The quality portion of the HealthLeaders Media Industry Survey 2009 offers insight into various aspects of healthcare quality—everything from infection control staffing levels to senior leaders' opinions—on the biggest barriers to improvement.
I am not a technophobe. I surf the Internet and listen to my iPod and watch digital TV just like the next fellow. Nevertheless, I also believe that technology can sometimes create barriers even as it spawns possibilities, and generate a false sense of security even as it protects us from bad things.
And so as much as electronic medical records, bar coding, radio frequency identification, and a host of other innovations have done to advance the cause of providing better, safer healthcare to patients, I confess I'm not entirely disappointed to see a growing emphasis on the fundamental human aspects of quality improvement.
In our HealthLeaders Media Industry Survey 2009 released this week, chief quality officers, chief nursing officers, and other executives charged with leading the quality and patient safety efforts at their organizations offered some intriguing thoughts on the role of technology in improving quality:
The best way to combat the spread of infections? Not even close—72% said hand washing.
When asked how effective EMR systems have been in improving quality and patient safety at their organizations, only 12% said an EMR was vital.
Thirty-three percent said their organization doesn't even have an EMR.
When asked to rate the effectiveness of eight measures in improving physicians' quality of care on a scale ranging from strongly effective to not effective, respondents' top answer was strongly effective for three of them: improved communication among doctors and hospitals, spending more time with patients, and a stronger focus on prevention and education.
Some notably low-tech perspectives, to be sure. The expanding awareness of the importance of seemingly simplistic practices can be seen elsewhere, as well. I talked to a quality leader at a California hospital for a story in the February issue of HealthLeaders magazine, also out this week, who told me her hospital cut medication errors by 20% in 30 days by having nurses wear vests when dispensing medications. Twenty percent in 30 days—just by creating a simple signal that certain people are not to be bothered when they're performing a certain task. And in the Wall Street Journal, I read a piece last week about how the Centers for Disease Control and Prevention says unsafe injection practices like reusing syringes are a leading cause of infections in physician offices and outpatient facilities. Reusing syringes? Seriously?
I know plenty of you could cite a litany of concrete improvements that provider organizations have realized from implementing high-tech initiatives. I know plenty of you would say that technology holds great promise for improving quality on a broad scale while also boosting efficiency and eliminating waste. And you'd be right on all counts. Technology can do a lot. But it can't do everything. Even if you have the most advanced computerized process in the world in use at your organization, it can still be undermined when human beings forget to wash their hands or don't dispose of a syringe or talk in the ear of a nurse who's dispensing medications.
The good news is that more and more healthcare leaders seem to be realizing the importance of addressing both the technological and human elements of quality improvement. Striking the proper balance between the two is the real challenge.
Jay Moore is managing editor for HealthLeaders magazine. He can be reached at jmoore@healthleadersmedia.com.
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The Joint Commission and the Nevada Department of Health and Human Services have agreed to share information about infection control breaches such as those blamed for a hepatitis C outbreak last year in southern Nevada. Officials said cooperation between The Joint Commission and the state should improve the detection and reporting of conditions such as those linked to nine confirmed cases of hepatitis C at the Endoscopy Center of Southern Nevada and the Gastroenterolgy Center of Nevada.
Officials at Dallas-based Parkland Memorial Hospital have announced changes in emergency room procedures to improve care and reduce long waits. Included is a new process for evaluating patients entering the ER, allowing them to confer immediately with a nurse or paramedic. Those interactions will permit better observation of patients as they await care, the hospital said. Some of the changes were the result of an Oct. 21 evaluation of Parkland's emergency operations by the Joint Commission.
Rose Lee Diggs, an 89-year-old woman whose body was found on the roof of University of Pittsburgh-Montefiore, was the victim of a vast, impersonal hospital system that favored profit over patient care, claims a lawsuit. The suit, brought by Diggs' son, accuses the University of Pittsburgh Medical Center of being "recklessly indifferent" in its handling of her treatment. The lawsuit also charges that UPMC created a dangerous healthcare environment with inadequate staffing levels, poor security, a dismal records system, and a patient population bursting at the seams.
An ambitious effort to cut costs and keep aging, sick Medicare patients out of the hospital mostly didn't work, a government-contracted study has found. The results show how tough it is to manage older patients with chronic diseases, who often take multiple prescriptions, see many different doctors, and sometimes get conflicting medical advice. The study also showed how hard it is to change the habits of older patients and their sometimes inflexible doctors, and points to the challenges the Obama administration will face in trying to reform healthcare for an aging nation.