or reduction of complications

• Transitions of care

• Patient Outcomes


Challenges in Healthcare Quality /Safety

• Three principal indicators of quality problems:

–Error Rates

–Overtreatment

–Undertreatment


Going from Evidence- Based Practice to Systems –Based Practice

• Compassion

• Pattern Recognition

• Judgment

PeoplePeople

• Simplification

• Standardization

ProcessProcess++

•↓ Memory Dependence

•↑Forcing Function

InformaticsInformatics++

• Reproducible Performance

SystemsSystems==


21st Century Trends: Healthcare Delivery System

8

Access

CostQuality


What is Value?

Quality

Value = Cost


Comprehensive Characteristics of Systems of Quality

• Continuous improvement in all activities and in all people

• Customer satisfaction for internal & external customer

• Efficient deployment of resources

• Employee, supplier, and customer development and recognition

• Environmental well-being

• Exemplary, visionary, and aggressive leadership

• Fast response time

• Full participation of employees, suppliers and customers

• Life- long relationships with customers Malcom Baldridge Nat’l Quality Award, 1995; Deming 1986; Juran,1992


Comprehensive Characteristics of Systems of Quality (con’t)

• Long-range perspectives• Partnerships upstream, downstream, and across functions• Prevention of error by designing in quality• Process mapping and process improvement• Providing customer value• Quantitative measurement and management-by-fact• Root- cause analysis• Shared Values, vision, and culture• Standard quality tools• Top management sponsorship and involvement• Waste reduction and cost containment


asking is the answer


We need a Health Care Delivery System that is

Predictive

Personalized

Pre-emptive

Participatory

(Elias Zerhouni 2008)

15


We have a Health Care Delivery System that is…..

Provider -- Centered

Price -- Driven

Knowledge-- Disconnected

Disease-- Focused

16


How do we get to the system we want?


A

I

D

E

T

Acknowledge

Introduce

Duration

Explanation

Thank You

Studer Group® : Taking You and Your Organization to the Next Level

HCAHPS Survey


H

E

A

R

T

Hear the Customer

Empathize

Apologize

Respond

Thank You

Studer Group® : Taking You and Your Organization to the Next Level


Healthcare for the Greatest Generation

Hospital

Provider

PharmacyPayer

NursingHome

Other

Patient


Healthcare for Boomers

Patient

Internet

PharmaAds

Payer/Employer

Disease Management

Health Clubs

Alternative Medicine Providers

Hospital

Pharmacy PayersImagingCenters

NursingHome

Others

Doctor Patient Relationship


Healthcare for Gen X & Y Information Flow Data as Currency

Patient

Payer/EmployerPrograms

PharmacyRetailHealth

UrgentCare

SpecialtyPhysicians

HealthClub

InternetSearches

PHR(Google & Microsoft)

Labs/Imaging &Surgical Centers

PrimaryCare

Providers


Intelligent Health Systems

(Gingrich & Desmond, Art of Transformation; 2006 © )

23


“Intelligent Health System” Principles

PEOPLE Individual-Centered, Incentive-Driven, Psychology-

Based Empowerment- Focused, Dedicated to the Right to Know Information About Price, Quality,

Providers and Personal Health Status

24

Patient &

Family

PROCESSESPrevention, Early

Detection, Self-Management,

Best Practices

TOOLSInformation Technology, Quality Expert Systems

(Gingrich & Desmond, Art of Transformation; 2006 © )


Intelligent Health Systems

•Patient/family Centered

•Values-Driven

•100% Coverage (not all government sponsored)

•Transparent price & quality information

•Knowledge – Intensive

(Gingrich & Desmond, Art of Transformation; 2006 ©)

25


Intelligent Health Systems (cont.)

•Prevention & health focused

•Electronically – based

•Binary – mediated market

(individual provider)

•Increased choice

(Gingrich & Desmond, Art of Transformation; 2006 ©)

26

*


Intelligent Health Systems (cont.)•New system of health justice

•Focused on quality of care and quality of life

•Metrics-led & outcomes-focused

• Collaborative leadership

• Overall cost decreases

• Rapid diffusion of innovation

27


Health Policy Agenda

• First time in 40 years that Access, Quality and Costs are allall at the top of the Health Policy Agenda – simultaneously


Policy

“A Government statement that defines a course of action which will attain or preserve some desired or acceptable state of affairs.” The purpose is to alter what would occur otherwise.

Milio (1981)


Health Policy

Both Political Parties will need to work together to develop and implement effective policies


Do not sub-optimize nursing,

Speak to the needs of the system as a whole

Nursing Issues regarding Policy


Nurses have a special place and a special role in imparting policy

changes but need to get the talk

“right”


To Be Successful in Influencing Policy:

• Stop talking about nursing care vs. medical care

Start talking about patient care services given by a

variety of providers with frequent overlap of skills • Stop talking about nursing research

Start talking about patient care outcome research

done by nurses• Provide clear evidence and documentation

- nursing's effect on patient outcomes

- profit & loss

- nursing margin and ROI

- what works


To Be Successful in Influencing Policy:

• Stop talking about reimbursement for nurses

Start talking about patient care services done by nurses


Strategies • Get involved as a volunteer in political

races. Donate to and attend low dollar events and attend high dollar events as a volunteer

• Stay connected with your professional associations at the state and national level

• Know your lobbyist well (Do not send letters)

• Network for Corporate Board Appointments –particularly in health care


Political Appointments how to secure

• Personal contact

• Donations

• Activity in party

• Behavior on other appointed committees

• Plum Book

• Head of appointments in White House and Cabinet offices


In Closing………..

The time to take this flight is now and this is your final boarding call.

partnership for patient safety: influencing and integrating health policy within an organization...

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