Variability in Patient Care Is Healthcare’s Hottest Topic
A transformation of the healthcare delivery system is about to occur thanks to reform legislation and continued market pressures. Topic A of the discussion is the perennial challenge to ensure consistent, quality patient care. How are you joining this important conversation?
Consistency in patient care has long been the Holy Grail for every healthcare provider. But as any medical professional can attest, achieving it presents an enormous challenge to the management skills and cooperative spirit within every single department, from admissions to environmental services.
A glance around any modern healthcare facility, large or small, reveals an overriding preoccupation with a perplexing variability in patient care. Despite the relentless pursuit of high standards set by institutions, reports of unexpected failures or justified patient complaints seem to surface with every shift. It’s like a stubborn case of MRSA that refuses to vacate the premises. And it’s a life-or-death issue.
Sadly, the challenge is about to get even more acute for providers thanks to healthcare reform, with its harsh mandates to dramatically increase the patient load – especially in the overburdened ER and tighter limits on reimbursement. “Doing more with less” is the sobering mantra of healthcare’s next era.
This coming transformation of the healthcare system will also mean increased pay-for-performance, more strident consumerism, and more prevalent quality rankings of providers. Yet as they throw a barrage of technological, management and plain old sensible tactics at patient care variability, providers are discovering that the obvious measures can sometimes be the most effective.
Among the more highly publicized initiatives, for example, is a strategy borrowed from fast food restaurants: greater use of checklists in the OR. “I introduced the checklist in my operating room, and I’ve not gotten through a week without it catching a problem,” says Boston surgeon Atul Gawande, author of The Checklist Manifesto: How to Get Things Right. Gawande devised a surgery checklist at eight facilities, a move credited with reducing major complications by 35 percent and deaths by 47 percent.
What is the checklist’s most effective component? It’s the simple act of ensuring that OR team members introduce themselves at the outset and discuss the assigned procedure in advance. It’s the very essence of communication.
Improving communication at nurse handover, monitoring surgeons’ planned time for theatre use against actual time, and implementing the World Health Organization briefing tool are other simple yet effective measures commonly employed to reduce errors. They rank alongside three other popular patient care initiatives: electronic medical records and admissions planners, increased use of evidence-based medicine, and systematic adoption of best practices.
Yet the search for reasons behind the wide disparity of patient care, both within and among institutions, reveals many root causes. Some are easily quantified, such as procedures not followed, cultural differences among the staff, funds not properly allocated and useful technologies not applied.
Others are more complicated. For example, there’s the pivotal role played by senior managers of facilities who orchestrate the dynamic balancing act around cost, access and quality of care. Call them the proverbial three legs of a stool, since adjustments in either access or quality directly impact costs.
Drill down into specific departments and you’ll encounter equally lively discussions about patient care. Within admissions, for example, the focus is on occupancy rates, patient flow data, planned and unplanned admissions (especially involving elective surgery), and improved communications between booking offices and wards. Patient care is the subject of every conversation, as it should be.
The Growing Importance of Training
But there is an even more effective remedy for patient care shortcomings that you may not have considered: Optimizing your institution’s learning program.
Employee training may well rank as a top priority at your organization. But that doesn’t mean training at your facility is as effective as it could be. And it certainly doesn’t mean training dollars are being put to their best use.
Indeed, a number of chief learning officers throughout the healthcare field can’t specify how and where they are training their own people. “I think we spend $40-$50 million on training every year, but I can only find $10 million,” laments one senior vice president of HR for a large west coast health system. Even directors of the most celebrated provider training programs concede to gaps in their delivery, especially their elusive night shift employees. So streamlining and optimizing that expenditure is well beyond their capability.
Within most large provider organizations, discrete training budgets are scattered throughout the enterprise as niche organizations develop and deliver their own specialty curricula. Likely as not, the facility’s own learning and development organization acquiesces to these individual preferences because its own staff is already overburdened and lacks the expertise.
But allowing that to happen could jeopardize the superior patient care that is so urgently sought by the organization and promised to patients. Why? For starters, there is little or no standardization of training anywhere in healthcare, especially in the provider community even among licensed personnel. That means it’s up to every hospital to ensure that their employees are and remain competent, an obligation that is typically interpreted on a departmental basis.
This lack of standardization is a primary reason for the wide disparity of care provided within the industry, especially within large organizations with multiple satellite sites and clinics. “When there is no standardization in training, how and where people get trained matters a great deal,” says the chief learning officer of a large medical institution in the southwest U.S.
In addition, standardized training programs integrate with other core strategies within an organization. Most importantly, they improve speed-to-competency and speed-to-proficiency. They also reduce redundancies and variability, drive safety by reducing errors, improve clinical outcomes and improve recruitment and retention.
When it comes to reducing overall costs, the numbers tell the story. A blended learning program that replaces unnecessary live instructor training with Internet-based learning can reduce an employee’s time off the job by 70 percent. It can also improve the performance quality of an organization’s technical workforce by 80 percent. Also, it can reduce overall training costs by 50 percent while more than doubling the number of employees who can participate.
For obvious reasons, the top learning priority for any provider is nursing, where training is both a competency issue and a competitive one for each facility’s most highly prized employees. But if you ask nurses if they’re satisfied with the amount and quality of training or mentoring that’s available to them, you might be surprised.
Just over the horizon is the next emergency in patient care training and provider liability. Future demands for providers to do more with less will mean increased reliance on an expanding cadre of employee who is less expensive than nurses, but who is also less knowledgeable and typically unlicensed for certain duties. It is the medical technician. An important manpower resource throughout healthcare, med techs are relied upon for a broad array of duties, including direct patient care.
“Techs are increasingly doing the work that RNs used to do, a trend that will accelerate under reimbursement,” predicts one large hospital training executive. “Unfortunately, there is a huge gap in knowledge between a licensed RN who must pass state board exams and a tech who does not,” she says. What’s worse, few hospitals provide techs with the organized training programs necessary to fill that gap, she says. At the minimum, the predicament increases the importance of allocating funds for continuing education affiliations.
It is a distressingly short leap between inferior and inefficient training and the standards of mortality, errors and patient safety that are commonly used to classify hospitals and upon which providers are rated and reimbursed.
Join the Transformation Conversation
For chief nursing officers and others who serve on health care’s front lines, variability of patient care is a life-or-death issue. No one knows this better than nurses, whose broad expertise and compassion are highly valued by their organizations and who largely represent the public face of their institution. Nurses have a vital stake in the discussion’s outcome. That is why it’s important that these respected professionals fully participate in the important conversations about healthcare’s future.
How are you participating in this conversation? Some of your peers are already offering ideas for reform and efficiency. Among chief financial officers, the discussion is about revenue cycle management and code efficiency. Chief operating officers are debating changes in supply chain management. Electronic medical records are the hot topic among information officers, while the adoption of best clinical practices are the concerns of medical and nursing executives.
Some of them also appreciate that among the greatest opportunities to helptransform healthcare is improving how their people learn and grow.
And while optimizing training might not be at the top of their list of variability issues, it is widely known that training and development are fundamental pillars of any successful provider organization. Career development, continuing education, compliance and certifications, leadership training, succession planning and clinical simulation training are just some of the educational concerns that confront nursing supervisors and administrators in today’s competitive hospital environment.
“We see organizational learning and development as a competitive business issue,” summarizes one senior executive at a large Midwestern hospital. “For us, it’s about being able to connect training to an overall strategy so that we can deliver the education the organization needs to meet its objectives,” she says.
Lastly, an optimized training program has at its fundamental core the goal of teamwork – the absolute heart of mistake-free patient care. Now what could be a more important discussion than that?
Raytheon Professional Services is a global leader in transforming learning environments within highly complex organizations. We are the Dallas-based subsidiary of Raytheon Company, the defense and aerospace contractor that has provided “life or death” training for the U.S. military for over 70 years. In short, we understand complicated environments.