May 2, 2012
“In October 2011, the Health Council of Canada hosted a national symposium on patient engagement. The plan was simple enough: we wanted to explore how good ideas have been, and could be, turned into action. As we began to develop the agenda for the day, we learned there is no shortage of Canadians—both within and outside the health system—with much to say on the matter. The over 160 people who attended collectively represented the Canadian health care system: patients; representatives from patient organizations; federal and provincial governments, regional health authorities, and local health integration networks; health system administrators; health care providers; and researchers.
We heard many perspectives. Patients told us what it is like to navigate the often intimidating and confusing Canadian health care system. Health care providers gave us an insider’s view of how they would improve this same system for their patients, and planners and administrators told us how they’re working to make patient centred care a reality. Our intention was three-fold: to raise awareness of the potential of patient engagement as an instrument of change; to spark a national dialogue that would build support for patient engagement; and to help those who are entering this burgeoning field of system-level change to gain insight into tools and experiences that are available to either start or advance their patient engagement work. To keep the momentum from that day going, we developed this commentary and proceedings report to inspire governments, health care workers, and patients to take up patient engagement in their own ways.
For the Health Council of Canada, our work didn’t end with the symposium. We will keep what we learned in October fresh in our minds, and embed it into all that we do. Patient engagement at all levels happens when we ask ourselves, “Is this the right thing to do so that patients and their caregivers have a voice?” We hope all symposium participants are doing the same.
We can learn from one another, share what others are doing well, and, more importantly, not be afraid to ask them how they did it. The ideas for change are out there. By sharing what we learn from those actively involved in health care, and putting that knowledge into practice, we can start to turn ideas and experience into a better reality for all Canadian patients.
Posted in READ Portal, Reports & Papers | Tagged with Canada, Health care reform, Patient-centered care, Quality improvement | No Comments
May 1, 2012
“Systems that provide healthcare workers with the opportunity to report hazards, hazardous situations, errors, close calls and adverse events make it possible for an organization that receives such reports to use these opportunities to learn and/or hold people accountable for their actions. When organizational learning is the primary goal, reporting should be confidential, voluntary and easy to perform and should lead to risk mitigation strategies following appropriate analysis; conversely, when the goal is accountability, reporting is more likely to be made mandatory. Reporting systems do not necessarily equate to safer patient care and have been criticized for capturing too many mundane events but only a small minority of important events. Reporting has been inappropriately equated with patient safety activity and mistakenly used for “measuring” system safety. However, if properly designed and supported, a reporting system can be an important component of an organizational strategy to foster a safety culture.
Healthcare is not as safe as it should or could be: rates of adverse events, defined as situations where patients suffer harm from the healthcare they receive (or not receiving care that would have helped), in acute care have been shown to be high. For example, the Canadian Adverse Events Study found that 7.5% of patients admitted to a Canadian hospital suffered an adverse event (Baker et al. 2004). The National Steering Committee on Patient Safety listed the comprehensive identification and the reporting of hazards as one of “nine key principles for action” that served as a foundation for the committee’s recommendations to make Canadian patients safer (National Steering Committee on Patient Safety 2002). Further, the committee recommended the adoption of non-punitive reporting policies within a quality improvement framework. Recently, the National System for Incident Reporting (Canadian Institute for Health Information 2011) was established by the Canadian Institute for Health Information, whose focus at the present time is incidents regarding hospital-based medication and intravenous fluids. The development of reporting systems to enhance patient safety has been proposed as a strategy in other countries; examples include the Australian Incident Monitoring System (Runciman 2002) and the National Reporting and Learning System in England and Wales (Williams and Osborn 2006).”
Posted in Journal Articles, READ Portal | Tagged with Benchmarking, Canada, Quality improvement, Safety | No Comments
April 19, 2012
“Recent research has demonstrated that an exceptional patient experience correlates with improved clinical quality, reduced readmissions and improved mortality. HCAHPS is a tool that can be used to help organizations improve the patient experience, and may have a related effect on clinical quality. With the implementation of value-based purchasing beginning with October 1, 2012 discharges, HCAHPS performance will also have an impact on financial goals.
This guide describes how HCAHPS data should be used in context with other information about organizational performance. It highlights cultural elements necessary to build a firm foundation for HCAHPS success. Once these foundational elements have been considered, the guide outlines a 5-step approach to using HCAHPS effectively to improve the patient experience, quality and safety:
- Understand HCAHPS data
- Set improvement priorities
- Identify and implement targeted interventions
- Engage the team
- Measure and monitor success
The appendix includes links to white papers and case studies that can help health care leaders better understand the HCAHPS survey and identify and successfully implement strategies for improvement.”
Posted in READ Portal, Reports & Papers | Tagged with Process improvement, Quality improvement | No Comments
March 21, 2012
“This toolkit is designed to help your hospital understand the Quality Indicators (QIs) from AHRQ, and support your use of them to successfully improve quality and patient safety in your hospital. Created by the RAND Corporation and the University HealthSystem Consortium with funding from AHRQ, it is available for all hospitals to use free of charge. The toolkit is a general guide to using improvement methods, with a particular focus on the QIs.
The AHRQ QIs use hospital administrative data to assess the quality of care provided, identify areas of concern in need of further investigation, and monitor progress over time. This toolkit focuses on the 17 Patient Safety Indicators (PSIs) and the 28 Inpatient Quality Indicators (IQIs).”
Posted in Multimedia, READ Portal | Tagged with Indicators, Patient-centered care, Process improvement, Quality improvement, Safety | No Comments
March 1, 2012
“Health system stakeholders at different levels are focused more than ever on improvements to quality of care. With heart disease continuing to be a top health issue for Canadians, quality improvement initiatives aimed at improving cardiac care are increasingly important. The Cardiac Care Quality Indicators are one such initiative, with the goal of supporting cardiac care centres in their quality improvement efforts by providing comparable facility-level information on a number of cardiac quality outcome indicators. Working together, the Canadian Institute for Health Information and the Cardiac Care Network of Ontario completed the pilot project for this initiative in Ontario and British Columbia in 2010. Based on the success of the pilot, a national expansion of the initiative is currently under way. This article details some of the processes that led to the success of the project and presents some high-level, de-identified results.”
Posted in Journal Articles, READ Portal | Tagged with Canada, Quality improvement, Quality of care | No Comments
February 28, 2012
“Background: There is growing interest in applying lean thinking in healthcare, yet, there is still limited knowledge of how and why lean interventions succeed (or fail). To address this gap, this in-depth case study examines a lean-inspired intervention in a Swedish pediatric Accident and Emergency department.
Methods: We used a mixed methods explanatory single case study design. Hospital performance data were analyzed using analysis of variance (ANOVA) and statistical process control techniques to assess changes in performance one year before and two years after the intervention. We collected qualitative data through non-participant observations, semi-structured interviews, and internal documents to describe the process and content of the lean intervention. We then analyzed empirical findings using four theoretical lean principles (Spear and Bowen 1999) to understand how and why the intervention worked in its local context as well as to identify its strengths and weaknesses.
Results: Improvements in waiting and lead times (19-24%) were achieved and sustained in the two years following lean-inspired changes to employee roles, staffing and scheduling, communication and coordination, expertise, workspace layout, and problem solving. These changes resulted in improvement because they: (a) standardized work and reduced ambiguity, (b) connected people who were dependent on one another, (c) enhanced seamless, uninterrupted flow through the process, and (d) empowered staff to investigate problems and to develop countermeasures using a “scientific method”. Contextual factors that may explain why not even greater improvement was achieved included: a mismatch between job tasks, licensing constraints, and competence; a perception of being monitored, and discomfort with inter-professional collaboration.
Conclusions: Drawing on Spear and Bowen’s theoretical propositions, this study explains how a package of lean-like changes translated into better care process management. It adds new knowledge regarding how lean principles can be beneficially applied in healthcare and identifies changes to professional roles as a potential challenge when introducing lean thinking there. This knowledge may enable health care organizations and managers in other settings to configure their own lean program and to better understand the reasons behind lean’s success (or failure).”
Posted in Journal Articles, READ Portal | Tagged with Benchmarking, Process improvement, Quality improvement | No Comments
February 20, 2012
“An emerging category of hospital quality initiatives, comparable to preventing medical errors and improving quality and patient safety, could be labeled “waste management” or “waste reduction.” “Waste” in this sense refers not to biohazardous substances in need of disposal, but to the overuse of medical resources—such as lab tests and pharmaceuticals—when they are not helpful to a patient’s medical management.”
“If patients are getting CAT scans they don’t really need or an extra day of telemetry because we don’t have criteria for who should be on telemetry, that’s wasteful, it’s costly, and it could be dangerous,” Dr. Wachter explained at the UCSF Management of the Hospitalized Patient meeting last October. “The data are clear that 30% of what we do in American medicine is of no value to patients—and some substantial portion of that is harmful as well. I think we as hospitalists should be identifying what these wasteful things are—and making the hard decisions to stop them.”
Posted in Mass Media Articles, READ Portal | Tagged with Process improvement, Quality improvement | No Comments
February 10, 2012
“Cultural competency in health care describes the ability of systems to provide care to patients with diverse values, beliefs and behaviors, including the tailoring of health care delivery to meet patients’ social, cultural and linguistic needs. A culturally competent health care system is one that acknowledges the importance of culture, incorporates the assessment of cross-cultural relations, recognizes the potential impact of cultural differences, expands cultural knowledge, and adapts services to meet culturally unique needs. Ultimately, cultural competency is recognized as an essential means of reducing racial and ethnic disparities in health care.
This guide explores the concept of cultural competency and builds the case for the enhancement of cultural competency in health care. It offers seven recommendations for improving cultural competency in health care organizations:
- Collect race, ethnicity and language preference (REAL) data.
- Identify and report disparities.
- Provide culturally and linguistically competent care.
- Develop culturally competent disease management programs.
- Increase diversity and minority workforce pipelines.
- Involve the community.
- Make cultural competency an institutional priority.”
Posted in READ Portal, Reports & Papers | Tagged with Hospital administration, Quality improvement | No Comments
February 9, 2012
“At a time when hospitals are under pressure to improve quality and make productivity savings, they need to find tools to support them. Service-line management (SLM) and service-line reporting (SLR) offer one approach. Service-line management is a system in which a hospital trust is divided into specialist clinical areas that are then managed, by clinicians, as distinct operational units. SLM enables clinicians and managers to plan service activities, set objectives and targets, monitor financial and operational activity and manage performance. Service-line reporting provides the necessary data on financial performance, activity, quality and staffing.
Service-line management: Can it improve quality and efficiency? presents the findings from a series of interviews with staff at seven NHS trusts that are using SLM or SLR, revealing how they are implementing this approach and identifying what helps and what hinders this way of working.
The paper outlines a number of important issues for trusts to consider when introducing SLM.
- The role of the board – including the need for both clear and consistent executive support for using SLM and for executives to be willing to relinquish control over decisions and budgets.
- Clinical engagement – especially the need to provide support and training to enable clinicians to take on leadership and management roles and to develop shared and realistic goals.
- Data – including identifying and evaluating existing sources of data and the need to accept that the time needed to implement SLM, the value of the information obtained, and the ease of data collection will vary between service lines because of external and clinical factors.
- Resources – including the challenge of finding the time and resources to dedicate to the introduction of SLR and SLM and the need for well-resourced and suitably skilled financial and informatics support.
The paper concludes that implementing SLR and SLM well is challenging, but it works best when it is part of the overall management approach of the trust and its day-to-day way of working.”
Posted in READ Portal, Reports & Papers | Tagged with Hospital administration, Quality assessment, Quality improvement | No Comments
December 8, 2011
“ABSTRACT: Recent reforms in Australia, England, and the Netherlands have sought to enhance the quality and accessibility of primary care. Quality improvement strategies include postgraduate training programs for family physicians, accreditation of general practitioner (GP) practices, and efforts to modify professional behaviors—for example, through clinical guideline development. Strategies for improving access include national performance targets, greater use of practice nurses, assured after-hours care, and medical advice telephone lines. All three countries have established midlevel primary care organizations both to coordinate primary care health services and to serve other functions, such as purchasing and population health planning. Better coordination of primary health care services is also the objective driving the use of patient enrollment in a single general practice. Payment reform is also a key element of English and Australian reforms, with both countries having introduced payment for quality initiatives. Dutch payment reform has stressed financial incentives for better management of chronic disease.
With well-developed primary care systems that have track records of strong performance, Australia, England, and the Netherlands offer some potentially useful lessons to the United States as it implements health care reforms. This brief outlines how primary care is provided in those three countries, it evaluates data on a range of primary care system performance indicators, and it examines the three countries’ major strategies for strengthening primary care:
- Promoting coordination of care;
- Reforming primary care payment;
- Improving quality and access.
Click here to read the full article
Posted in READ Portal, Reports & Papers | Tagged with Benchmarking, Health care reform, Primary health care, Quality control, Quality improvement | No Comments
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