Working with Management on Issues of Patient Safety.

Ohio Nurses Association Convention11 October 2013

Katherine A. Kany, MSN, BS, RNAssistant Director/AFT Healthcare

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Forces Compelling Collaboration

• Patient Protection and Affordable Care Act (ACA)

• Medicare reimbursement changes• Satisfaction as a proxy for quality• Population demographics• Survival in the marketplace• Cost of poor decision-making

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Creating Joint Projects to Address Safety & Quality

• Patient safety & quality of care are the driving forces for the ACA and receive high priority in federal grant funding: AHRQ, HRSA, CMS, philanthropic orgs.

• Data on hospital performance can be found at www.medicare.gov/hospitalcompare

• Using existing contract provisions and committees as opportunities for joint initiatives.

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Why Your Expert Input is Critical

• Responsibility to patients and their families

• Working at the intersection of decision-making and care-delivery

• Exquisite predictive ability to anticipate what will and won’t work

• Rapid assessment, feedback, and readjustment capacity

• Opportunity for professional recognition

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Emerging Model for Labor-Management Partnerships

• The focus is on achieving excellence in the quality, safety and cost of patient care, not just better relations.

• Improvement efforts directly support the organization’s overall strategy and performance objectives.

• Joint efforts need to involve physician leadership, not just management and unionized staff.

• Change starts at the point of care, not at the top of the organization.

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Determining the Work

• (Jointly) identify the issue and get buy-in from the top of the organization.

• Use data to support the gravity of the issue—and at every other point along the way.

• Keep the project manageable (unit-level)and “doable” (win/win).

• Think about all the “players” who touch the issue you have identified.

• Avoid after-hours meetings and fold this priority into day-to-day business.

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Safety & Quality in Your Facility

• What problem(s) do you see on your unit?• How well is your facility doing compared to

others? Data on hospital performance can be found at www.medicare.gov/hospitalcompare

• How do these problems relate to the safety & quality of care delivery?

• How aware are unit and hospital managers?• How much of a reduction in reimbursement is

your facility experiencing as a result? You can see how well your facility is doing at this site:www.ahd.com

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Hospital Compare Data

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Hospital Acquired Conditions

Cleveland Clinic

US National Rate

Objects left in body

0.049per 1,000 disch.

0.028per 1,000 disch.

Severe pressure sores (bed sores)

0.691per 1,000

0.136per 1,000

Falls and injuries 0.271per 1,000

0.372per 1,000

Infection from a urinary catheter

0.814per 1,000

0.358per 1,000

Developing the Process

• Utilize existing committees wherever possible and supplement staff as needed.

• Give the project team support, data, resources and any training they identify as necessary.

• Toss out all presumptions of the causes of, and solutions for, problems.

• Invite perspective beyond the team; share updates and results with all unit staff.

• Share information and results across units, departments

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Case Study: Press Ganey Nightmares

• Dismal patient and staff satisfaction scores in small community hospital.

• Millions spent in failed QI programs.• Public humiliation of staff named by

patients in surveys.• Living in the shadow of two major

competitors.• La voila’: management turns to labor for

help. • Project identified, “worked,” and resolved

after three months.12

What Project Can you Propose?

• Do you have a supportive unit manager?• Do you have an existing committee

through which the work can be done?• Which personnel and departments would

you involve?• How would you measure success?• Would the project require funding?• Do you need expert assistance?

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References• Fleischut, P. M., Faggiani, S. L., Evans, A. S., Brenner, S.,

Liebowitz, R. S., Forese, L., & ... Lazar, E. J. (2012). The Effect of a Novel Housestaff Quality Council on Quality and Patient Safety. Joint Commission Journal On Quality & Patient Safety, 38(7), 311-317.

• Dearmon, V., Roussel, L., Buckner, E. B., Mulekar, M., Pomrenke, B., Salas, S., & ... Brown, A. (2013). Transforming Care at the Bedside (TCAB): Enhancing Direct Care and Value-added Care. Journal Of Nursing Management, 21(4), 668-678.

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Resources for Funding

• Agency for Healthcare Research & Quality (AHRQ): http://www.ahrq.gov/funding/index.htm

• Centers for Medicare & Medicaid Services (CMS) Innovation Center: http://innovation.cms.gov/initiatives/Health-Care-Innovation-Awards/Round-2.html

• Health Resources and Services Administration (HRSA): http://www.hrsa.gov/grants/apply/assistance/pcmh/

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