THE BUSINESS CASE FOR PATIENT SAFETY

1. April, 2003 THE BUSINESS CASE FOR PATIENT SAFETY Fay Rozovsky, JD, MPH, DFASHRM Marsh Health Care Practice Richmond, VA

2. THE DRIVING INFLUENCES CONSUMERS PAYERS It is all about patient safety FEDs STATES ACCREDITATION TRADE ASSNs PROFESSIONAL GROUPS UNIONS “THE COMBO” MEDIA

3. THE STATE OFPATIENT SAFETY • MULTIPLE PLAYERS SETTING STANDARDS AND EXPECTATIONS • STATES ENACTING “REFORMS”GEARED TO PATIENT SAFETY • JCAHO • PATIENT SAFETYACCREDITATION STANDARDS • “PERFORMANCE REPORTS” • LINK ERROR TO STAFFING

4. THE PAYER PERSPECTIVE • HEALTH INSURANCEPREMIUMS INCREASING • DISSATISFACTION ABOUT OUTCOMES OF CARE • FRUSTRATION WITH “NO ONE” DOING ANYTHING TO FIX THE SYSTEM

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

6. PROFESSIONAL LIABIILTY • WHAT “FIRST DOLLAR” COVERAGE? • WHAT INSURANCE? • LARGE PREMIUM INCREASES, LOWER LIMITS SOME CANNOT PURCHASE PROFESSIONAL LIABILITY INSURANCE

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

8. THE STATES • MORE “REFORMS” GEARED TO REPORTING • INCREASE IN JUAs • CAPS ON MED MAL LEGISLATED "PATIENT SAFETY"

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…….

10. AS CONSUMERS UNIONS QUALITY SAFE CARE PATIENT SAFETY STAFFING EFFECTIVENESS COMPETENCY TRAINING AS HEALTHCARE PROFESSIONALS

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.

12. WHAT’S MISSING? • COMPREHENSIVE SYSTEMTIC CHANGES • COST-EFFECTIVE, EVIDENCE BASED SOLUTIONS • FUNDING TO DRIVE CHANGE THE SYSTEM IS IN TRAUMA AND NEEDS AN OVERHAUL

13. THE COMPREHENSIVESOLUTION - I • A PUBLIC HEALTH REPONSE FROM RM • ELIMINATE, CONTROL, MITIGATE PRECUSORS TO HIGH ACUITY - HIGH RISK SITUATIONS COMMUNITY HEALTHCARE “GROUP” HEALTHCARE PREVENTIVE HEALTHCARE COMPREHENSIVE SOLUTION MANAGE “AT RISK” EVIDENCE BASED ACUTE CARE SERVICES

14. 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 INFRASTRUCTURE CHANGE

15. THE COMPREHENSIVESOLUTION - III UTILIZING A BUSINESS MODEL FOR CHANGE FAILURE MODE ANALYSIS ROOT CAUSE ANALYSIS SYSTEM CHANGES TIED TO MEASURABLE QUALITY, CLINICAL OUTCOMES METRICS THAT DEMONSTRATE THE “RETURN ON INVESTMENT” IN PATIENT SAFETY

16. CREDENTIALING COMPETENCY EXAMPLES OF CHANGE PREP EVISICU OPEN DISCLOSURE QUALITY OUTCOMES FROM INFRASTRUCTURE CHANGE “SPEAK UP” PT/FAMILY AS “SAFETY OFFICER” PENMANSHIP 101 COMMUNICATIONS MHAUS CONSENT AS PT SAFETY TOOL

17. EXAMPLES OF CHANGE - II TIME INSENSITIVE PREDICTIVE INSTRUMENT ECG ORANGE JUICE STUDY - LOWER MORBIDITY-MORTALITY IN MFM TECHNOLOGICAL SAFETY PUBLIC HEALTH RISK MANAGEMENT

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

19. Business Needs Risk Assessment Strategic Risk: CEO Financial Risk: CFO • Cash flow problems • Adjusting to capitation payments • New competitors • Management succession • New technology • New government regulations • Access to capital markets • Achieving net income targets HCO • Workers Compensation • Unionization • Employment practices • Recruitment of nurses or systems analysts • Fire, flood, windstorm • General liability • Medical malpractice • HIPAA Compliance: Privacy Hazard Risk: RM Operational Risk: COO

20. THE ROI OF PATIENT SAFETY FMEA RCA ROI 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 IDENTIFY SIGNIFICANT FEW THAT MERIT FAILURE MODE EFFECT ANALYSIS

21. ANALYZE THE EVENT BUILD A LOGIC TREE WITH VALIDATION OF HYPOTHESES TRACK VALIDATION COSTS

22. THE ROI OF ANALYSIS OUTCOMES SUMMARY REPORT ROI FOR EACH RECOMMENDATION

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

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