But take a look anyway, if you have an interest in process improvement in hospitals. This is a collection of my best posts on this topic.

Wednesday, January 28, 2009

The fear of transparency clouds all

I have been worried lately that I may have adopted radical views on quality and safety in hospitals, that I may be out of the mainstream of American life when I suggest that we should jointly determine to eliminate certain types of infections or engage in protocols to enhance patient safety. I was also worried that my insistence on the importance of transparency with regard to these issues was just too outlandish for people to absorb and accept.

Imagine my relief then, to read this editorial in USA Today. Hardly a radical journal, the editors write:

Too many Americans go into hospitals for treatment and end up getting sicker....

A greater sense of urgency is needed....

Why are infections so widespread? In part, of course, because hospitals are full of sick people and germs. But medical professionals, hospital administrators and government regulators are failing to demand adherence to actions they already know will protect patients....

Secrecy allows the problem to fester. Although 23 states require hospitals to report infections to one of four unlinked federal databases, reporting is so scattershot that there's no way to determine whether the problem has been getting better or worse.

On the comments under the post below, some of the world's experts on quality and safety offer their perspectives on this issue. What is it about the medical community that makes it so hard for these views to be accepted? A close colleague writes to me saying, "I imagine the fear of transparency clouds all."

Look at the numbers in the editorial: Tens of thousands of deaths from often preventable infections. We -- and I mean the academic medical centers in general -- rely too much on our reputations. It is beyond time to hold ourselves to a higher standard. As I have said before, if we fail to do so, it will be done for us and to us by legislative and regulatory action, and such action is bound to be less accurate and helpful than the kind of self-reporting I have advocated here.

Thursday, January 22, 2009

Caller-Outer of the Month Award #2

It was time last night for the second Caller-Outer of the Month Award, given by our Board of Directors to an employee who exemplified the principles of BIDMC SPIRIT in pointing out a problem that was interfering with the staff's ability to do their jobs. This one went to Sharon O'Donoghue, clinical specialist in the medical intensive care units, seen above.

Here's the story. Last spring, based on observations from several ICU nurses, Sharon called out a frustrating problem: Inpatient nurses were unable to read many consult notes or follow up on tests because they did not have access to webOMR. WebOMR displays results and provides access to notes and other documentation. Instead, the nurses had to waste time searching in different locations for labs, imaging and plans of care.

Why? Because the original version of webOMR was optimized for outpatient workflows and was initially rolled out to outpatient providers. It had never been offered to the inpatient nurses or authorized to them as part of their information system log-in credentials. In fact these nurses first learned about the existence of the system when they happened to look over the shoulders of some doctors! Absent this access, the nurses had to use older programs that were not as complete, were not web-based, and were not as easy to use. This situation had existed for years.

Within a couple of days, Larry Markson, MD, Vice President, Clinical Information Systems, provided a simple way to give read access to webOMR to the inpatient RN staff, fitting the inpatient workflow. The result was enhanced patient care and improvement in the day-to-day lives of our 1400 nurses.

Sharon received a congratulatory letter, plus two super tickets to a Red Sox game of her choice this spring.