April 23, 2012
“Ten years ago, in September 2002, the National Steering Committee on Patient Safety delivered its report urging the development of the Canadian Patient Safety Institute and enhanced efforts to identify and reduce the risk of patient harm across the healthcare system. Two years later, the Canadian Adverse Events Study (Baker et al. 2004) provided data on patient safety in acute care – data that reported levels of harm far greater than most suspected. Today, virtually all Canadian healthcare organizations have goals around improving the safety and quality of care, and many have implemented reporting systems that identify patient safety incidents and track the implementation of recommendations to reduce hazards. In only a decade, patient safety has been transformed from the esoteric interest of a small number of champions to an essential component of healthcare performance across Canada. Today, patient safety is a fundamental prerequisite for the healthcare system: quality is impossible unless patients are protected from unintended harm.”
Posted in Journal Articles, READ Portal | Tagged with Canada, Health care reform, Quality control, Safety | No Comments
February 6, 2012
“Study objective:We examine practical aspects of collecting time-based emergency department (ED) performance measures.
Methods: Seven measures were implemented in 6 hospitals during 1 year. Structured interviews were used to assess the benefits and burdens of reporting. In 2 hospitals, Centers for Medicare & Medicaid Services (CMS) sample size requirements for 3 measures were compared to a reasonable sample size estimate (in which 95% of samples fell within 15 minutes of the population median).
Results: ED performance data on 29,587 admitted patients and 127,467 discharged patients were reported. Median throughput time for admitted patients ranged from 327 to 663 minutes and for discharged patients ranged from 143 to 311 minutes. Other performance measures varied similarly (2- to 3-fold between hospitals). In general, ED throughput was longer at academic sites and those with higher volume. Several benefits of reporting were identified, including promoting ED quality improvement, accountability, and practice standardization. The burdens included having to access multiple information technology systems and difficulties setting up the data collection. Most respondents found great value in the throughput measures and time to pain medication but less value in time to chest radiograph. The human capital required to implement measures varied by hospital and staff demonstrated a learning curve. Our empirically derived minimum reliable sample sizes were different from CMS recommendations.
Conclusion: There is great variation in performance between EDs in time-based ED measures. There are multiple reporting benefits. Reporting burdens seemed to lessen after data systems were established. The CMS sample size requirements for throughput measures may not be optimal compared with actual ED throughput data.”
Posted in Journal Articles, READ Portal | Tagged with Efficiency, Process improvement, Quality control | 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
May 30, 2011
“The lack of systematic oversight of physician performance has led to some serious cases related to physician competence and behaviour. We are currently implementing a hospital-wide approach to improve physician oversight by incorporating it into the hospital credentialing process. Our proposed credentialing method involves four systems: (1) a system for monitoring and reporting clinical performance; (2) a system for evaluating physician behaviour; (3) a complaints management system; and (4) an administrative system for maintaining documentation. In our method, physicians are responsible for implementing an annual performance assessment program. The hospital will be responsible for the complaints management system and the system for collecting and reporting relevant health outcomes. Physicians and the hospital will share responsibility for monitoring professional behaviour. Medical leadership, effective governance, appropriate supporting information systems and adequate human resources are required for the program to be successful. Our program is proactive and will allow our hospital to enhance safety through a quality assurance framework and by complementing existing safety activities. Our program could be extended to non-hospital physicians through regional health or provider networks. Central licensing authorities could help to coordinate these programs on a province- or state-wide basis to ensure uniformity of standards and to avoid duplication of efforts.”
Posted in Journal Articles, READ Portal | Tagged with Leadership, Process improvement, Quality control, Quality improvement, Safety | No Comments
May 6, 2011
“As part of a systemwide transformation, the VA formed its National Center for Patient Safety to foster an organizational culture of safety within its nationwide network of hospitals and outpatient clinics. A recent medical team training program designed to improve communication among operating room staff was associated with a reduction in surgical mortality and improvements in quality of care, on-time surgery starts, and staff morale. The program is now being expanded to other clinical units, along with a patient engagement program that prevents errors by facilitating communication relating to patients’ daily care plans. A recognition program stimulated facilities to conduct timelier and higher-quality root-cause analyses of reported safety events to identify stronger actions for preventing their recurrence. Other initiatives have reduced rates of health care–associated infections, patient mortality, and post-operative complications. Success factors include leadership accountability for performance and organizational support for testing, expanding, and adopting improvements.”
Posted in Journal Articles, READ Portal | Tagged with Benchmarking, Efficiency, Mortality rates, Quality control, Quality improvement, Safety | No Comments
May 2, 2011
Klein, S., & McCarthy, D. (2011). Sentara Healthcare: Making Patient Safety an Enduring Organizational Value. The Commonweatlh Fund. http://www.commonwealthfund.org/Content/Publications/Case-Studies/2011/Mar/Sentara-Healthcare.aspx. Sentara Healthcare, an integrated health care delivery system serving parts of Virginia and North Carolina, has developed a systematic program to foster a culture of safety throughout its member hospitals, with the aim of reducing the […]
Posted in Journal Articles, READ Portal | Tagged with Benchmarking, Efficiency, Policy, Quality assessment, Quality control, Quality improvement, Safety | No Comments
April 27, 2011
Four case studies document the progress achieved in the past five years by health care organizations that were early leaders in patient safety improvement. Their experience reflects an expansion of interventions from individual hospital units to whole facilities and delivery systems, including new settings such as home health care. Approaches include developing practical methods for training, coaching, and motivating staff to engage in patient safety work; designing effective tools and systems to minimize error and maximize learning; and leading change by setting ambitious goals, measuring and holding units accountable for performance, and sharing stories to convey values. Results include advancements in safety practices, reductions in serious events of patient harm, improved organizational safety climate and morale, and declines in malpractice claims. Keeping the commitment to patient safety has required sustained focus on making safety a core organizational value, a willingness to innovate and adapt, and perseverance in pursuing goals.
Posted in Journal Articles, READ Portal | Tagged with Patient-centered care, Quality control, Risk assessment, Safety | No Comments
April 26, 2011
“Variations in health care in the NHS are a persistent and ubiquitous problem. But which variations are acceptable or warranted – for example, variations driven by clinical need and informed patient choice – and which are not? The important question is how to promote ‘good’ variation and minimise ‘bad’ variation.
Variations in health care: The good, the bad and the inexplicable explores the possible causes of variation, shows the different ways in which variations can be measured, and analyses variations by PCT in rates of elective hospital admissions for selected procedures.
The causes of variation are complex and inter-related – they may be affected by, for example, differences in geographical patterns of illness, differences in clinicians’ behaviour, the effects of incentives in the financing of health care. These causes are mapped and discussed.”
Posted in Journal Articles, READ Portal | Tagged with Decision making, Policy, Program evaluation, Quality assessment, Quality control, Quality improvement, Safety | No Comments
April 15, 2011
“The considerable gap between what we know from research and what is done in clinical practice is well known. Proposed responses include the Evidence-Based Medicine (EBM) and Clinical Quality Improvement. EBM has focused more on ‘doing the right things’—based on external research evidence—whereas Quality Improvement (QI) has focused more on ‘doing things right’—based on local processes. However, these are complementary and in combination direct us how to ‘do the right things right’. This article examines the differences and similarities in the two approaches and proposes that by integrating the bedside application, the methodological development and the training of these complementary disciplines both would gain.”
Posted in Journal Articles, READ Portal | Tagged with Evidence-based, Quality control, Quality improvement | No Comments
April 5, 2011
This journal article reviews the implementation a two electronic systems, the Patient Safety Net (PSN) (an error reporting system) and of the Provider Order Entry (POE) program (a prescribing system). The results of this study saw an 88% decrease in prescription errors as a direct result of implementing this system, as medical errors relating to human factors (i.e. handwriting illegibility, prescriber fatigue) were nullified.
“(Article authors) educated and trained staff in (system) use, conducted concurrent chart reviews to estimate true error reduction, and provided continuous feedback as errors occurred. The intervention described here resulted in a reduction in MEs (medical errors) in association with performance improvement efforts that were conducted over 5 years and involved 65,466 patient days, and 617,524 billed doses, which is the largest study of an intervention to reduce psychiatric medication errors reported to date.”
Posted in Journal Articles, READ Portal | Tagged with e-health, Prevention and control, Quality control, Quality improvement | No Comments