The Culture of Health Care

2. The Culture of Health Care Sociotechnical Aspects: Clinicians and Technology Lecture b This material (Comp 2 Unit 10) was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015. This material was updated in 2016 by Bellevue College under Award Number 90WT0002. This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/.

3. Sociotechnical Aspects: Clinicians and TechnologyLearning Objectives • Describe the concepts of medical error and patient safety (Lectures a, b). • Discuss error as an individual problem and as a system problem (Lecture a). • Compare and contrast the interaction and interdependence of social and technical “resistance to change” (Lecture c). • Discuss the challenges inherent with adapting work processes to new technology (Lecture c). • Discuss the downside of adapting technology to work practices and why this is not desirable (Lecture c). • Discuss the impact of changing sociotechnical processes on quality, efficiency, and safety (Lectures a, b).

4. Patient Safety Goals • The National Patient Safety Goals (NPSGs) • Promoted by The Joint Commission • Set of regulations addressing safety issues including: • Infections by antibiotic-resistant microorganisms • Catheter-related bloodstream infections (CRBSIs) • Surgical site infections (SSIs)

5. Improving Patient Safety by Implementing a “Do Not Use” List • In 2001, The Joint Commission issued a Sentinel Event Alert on the topic of medical abbreviations • In 2002, a National Patient Safety Goal was approved that required accredited organizations to develop and implement a “do not use” list of abbreviations • In 2004, The Joint Commission created its “do not use” list as part of the requirements • In 2010, NPSG.02.02.01 was integrated into The Joint Commission Information Management standards

6. Infection Control as a Patient Safety Measure • Examples of methodologies used to control infection in the inpatient setting • Emphasis on hand hygiene • Immunizing health care professionals to avoid the spread of disease • Using antibiotics appropriately to reduce antibiotic resistance • Identifying and appropriately isolating patients with infectious pathogens • Revising training and competency assessments • Using safer medications

7. Universal Protocol for Preventing Patient Harm during Surgery • In 2003, the Joint Commission approved the Universal Protocol for Preventing Wrong Site, Wrong Procedure and Wrong Person Surgery • Since 2004, protocol required for all accredited facilities • Components of Universal Protocol:  • Conducting a pre-procedure patient/site verification process • Marking the procedure site prior to surgery • Performing a pre-procedure time-out

8. Other Promoters of Patient Safety • Patient safety promoted by organizations • Example: Leapfrog Group, a voluntary program initiated by large employers and organizations of purchasers • Leapfrog initiatives include the Leapfrog Hospital Survey and a number of initiatives that improve patient safety

9. Some Leapfrog Members Employers • The Boeing Company • Chrysler • FedEx Corporation • General Motors Corporation • Goodwill Industries Central IN • IBM • Intel Corporation • Lockheed Martin • Maine State Employee Health Commission • Motorola, Inc. • Ohio Public Employees Retirement System • Sprint • Toyota • UPS • United Technologies Corporation Organizations of Purchasers • Colorado Business Group on Health • Indiana Employers Quality Health Alliance • Iowa Buyers Health Alliance • Lehigh Valley Business Coalition on Health • Las Vegas Health Services Coalition • Maine Health Management Coalition • Massachusetts Healthcare Purchaser Group • Nevada Healthcare Coalition • New Hampshire Purchasers Group on Health • New Jersey Healthcare Quality Institute • New York Business Group on Health • Niagara Health Quality Coalition • Pacific Business Group on Health • Savannah Business Group on Health • South Carolina Business Coalition on Health

10. Other Promoters of Patient Safety Continued • Nonprofit organizations • Example: National Quality Forum (NQF) • Goals: • Sets national priorities and goals • Endorses national consensus standards • Promotes the attainment of national goals

11. Other Promoters of Patient Safety Continued 2 • Consumer organizations • Example: Consumer Reports • Rates hospitals, cardiac surgical groups, treatments, natural medicines • Multiple methodologies for rating • Performance data • Patient ratings

12. Patient Ratings of Hospitals • HCAHPS questions ask about • Communication • Pain control • Assistance • Cleanliness and quietness • Medication and discharge information • Whether the patient would recommend the hospital to family and friends • The patients’ overall rating of their experience

13. Sociotechnical Aspects: Clinicians and TechnologySummary – Lecture b • Patient safety is promoted by using enhancements in technology coupled with improvements in how people work • This sociotechnical process is assisted by agencies such as The Joint Commission • Organizations such as the Leapfrog Group, the National Quality Forum, and consumer organizations promote patient safety

14. Sociotechnical Aspects: Clinicians and TechnologyReferences – Lecture b References Ebright, P. (2014). Culture of safety part one: Moving beyond blame. University of California. MERLOT. Retrieved from https://www.merlot.org/merlot/materials.htm%3Bjsessionid= F7A1AA5120282BC1123A261CCB3EEEDC?pageSize=&page=10&userId=19195 Fonarow, G., Abraham, W., Albert, N. M., et al. (2007). Association between performance measures and clinical outcomes for patients hospitalized with heart failure. JAMA, 297, 61–70. Fowles, J. B., & Commonwealth Fund. (2008). Performance measures using electronic health records: Five case studies. Washington, DC: Commonwealth Fund. Retrieved from http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=685103 Institute of Medicine. (2000). To err is human: Building a safer health system. National Academies Press. Retrieved from http://books.nap.edu/openbook.php?isbn=0309068371 The Joint Commission. (n.d.). Universal protocol poster. Retrieved from http://www.jointcommission.org/assets/1/18/UP_Poster.pdf The Joint Commission. (2009). Measuring hand hygiene adherence: Overcoming the challenges. Retrieved from http://www.jointcommission.org/assets/1/18/hh_monograph.pdf. The Joint Commission. (2015). Facts about the do not use list of abbreviations. Retrieved from http://www.jointcommission.org/facts_about_do_not_use_list/ Landon, B., Normand, S., Blumenthal, D., & Daley, J. (2003). Physician clinical performance assessment: Prospects and barriers. JAMA, 290, 1183–1189.

15. Sociotechnical Aspects: Clinicians and TechnologyReferences – Lecture b Continued Leape, L. L. (1994). Error in medicine. JAMA, 272(23),1851–1857. Lindenauer, P., Remus, D., Roman, S., et al. (2007). Public reporting and pay for performance in hospital quality improvement. New England Journal of Medicine, 356, 486–496. Lynn, J., & Baily, M., et al. (2007). The ethics of using quality improvement methods in healthcare. Annals of Internal Medicine, 146, 666–673.

16. The Culture of Health CareSociotechnical Aspects: Clinicians and TechnologyLecture b This material was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number IU24OC000015. This material was updated in 2016 by Bellevue College under Award Number 90WT0002.