It's that time of year, again, when any self-respecting healthcare provider looks to bone up on the latest terms in the lexicon. As in previous years, we welcome your suggestions for the next installment of this annual list.
1. Oculostenotic Reflex
Writing in the journal Circulation in 1995, Eric Topol, MD, and Steven Nissen, MD, described the term oculostenotic reflex as the "irresistible temptation among some invasive cardiologists to perform angioplasty on any significant residual stenosis after thrombolysis."
The phrase has resurfaced in light of current estimates that at least 11%, or as many as one-third or even one-half of interventional cardiology procedures and certain other invasive cardiac operations may unnecessary or even harmful because the conditions are better treated with medications.
As hospitals look to reduce costs and improve outcomes, and as organizations step away from fee-for-service payment systems, look for this phrase to be increasingly used as a metaphor for unnecessary, expensive and potentially harmful care.
2. The Three Biases
- Confirmation
- Pro intervention
- Pro technology
These terms have long been understood to impede objective research. They're the reason why clinical trials are best conducted when investigators are blinded to who gets what treatment regimen. But now they're increasingly appreciated as what happens in normal human brains to direct behavior that results in errors.
1.Confirmation Bias: A caregiver wants to think that a patient received the correct medication, selects a drug because it's in the place where the right one was before and where it ought to still be, even if it isn't.
2.Pro-Intervention Bias: The belief that no matter what, it is better for a caregiver to perform a procedure or prescribe a medication than to do nothing, because otherwise, what use would the caregiver have?
3.Pro-Technology Bias: The belief that a new device, drug, procedure, or approach is better for no other reason than that it is complicated, or expensive, or new.
3. Highly Reliable Organization or HRO
Companies that produce goods and services that have the potential to cause serious harm to large numbers of people and property because of even small mistakes, but somehow rarely if ever do. Airlines, aircraft carriers, nuclear power plants, nuclear disarmament facilities, pharmaceutical companies, large chain restaurants, and healthcare organizations all fit the definition.
To become a highly reliable organization, executives, mid-managers and rank and file workers must all embrace a culture that encourages uniformity and consistency, the blame-free reporting of errors that lead to a safe operation or process each and every time.
4. 'All Cause' Measurement Science
Look for this phrasing to increasingly describe the quality measures that healthcare organizations will be increasingly expected to achieve. For example, instead of just measuring 30-day readmission rates for the currently reviewed three diseases or conditions, (congestive heart failure, pneumonia, and heart attack), policymakers anticipate hospitals soon will be scored, and possibly penalized, for their overall readmission rates.
5. 'All-or-Nothing' Measurement Science
Likewise, in some payment bundles, healthcare organizations now receive partial credit for achieving five out of six specific measures.
But Don Berwick, MD, former administrator of the Centers for Medicare & Medicaid Services, pointed out in a recent interview, that this is where measurement science needs to be, to measure "total system performance, 'all-or-nothing' metrics, where you don't get partial credit if you leave something out, or measures that have to do with patient well-being and comprehensive care.
"It's like buying a car and everything is fine except they left out the right front brake. That's a zero. That car is broken." Only five in six, you get no points for any of it.
6. Sustainability
After a healthcare organization has improved on a particular quality measure, the tough part comes, which is making sure that the improvement is maintained, and not ignored once the goal has been achieved or "topped out."
7. The Choluteca Bridge
A 1930s engineering feat in Honduras is a metaphor for today's healthcare system, according to several speakers at the December Institute for Healthcare Improvement National Forum in Orlando, including Don Berwick, MD, former CMS administrator, and Scott Weingarten, MD, of director of health services research at Cedars Sinai Health System in Los Angeles.
The Choluteca Bridge was built by the U.S. Army Corps of Engineers with such design strength, it could withstand the worst of hurricanes that affected the area. When Hurricane Mitch came in 1998, it destroyed 150 Honduran bridges, but not the Choluteca Bridge. Instead, the storm rerouted the Choluteca River. So now, the Choluteca Bridge is useless.
Today's healthcare organizations are like the Choluteca Bridge, because they were designed and built for a different river, the heavy-duty, invasive procedures in high volume and serious illness, not for prevention and health, several speakers said during a recent talk at the Institute for Healthcare Improvement meeting in Orlando.
8. Medical Extensivist
These professionals can be internal medicine specialists, hospitalists, or perhaps advance practice nurses who decide to extend their scope of care beyond the walls of a hospital or the intensive care unit to the discharge care setting.
The idea is that for patients with chronic illness, physician or advanced practice nursing expertise may reduce length of stay and keep patients healthier in their homes, board and care, or skilled nursing facilities.
With home visits on a routine schedule, these extensivists may avert the cascade of resource use and deterioration that can come when patients wait to report symptom changes until they call 911, and come back into the healthcare system through the emergency room.
9. Human Factor Analysis
An error investigative process that goes beyond performing the traditional "root cause analysis" which asks the questions "what" and "who" and then blames the "who," rather than asking "Why"
The idea behind this human factor science is that by understanding basic human behavior, asking the why something happened, one can anticipate where errors in healthcare processes occur and make it difficult or impossible for those same mistakes to occur.
For example, computer lock outs that prevent the ordering of certain medications without several layers of override could prevent drug prescribing and administration mishaps.
At a recent IHI forum, quality and safety experts from the Greenville Hospital System in South Carolina admonished attendees to continue to ask why an event occurred "until all preceding causes are identified." Even factors such as fatigue, or eyesight failures, or hurried decision necessity should be evaluated in order to avoid the next mistake.
10. Innovation That Is Not
Several leading health policy thinkers, including Don Berwick and Ashish Jha of the Harvard School of Public Health, recently said the most common catchword they've heard this past year is "innovation."
But Berwick in his IHI keynote address in Orlando Dec. 12, said that some technologies the word describes merely amount to "another category of greed" such as when a so-called innovative technology is put into practice that "does not help."
The word is "in the title of half the conferences I go to now," Berwick said, adding that many, if not most "of the changes in healthcare equipment, products and services that are called innovations don't help...They give worse care at higher cost...
At a recent convention on new healthcare technology, he said, 6,000 vendors rolled out their products, which he described as "robotic this and fiber optic that. And titanium whatever, ceramics."
"But every instinct I have is whispering to me that most everything I saw isn't just not worth the money, it will add complexity and risk and downstream costs, and yet public policy can do nearly nothing about it."
11. ALARA
An acronym for "as low as reasonably possible." Apply to imaging radiation dosages, medication, frequency and cost, as appropriate.
12. Population Health
In healthcare, this phrase has different meanings to different types of providers. For large organizations and public health agencies, it means the populations of entire communities.
For physicians in a practice, it might mean their regular patients with common diseases or conditions, such as diabetes. For a hospital or healthcare system, it may mean anyone insured by a provider with a contract with a large insurer in the region. For an accountable care organization, it may mean anyone who is in the ACO.
13. Transforming or transformative.
It sounds like a mystical experience, with an implication that a provider or healthcare system is zapped into good behavior or culture with a key stroke or single action or decision, which happens very quickly.
But throughout the country, hundreds to thousands of healthcare providers and systems are undergoing transformation, apparently a cultural, psychological, and behavioral metamorphosis.
Actually, the Joint Commission in 2009 established its Center for Transforming Healthcare to tackle key projects that "use a systematic approach to analyze specific breakdowns in care and discover their underlying causes to develop targeted solutions.
Recently, the Joint Commission's center has rolled out several illuminating projects, such Colorectal Surgical Site infections, handoffs and hand hygiene improvement projects, sepsis, fall, and wrong site surgery prevention projects.
See Also:
12 Buzzwords for 2012
13 Hot ACO Buzzwords All Providers Should Know
11 Buzzwords for 2011
Add 'Healthcare Innovation Center' to Buzzwords List