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Hardly a month goes by when there isn’t a high profile reminder about how concerned the public should be with the safety and quality of healthcare in the United States. Last year, Time and Newsweek published feature articles about the startling prevalence of preventable medical errors and variable care quality in some of our nation’s best hospitals (case reporting that even physicians and their family members are victims of serous mistakes). This year it has been the NY Times, USA Today and other “daily papers” documenting the findings of prominent national healthcare studies (HealthGrades Report on Hospital Quality and Patient Safety; Commonwealth Fund Reports), which essentially conclude that despite very bright, caring and committed administrators, physicians and nurses, hospitals continue to struggle with avoidable errors, hospital acquired conditions, uneven care/service quality and patient dissatisfaction.
What is perhaps most alarming is that it has been over a decade since the Institute of Medicine, the Joint Commission on the Accreditation of Hospitals and other Healthcare Organizations (JCAHO), the Institute for Healthcare Improvement and others, issued a “call to arms” to address Healthcare’s ills. The good news is that a universal trilogy of improvement approaches (Process Improvement, Best Practice, Process Automation) has emerged in healthcare, resulting in the standardization and improvement of many care and service processes. The clearly more ominous news - more innovation and improvement progress is needed in our hospitals ASAP.
White Space Business Modeling would ask Healthcare’s leaders, “What
is the white space gap in hospital care, which if addressed, might quickly
lead to consistently better outcomes?” What we know isn’t missing is
the day-to-day use of Process Improvement methods, Evidence-Based Best
Practice benchmarking and Process Automation – all of which, however,
fairly exclusively address improving the “WHATs” that care providers
do. The missing innovative link - a Patient Safety and Quality strategy
which focuses equal time on the behavioral “HOWs” of care provision
and the technical “WHATs” associated with care/service outcomes: Healthcare
Values: Patient Safety First ©.
Healthcare Values: Patient Safety First © (HCV:PSF) is based on
the logically adequate and empirically valid premise that it is shortcomings
involving
the “HOWs” of Communication, Collaboration and Patient/Safety-First
behaviors which cause most medical errors, hospital acquired conditions,
variable care/service quality and people dissatisfaction. A visit to
JCAHO’s sentinel-event webpage shows that Communication deficits, by
far, are the leading root cause for serious medical errors and hospital
acquired infections, with shortcomings involving the “HOWs” of Patient/Safety-First
(e.g. procedural non-compliance) and Leadership not far behind.
The HCV:PSF system is designed on the foundation tenet that hospital "Cultures
of Safety" can only be sustained with:
- Equal and priority focus on the key “behavioral HOWs” and
“technical WHATs” of care/service provision,
-
Measurable behavioral and technical care/service standards
which are used to continuously manage care/service
outcomes,
-
Structured quarterly performance coaching dialogues
guided by core behavioral and technical care/service
outcomes data,
-
Redesigned HR continuum (employee selection through
performance evaluation) primarily based on priority behavioral
and technical quality/safety standards.
Together, these quintessential tactics inculcate a highest quality and safest care and service culture by: routinizing priority-focused performance management, strengthening 1:1 and Team manager-staff relationships, informing improvement opportunities and providing a measurable infrastructure which drives shared accountability for best possible care/service outcomes.
What follows is a Healthcare Values: Patient Safety First © Executive
Summary recently presented as one of only four master learning sessions
at ASHHRA’
s National conference, and has garnered interest at the Institute for
Healthcare Improvement as a tactical managerial science healthcare innovation.
What becomes clear, is that HCV:PSF implementation is a highly participatory
process involving both leadership and staff, which produces customized
performance measures consistent with a given hospital’s language and
culture. It can be implemented hospital-wide over time, or applied to
specific microsystems, where sustainable safety climates and team functioning
are directly related to improved clinical outcomes (i.e. Intensive Care
Units). Perhaps most advantageous, is that HCV:PSF is complimentary to,
and will act to enhance through tactical sustainability mechanisms, other
Quality and Patient Safety improvement programs/approaches already in
place.
Healthcare Values: Patient Safety First ©
- Executive Summary
Introduction
Healthcare Values: Patient Safety First © (HCV:PSF) is Patient Safety and
Quality managerial science innovation which mobilizes hospitals to achieve and
sustain
extraordinary
care/service outcomes, patient satisfaction excellence and first-rate employee
engagement. HCV:PSF accomplishes this by systematically integrating Quality/Safety
Management, Human Resources and Operations functions toward the top-priority
goal of best and safest clinical care/service, and by implementing Performance
Outcomes Sustainability Coaching.
Quality & Patient Safety Transformation
While “first generation” hospital transformation efforts organize and communicate
leadership goals, strategies, tactics, and values (alignment), “second generation”
transformation is required to continuously impact the behavior of those managers
and employees “closest to the action” to sustain best and safest performance
results (integration). HCV: PSF efficiently achieves hospital quality/safety
integration by combining key Quality/Safety/HR/Ops infrastructure elements and
by standardizing, measuring and performance-coaching those behaviors and processes
known to prevent most errors, clinical variation and people dissatisfaction.
HCV: PSF offers unique user-friendly methods and tools to orchestrate a hospital’s
journey to “second generation” quality and patient safety transformation, sustained
day-to-day through “communication, collaboration, and patient/safety-first” behavioral
excellence. Since HCV:PSF implementation involves significant leadership and
staff
co-participation, change management resistance is minimized and “deliverables”
are customized to best fit with existing hospital language, processes and culture.
Performance Outcomes Sustainability Coaching
Throughout HCV: PSF, the quintessential process innovation which leads to sustained
error reduction, clinical/service excellence and better people-satisfaction is
Performance Outcomes Sustainability Coaching (POS-Coaching). POS-Coaching consists
of structured supervisor – employee dialogues (4-6 times per year) which guide
leaders to focus 50% of performance management time on “root-cause prevention”
behavioral competencies and 50% on key technical care/service outcomes. Thus,
this specialized coaching methodology integrates Quality/HR/Ops by proactively
managing target-behaviors associated with precluding preventable errors, clinical
variation and people dissatisfaction - while concomitantly holding performance
accountability for major clinical/service/ops outcomes. All POS-Coaching dialogues
conclude with managers thanking staff for their hard work, sharing hospital updates
and asking for improvement suggestions which might further enhance performance
results and/or prevent errors (most hospital never-events are “system-based”
and “waiting to happen”). In these regards, POS-Coaching develops ongoing mutually
supportive supervisor-employee relationships which address clinical errors/variation,
inform improvement opportunities and significantly enhance staff engagement.
Healthcare Values: Patient Safety First © System
Decision Map
The “Health Care Values: Patient Safety First” © decision
map
(see below) outlines the key developmental steps for hospitals to evolve beyond organizational alignment toward quality/safety integration. The map’s first three decision points:
#1 Strategic/Tactical Hospital Plan
#2 “Choice” Provider & Employer
#3 Mission Critical Values
are essential to “first-generation” alignment. “Second generation” organizational integration begins during decision step #4, at which point key hospital values are correlated with those generic safety and quality values known to reduce preventable errors/safety incidents, improve clinical/service outcomes and optimize patient and employee satisfaction (Communication, Collaboration, Patient/Safety-First, Continuous Improvement and Technical Excellence).
Step #4’s final deliverable produces (with much leader and staff input)
a values-driven operationally defined set of behavior measures which
codify a hospital’s priority behavioral and technical competencies (can’t
manage that which you don’t measure). Together, these values and associated
behavioral measures comprise the foundation upon which HCV:PSF integrates
and manages a hospital’s Quality/Safety Mgt, HR, and Operations functions,
forming the basis for accelerated “second generation” transformational
growth.
Step #5 illustrates how such behavioral and technical measures inform and drive a hospital’s entire HR continuum, from employee selection and leadership development, through formal performance evaluation incorporating P4P.
Conclusion
In short, Healthcare Values: Patient Safety First © is a Healthcare Quality/Safety
innovation designed to help hospitals attain that most important strategic goal
-
Performance Excellence Sustainability. HCV: PSF’s integrated methodology,
which essentially superimposes key behavioral competencies across technical care/service
priorities, provides the catalyst and measurable infrastructure for sustainable
quality/safety transformational change. The melding of Quality/Safety Management,
Human Resources and Operations powerfully communicates an internally consistent
message hospital-wide about the highest priorities of care excellence and patient
safety. The POS-Coaching process further inculcates a culture of safety and continuous
improvement, while managing accountability for results. Since the same HCV:PSF
behaviors processes which improve Patient Safety and Quality also enhance Patient
Satisfaction and Employee Engagement, HCV:PSF implementation results in happier
patients/families and more committed staff. It should not go unmentioned that
HCV:PSF deliberately addresses healthcare’s transformational change-resistance
realities related to design, complexity and work-place relationship issues with
the following basic tenets:
- Simple, customized and logical design
- Objective measurability and fair performance evaluation
- Integrated and internally consistent Quality&Safety/HR/Ops infrastructure
- Standardization and training of leadership competencies and processes
- 1:1 and team relationship-building through POS-Coaching.
In the final analysis,
HCV:PSF addresses healthcare’s biggest vulnerability, sustaining best clinical/service
service outcomes and patient satisfaction excellence, by systematically managing
performance accountability….not only for what care and service is delivered,
but for how it is provided. Hospitals are the most transactional and emotional
of all work settings, beset with the realities of short/temporary staffing,
relationship politics and unpredictable crises/emergencies, and are fiercely
unresponsive to traditional training methods and “layered” improvement initiatives.
Because HCV: PSF delivers a custom-designed permanent and internally consistent
“performance improvement-measurement-management” system, which is created with
leadership and staff input, it will not be construed as another “flavor of the
month”, but instead, “the order of every day, on behalf of each and every patient”.
Healthcare Values:
Patient Safety First © System Decision Map
(NOTE: Decision Map tools
are in the process of being updated)
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