COVID-19 has been a major focus for healthcare organizations for more than a year now, but when asked about what other issues need to be emphasized moving forward, 75.9% of respondents felt staff retention was the biggest concern.
This article was originally published May 13, 2021 on PSQH
As part of National Nurses Week, PSQH reached out to our readers with a few questions about how nursing impacts patient safety and healthcare quality.
The Quick Poll had a total of 83 respondents.
Strengthening Nursing’s Role in Quality and Patient Safety
Asked about how their organizations can help strengthen nursing’s role in quality and patient safety efforts, 77% of respondents said more education and training is needed. In addition, 60.2% said mentoring from leadership was necessary, while 39.8% called for increased emotional support and 28.9% said more leadership opportunities for nurses would be helpful.
Post-COVID focus
COVID-19 has been a major focus for healthcare organizations for more than a year now, but when asked about what other issues need to be emphasized moving forward, 75.9% of respondents felt staff retention was the biggest concern. Other issues that deserve focus include care transitions between settings (53%), diagnostic errors (32.5%), and dealing with the opioid crisis (20.5%). Respondents also filled in specific issues including Just Culture, respect between departments, community health, surrogate support for isolated residents, burnout, continuing education, and specimen re-collects.
Workplace violence
Asked about their level of concern about workplace violence in their organization, 21.7% of respondents said they were very concerned, 24.1% were concerned, 30.1% were somewhat concerned, and 24.3% said they were not concerned.
Optimism in a post-pandemic world
Survey respondents were optimistic about the state of patient safety once the pandemic ends (whenever that is). A total of 49.4% of respondents said they were optimistic, with another 40.1% indicating they were somewhat optimistic, while 9.6% said they were very optimistic.
Asked how much the pandemic is continuing to affect their organization, 71.7% of respondents said they were still dealing with COVID-19, but they have it under control.
This article was originally published March 17, 2021 on PSQH
As part of PSQH’s celebration of Patient Safety Awareness Week, we decided to reach out to our readers with a few questions to find out the state of patient safety efforts in the midst of the COVID-19 pandemic.
The Quick Poll had a total of 100 respondents.
The impact of COVID-19
Asked how much the pandemic is continuing to affect their organization, 71.7% of respondents said they were still dealing with COVID-19, but they have it under control. Another 25.3% said COVID-19 was a huge burden on their organization, while 3% said the pandemic isn’t an issue for them anymore.
Clinician burnout and cognitive overload
The pandemic has had obvious impacts on patients, but it has also contributed to an existing crisis for caregivers. Asked how the pandemic has affected clinician burnout and cognitive overload in their organization, 61% of respondents said burnout and cognitive overload have increased slightly. Twenty-nine percent said a difficult situation has gotten much worse, while 10% said the pandemic hasn’t changed the levels of burnout and cognitive overload.
Telehealth in the spotlight
One good thing to come out of the COVID-19 pandemic is the use of technology to help providers and patients stay in touch while avoiding close contact. Seventy percent of respondents said they’ve used telehealth to maintain a connection with patients and avoid unnecessary visits. Another 17% said telehealth has had a slight impact on their day-to-day activities, and 13% said they haven’t used telehealth much over the last year.
Staff retention
Another byproduct of the ongoing pandemic is a concern voiced by healthcare organizations about holding onto frontline workers such as nurses. Asked how much of a challenge staff retention is for their organization, 36% of respondents said it’s extremely challenging. Forty-eight percent said retention is somewhat challenging and 16% feel it is not challenging at all.
Releasing the action plan in the midst of a pandemic creates more will to achieve the recommendations it sets out, said Kedar Mate, MD, president and CEO of the IHI.
This article was originally published September 14, 2020 on PSQH
With the goal of eliminating preventable medical harm, a new National Action Plan was released today by the Institute for Healthcare Improvement’s (IHI) National Steering Committee for Patient Safety (NSC).
The plan is designed to provide health systems with advice and directions based on evidence-based practices, case studies, interventions, and new innovations. The report, Safer Together: A National Action Plan to Advance Patient Safety, was put together with the input of 27 federal agencies, safety organizations and experts, and patient and family advocates.
“The plan shows how leaders can move from measurement to action,” said NSC Co-Chair Jeffrey Brady, MD, MPH, who directs the Center for Quality Improvement and Patient Safety at the U.S. Agency for Healthcare Research and Quality, during a IHI-hosted press call.
One goal of the plan is to create an “anti-silo effect,” he noted. “We know that no single person or organization alone can guarantee patient safety. Working together is a must.”
The plan focuses on four areas: Culture, leadership and governance, workforce safety, and learning systems. To help organizations act on the recommendations in these areas, the plan includes a 41-page report with implementation tactics, case examples, tools, and resources. These are available online, including a downloadable self-assessment tool and an implementation resource guide.
Workforce safety is a major focus in the report because of the inherent risks in the healthcare profession, said Mary Beth Kingston, PhD, RN, NEA-BC, chief nursing officer at Advocate Aurora Health, who co-chaired the NSC subcommittee on workforce safety. “Healthcare has one of the highest rates of illness and workplace injuries of any industry,” she said. “Psychological and emotional injuries can also occur.”
Medical errors can also lead to emotional trauma for caregivers, and there is also moral distress, which arises from situations when policies or procedures prevent caregivers from doing what they think is right, Kingston added. Organizations must create a culture of safety that promotes psychological well-being, she said.
In addition, “the risk of exposure to infectious disease is not new to healthcare,” she said. But “it has been tremendously magnified by COVID-19.”
Patient and family engagement has come a long way, but there’s more to be done, said Helen Haskell, MA, founder of Mothers Against Medical Error, who worked on the National Action Plan. “Patient safety, for all its years of trying, hasn’t progressed the way it should have,” she said. “Progress in patient engagement has been one of the bright spots,” but we can do better.
The pandemic has made it difficult for organizations to keep patients and families engaged in their care, Haskell noted. “Healthcare organizations responded to the pandemic by unilaterally keeping patients and families apart,” she said.
The new action plan provides tools to help healthcare organizations achieve these patient engagement goals and “help take this to the next level,” Haskell added.
Tejal K. Gandhi, MD, MPH, CPPS, IHI senior fellow and chief safety and improvement officer, Press Ganey Associates, said the report includes different timelines for its recommendations, some that can be done in the short term and others that will take years to accomplish.
“The report is certainly geared mainly to leaders across all the sectors of healthcare,” said Gandhi, co-chair of the NSC. “It’s meant for leaders to take stock of what they’re doing.”
Work on the report began in 2018 and was completed in January 2020, prior to the COVID-19 pandemic reaching the U.S., Gandhi said. The recommendations were re-evaluated during the pandemic, but everything remained relevant, she added.
Releasing the action plan in the midst of a pandemic creates more will to achieve the recommendations it sets out, said Kedar Mate, MD, president and CEO of the IHI. “There’s been a tremendous wealth of new ideas,” he said. “Execution on ideas is harder. Can we maintain the energy and focus like we know we must?”
A survey finds 63% of hospital nurses report burnout.
Editor's note: This article originally appeared on PSQH.
The World Health Organization (WHO) this week said it now officially recognizes workplace burnout in the 11th edition of its International Classification of Diseases (ICD-11). This comes as the healthcare industry is seeing an increasing number of cases of clinician burnout.
The WHO defines burnout as "a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed." A WHO statement made it clear that burnout is listed as an "occupational phenomenon. It is not classified as a medical condition."
The ICD-11 says burnout is characterized by three dimensions:
Feelings of energy depletion or exhaustion
Increased mental distance from one’s job, or feelings of negativism or cynicism related to one’s job
Reduced professional efficacy
A 2017 Kronos survey of registered nurses employed in hospitals found that 63% say they experience burnout. A report from Press Ganey released last fall found that resilience, seen as an antidote to burnout, varies according to demographics such as generation, role, and shift.
"Nurse burnout is a direct consequence of administrative processes that leave nurses overworked and underappreciated," said Will Eadie, vice president of sales and strategy for WorkJam, a workforce management application used by healthcare providers, in an email. "Addressing these problems demands process-based, high-level changes."
Eadie recommends making the following process updates to relieve pressure on nurses:
Increasing schedule flexibility. “When nurses don’t have the freedom to make changes to their intensive schedules, excessively long workweeks become normalized. By using a more agile scheduling system, healthcare providers can eliminate the feeling of being boxed into an unmanageable workweek.”
Improving internal communications. “When nurses feel excluded from high-level health system communications, it only compounds feelings of powerlessness. By consolidating communications on a single, navigable platform, healthcare organizations can provide nurses with an added level of connectivity, which can help them feel more engaged in their work.”
Providing better training. "Too often, nurses—particularly traveling nurses—are thrown into a new role without proper training on how to navigate job-related stress. The absence of on-demand, self-service training is a recipe for burnout. Instead, healthcare organizations should carefully evaluate their learning management systems to ensure these processes account not only for patient care, but for the nurses, too. Nurses should emerge from training with a sense of understanding and accomplishment."
Matt Fairhurst, CEO and co-founder of in-home care workforce management platform Skedulo, said in an email that burnout is especially prevalent in healthcare organizations because of the high-stress, high-impact working environment.
"Not only is there an imperative to provide accurate and timely care, but clinicians and other caregivers must also abide by strict policies that govern how that care is administered and recorded,” he said. “To deliver the best care, healthcare professionals must empathize with patients and their families, often taking on emotional burden in sensitive and urgent situations. This leaves little room for the stress that accompanies inefficient processes and operational pain points that can come with working in these environments."
Based on the hospital inpatient suicides reported to the National Violent Death Reporting System, it was estimated that between 48.5 and 64.9 hospital inpatient suicides occur annually in the U.S., and of that total, 31 to 51.7 are expected to involve psychiatric inpatients.
This is significantly lower than the widely cited figure of 1,500 hospital inpatient suicides per year.
The study analyzed data from 27 states reporting to the NVDRS for 2014-2015 and from hospitals reporting to The Joint Commission’s Sentinel Event database from 2010 to 2017. The study was conducted to provide a more accurate estimate of the rate of inpatient suicides and the method and location of suicides
The researchers, led by Scott C. Williams, PsyD, director of TJC’s Department of Research, write that the previous estimate is based on a 1984 article that posited inpatient suicide accounts for about 5% of the annual total of suicide deaths in the United Kingdom. No source was given for the estimate, but it was later used in another article in 1993 that mentioned there were approximately 30,000 suicides per year in the U.S., with 5% to 6%, or about 1,500, occurring in hospitals. The article was cited in a 2003 clinical practice guideline from the American Psychiatric Association and the figure has been widely referred to since then, the researchers write.
The most common method of inpatient suicide in both the NVDRS and TJC Sentinel Event databases was hanging (71.7% and 70.3%, respectively). According to the Sentinel Event database, which noted the location and ligature fixation point for hangings, of sentinel event suicides:
50.8% took place in the bathroom
33.8% in the bedroom
4.1% in the closet
3.6% in the shower
7.7% in another location
A door, door handle, or door hinge was the most commonly used fixture point (53.8%).
Almost exactly a year after announcing its merger with the National Patient Safety Foundation (NPSF), the Institute for Healthcare Improvement (IHI) is rolling out its planned activities for Patient Safety Awareness Week(PSAW). Running through March 17, the week is focusing on culture of safety and patient engagement.
This is the first PSAW run by the merged IHI-NPSF after 15 years as an NPSF-organized event, and the week has consistently grown in impact, says Tejal K. Gandhi, MD, MPH, CPPS, IHI’s chief clinical and safety officer. “We get a lot of great attention,” she adds.
The goal of the week is to “have a visible and focused discussion on patient safety,” Gandhi says. “We promote tools that organizations and patients can be using throughout the year.”
The week’s events kick off on Monday, March 12 with a complimentary webcast, Engaging Patients and Providers: Speaking Up for Patient Safety, scheduled for 1 to 2 p.m. Eastern time. Gandhi will moderate a panel featuring the following experts: Jeff Brady, MD, MPH, director of the Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality (AHRQ); Tiffany Christensen, vice president of experience innovation, Beryl Institute; and Gerald Hickson, MD, senior vice president of quality, safety and risk prevention, Joseph C. Ross Chair in Medical Education and Administration, Vanderbilt University Medical Center. The panel will discuss the importance of speaking up from the perspective of clinicians, challenges, and families. The program is free of charge, but registration is required.
On Friday, March 16, the IHI (@IHI) is hosting a Twitter chat from 12 to 1 p.m. Eastern time called Building a Safety Culture. Governmental, advocacy, and professional organizations and individuals will share questions, challenges, and strategies to advance a culture of safety in healthcare. All are invited to participate using the event hashtag #PSAW18.
In addition, the IHI encourages those participating in PSAW to share their activities throughout the week on social media and on the event website. Participants can go to the site and take a patient safety pledge, get ideas on how to engage staff and patients, download free resources, order branded materials, or honor a loved one impacted by a medical error.
Gandhi says there has always been a willingness on the part of clinicians to improve patient safety, but other things sometimes get in the way. “There’s so many competing priorities for clinicians that it’s hard to get traction on patient safety,” she adds.
Culture of safety has been a focus for years, but the results have been mixed. “We’re seeing a lot of attention, we’re probably making some progress, but there’s a huge way to go still,” notes Gandhi.
A recent survey conducted by the IHI/NPSF Lucian Leape Institute and NORC at the University of Chicago found that 21% of people report experiencing a medical error in their own care, with one third reporting an error in the care of a relative or friend. The survey of more than 2,500 adults was conducted by NORC last year.
Nearly half of those who reported experiencing a medical error say they spoke up about it to a medical professional, but of those who didn’t, most said they either didn’t think it would do any good or they didn’t know how to report the error. One of the goals of PSAW is to convince healthcare professionals, patients, and families to speak up and report errors or ask questions about their care, says Gandhi.
The survey also found that ambulatory settings are a frequent site of medical errors, which Gandhi says is important to note.
Accreditors such as The Joint Commission would have been required to post final survey reports online within 90 days of delivering them to hospitals. But it turns out federal law may prohibit such a requirement.
This article was originally published in Inside The Joint Commission, August 7, 2017.
By A.J. Plunkett
A proposal by CMS to have accrediting organizations (AO) post the details of survey reports online was withdrawn by the agency, not because of negative comments—although there were plenty—but because it might be prohibited under federal law.
CMS first made the proposal in April, tucking it into the latter pages of the long proposed changes to the Inpatient Prospective Payment System (IPPS) for the upcoming fiscal year.
The proposal was to have AOs post final survey reports online within 90 days that the same information is available to the hospital or other healthcare organization, including details of all initial and recertification surveys at that provider in the prior three years, as well as the accepted plans of correction (PoC).
AOs now post only whether an organization is accredited or not, and do not make details of findings public.
CMS argued its proposal was to promote transparency in healthcare, and noted that it posts its own survey reports online. But critics responded that the CMS reports are made available in a hard-to-read spreadsheet and that the federal agency was responsible for far fewer surveys at healthcare organizations that were often surveyed only after a complaint.
In public comments to CMS concerning the proposal, The Joint Commission said that requiring survey details be made public would have a “chilling effect” on efforts to raise standards of quality. Dr. Mark R. Chassin, Joint Commission president and CEO, wrote: “There will be a race to the bottom on quality as health care organizations seek out oversight bodies that will report on the least number of standards comparable to the Medicare requirements. This may also lead to a growth in non-accredited facilities that will then be surveyed at taxpayer expense and with fewer oversight visits.”
Other groups similarly weighed in against the proposal and offered alternatives. In the end, though, it was shot down because it might potentially be prohibited.
In the IPPS final rule published Aug. 2, CMS noted that its proposal included revising the federal regulations overseeing Medicare to incorporate the requirement for AOs to post report details publicly.
“Section 1865(b) of the Act prohibits CMS from disclosing survey reports or compelling the AOs to disclose their reports themselves. The suggestion by CMS to have the AOs post their survey reports may appear as if CMS was attempting to circumvent the provision of section 1865(b) of the Act. Therefore, this provision is effectively being withdrawn.”
The first nurses strike at a Boston hospital in more than 30 years ended with nurses returning to work Monday. Contract negotiations will resume at an unknown date.
By Jay Kumar
Members of the Massachusetts Nurses Association (MNA) were back on the job Monday at Tufts Medical Center in Boston after a one-day strike and four-day lockout ended.
Last Wednesday, 1,200 MNA members employed at Tufts went on a one-day strike after contract negotiations stalled. The nurses, who sought higher pay and improved pensions, also cited safety concerns over Tufts’ staffing practices. The union said nurses have been assigned too many patients at once, with a management taking a “bare-bones approach” to staffing.
Staff nurses tried to return to work on Thursday, but were barred from doing so as Tufts brought in 320 replacements on five-day contracts. Approximately 300 of the striking nurses returned Monday, with the rest planned to return over the next several days, the Boston Globe reported.
Negotiations are expected to resume, but officials have not said when, according to the Globe.
The situation grew heated Sunday when some protesters allegedly confronted replacement nurses and blocked buses that were to transport them to the hospital, a Tufts spokeswoman said. She added that strike supporters banged on the buses, threw coffee, and yelled profanities at the replacements, but the MNA said it was unaware of the incident until it was reported.
The strike was the first by nurses at a Boston hospital since 1986.