Patient Safety Focus

Interview Series: Dr. Meghan Dierks discusses how HVA increases hand-hygiene compliance

As we continue our interview series with today’s thought leaders in patient safety, we spoke with Dr. Meghan Dierks, Assistant Professor, Harvard Medical School.

HVA (Hospital Video Auditing) is an innovative, non-intrusive, 24/7 auditing technology that significantly improves compliance with patient safety and hand washing practices and protocols

In structuring the HVA program at a surgery center in the southeastern United States, Dr. Dierks has witnessed compliance scores soar from 35% to 90%+... and even more striking, she's seen compliance rates remain there.

In what ways, and to meet which specific goals, is the healthcare facility using HVA?

"We applied the technology to tackle a refractory problem in the healthcare compliance arena--the very basic safety protocol revolving around hand-hygiene and getting physicians to modify their safety behavior. The technology was two-fold: first, it would provide us the ability to collect highly reliable data and we hadn't been able to in the past. And, second, by nature of collecting high-quality data and instilling a feedback loop to relay that data to physicians practicing in that environment we could achieve a behavioral change.

We had two goals, both of which were achieved through the use of HVA. First, we needed to be able to collect highly reliable data over a sustained period of time on hand hygiene behaviors--something that has been difficult to achieve using other strategies. Second, in order to achieve a behavioral change, we needed to be able to use this data to provide continuous performance feedback to the healthcare workers practicing in that environment."

What significant points of success and improvements have you witnessed from the surgery center using the technology?

"Prior published studies have demonstrated that other efforts and interventions--such as employing human observers or posting educational signage--achieve short term, but not sustainable improvements in compliance. HVA is a highly reliable data-collection technique that enabled us to continuously measure performance over a long period of time in the surgery center, and document positive movement toward an established goal.

We are now reaching our sixth month of continuous measurement and feedback. Using HVA, we identified a relatively low baseline compliance rate of 38%. We provided weekly feedback, and over the next several weeks, saw dramatic improvements in compliance. This relatively high compliance rate has now been sustained in the 88%-98% range for six months. While the fact that we achieved 98% compliance within four weeks is remarkable, equally striking is the sustainability of the behavior change."

Interview Series: Dr. Kumar discusses PMEs and Fatal Care

As part of our interview series with today’s thought leaders in patient safety, we spoke with Dr. Sanjaya Kumar, author of the just-released book Fatal Care.

Each year as many as 98,000 patient deaths occur in the United States as a result of preventable medical errors (PMEs) in hospitals--with PMEs impacting or harming at least 5 million Americans annually and costing more than $17-21 billion.

These sobering statistics from the Institute of Medicine (IOM) and the Institute for Healthcare Improvement (IHI) provide a glimpse into a national crisis that harms or kills hundreds of innocent people each day. But they are only nameless, faceless numbers and can't illustrate the human cost behind the data. Moreover, they only reveal the problem and not the underlying causes or potential solutions.

Unique and unlike other healthcare-related books, Fatal Care blends true, real-life dramas that illustrate gaps in the healthcare system with factual information and analysis for healthcare consumers and professionals.

What inspired you to write Fatal Care?

"There is an epidemic in this country called preventable medical errors. They, for the most part, go unnoticed while claiming the lives of hundreds of people in the United States each day.These deaths are sacrifices that are unreported, unrecognized and not acknowledged.

I wrote Fatal Care in an effort to provide a voice and a face to those nameless and faceless victims. I want the world to know that this epidemic exists and that they can easily become the next victim. My hope is that this book helps both those accessing care and those who provide that care."

In your opinion, what are the "top actions/priorities" that will move the industry much closer to eradicating PMEs and HAIs?

"First and foremost the actions and priorities outlined are long-term solutions. There are no easy fixes to complex system issues such as preventable medical errors. That said, there are several high priority actions healthcare providers and consumers need to address in order to drive positive change. First, healthcare providers need better cataloging of errors in a standardized fashion. This will allow for accurate trend and intervention identification leading to preventable medical error reduction.

Secondly, the industry needs increased shared knowledge access for cross industry learning. Also, healthcare organizations have to embrace adherence and compliance to evidence-based best practices as this ensures known mistakes are not repeated.

Finally, consumers really need to become educated advocates for their own care. Gone are the days where people can go blindly to their healthcare provider and expect that everything will be taken care of for them."

Interview Series: Dr. Halamka discusses how technology can improve patient safety

As part of our interview series with today’s thought leaders in patient safety, we spoke with John D. Halamka, MD, MS.

Dr. Halamka is Chief Information Officer of the CareGroup Health System, Chief Information Officer and Dean for Technology at Harvard Medical School, Chairman of the New England Health Electronic Data Interchange Network (NEHEN), CEO of MA-SHARE (the Regional Health Information Organization), Chair of the US Healthcare Information Technology Standards Panel (HITSP), and a practicing Emergency Physician.

If that sounds like a tremendous amount of responsibility, it is--in all, his work supports 3,000 doctors, 18,000 faculty and 3 million patients... not to mention his finding time to publish an informative and enlightening blog.

Q: How are the hospitals that you’re working with using technology to reduce errors and lower risk?

A: “Populate electronic medical records: Achieve 85% electronic clinical documentation by 2011 via consistent use of automated history and physicals, electronic progress notes, eForms and scanning technologies.

Medication Management: Achieve end to end electronic medication administration by 2009 through the consistent use of provider order entry in all inpatient areas, electronic prescribing in all ambulatory areas, medication reconciliation at each transition in the care process, and electronic medication administration records based on bar coded medications.

Training, education and competency: complete a new hospital policy requiring the consistent use of our EMR to manage problem lists, medication management, notes and ordering by July 2008.”

Q: Do you think technology (or tech innovations/solutions) has the potential to help hospitals improve patient safety, and why?

A: “Coordination of care among providers via e-Prescribing and use of electronic health records will ensure smooth handoffs, reducing medical error. Empowering the patient to be the stewards of their own data via personal health records will encourage doctor/patient shared decision making, transparency into the medical record including the correction of errors, and respect for patient privacy preferences when sharing data.”

Q: In your opinion, what are the “top actions/priorities” that will move the industry much closer to eradicating PMEs and HAIs?

A: "End to end electronic medication workflows including e-Prescribing, provider order entry, and electronic medication administration records.

100% electronic documentation including all outpatient and inpatient notes, diagnostic test results and images.

Decision support systems which enforce best practices including guidelines, protocols and care plans."

• For Dr. Halamka's blog, please go here.
• Is there a thought leader that you would like to see interviewed? Please email us here.
• For all interviews with today's patient safety thought leaders, please go here.

Interview Series: Leapfrog leverages collective purchasing power for big leaps in patient safety

To kickoff our interview series with today’s thought leaders in patient safety, we spoke with Leah Binder, CEO of The Leapfrog Group.

Launched in 2000, Leapfrog is a unique initiative because it is driven by organizations that buy healthcare with the aim of mobilizing their employer purchasing power to alert America’s health industry that big leaps in healthcare safety, quality and customer value will be recognized and rewarded.

Among other initiatives, Leapfrog works with its employer members to encourage transparency and easy access to health care information, as well as rewards for hospitals that have a proven record of high quality care.

How is The Leapfrog Group working to improve patient safety?

Leapfrog represents the interests of the nation’s large employers, formed by a group of CEOs who were very disturbed by the 1999 IOM report that estimated that up to 98,000 Americans die unnecessarily every year from preventable medical errors (PMEs), with millions more harmed as a result of hospital-acquired infections (HAIs). So our founders wanted to see if we could make major change to address that problem--and they named it “Leapfrog” to make giants leaps forward, not just incremental change.

What Leapfrog does is survey hospitals and we ask them questions based upon NQF’s well-established, evidence-based measures that tell us about the quality and safety of hospitals. We then score them and place the information online so that employers may use that information to work with health plans and structure pay-for-performance (PFP) programs.

Employers have not traditionally used their purchasing power to influence healthcare services they purchase--they haven’t been able to simply insist that they deserve a certain level of quality for what they’re spending. Leapfrog is employers’ answer to that. In addition to asserting employers’ standards as purchasers of healthcare, Leapfrog advocates transparency so that people can choose hospitals based on safety practices and quality of care.

In your opinion, what are the “top priorities” that will move the industry much closer to eradicating PMEs and HAIs?

There are three top priorities. The first priority is to transform financing, because we currently have a financing system that too often rewards the wrong things. We tend to reward what we don’t want to happen and we tend to under-finance what we do. For example, right now--though not for long--the hospitals that have the highest levels of HAIs are probably getting the highest reimbursements from Medicare. Another example: our healthcare system tends to pay inadequately for prevention but readily spends huge sums for emergency or acute care that might have been avoided through better prevention. So we as a country are often financing at odds with our values.

The second top priority is that we have to support hospitals and recognize how difficult it is to change. It’s a comprehensive systems change to decrease HAIs and involves a change across the board and everyone--from doctors to administrators to those that register the patients--needs to play a role in that change. Employers, like our organization’s members, are the first to recognize how hard change is because they understand it from the standpoint of their own companies--but they also understand that we are in the business of enforcing accountability.”

The third top priority is transparency. Purchasers and consumers need to have information on the safety of providers in order to choose the best. Having more consumers using information about quality helps drive change in the system.