Pennsylvania Gov. Ed Rendell says the state has begun one of the nation's most comprehensive programs to help people who suffer from chronic diseases. The program is in place in southeastern Pennsylvania and will be expanded statewide over the next year. It calls for educating patients about ways to improve their health, coordinating their care through teams of primary care doctors and other healthcare professionals, and changing the way insurers reimburse providers.
Timeouts to wash hands and put on hairnets, a checklist to ensure that precautions are taken, and advertising campaigns directed at doctors and patients have been credited with reducing the number of serious infections at New York City's public hospitals. Since 2005, central-line bloodstream infections have fallen 55% in adult intensive care units at the city's 11 public hospitals, according to new statistics. Ventilator-associated pneumonia declined by 78%.
A mental health patient at Fort Worth, TX-based John Peter Smith Hospital died after the staff summoned an ambulance to take him to the emergency room instead of calling for doctors a little more than five minutes away. The ambulance took 15 minutes to arrive, and the hospital violated state law by its actions, an investigation by the Texas Department of State Health Services found. JPS' policy for emergency care at the psychiatric facility amounted to performing CPR and calling 911, and that was flawed, according to state investigators.
Efforts to make the blood thinner heparin safer, and to replace supplies that were depleted by a major recall, have meant new safety concerns for hospitals, heart clinics and dialysis centers that use it. The drug was recalled in February after contamination during production in China led to as many as 81 deaths in the United States. Its leading maker has suspended manufacture of most of its heparin products. The resulting shortage of heparin means heparin from new suppliers is arriving in different quantities and strengths than medical staffs are accustomed to, and pharmacists and others worry that patients may be vulnerable to receiving improper doses.
The CDC speculates that 1.7 million patients get hospital infections each year, and some suspect that it is actually several times that number. By screening patients for infections, however, hospitals can identify MRSA positive patients, isolate them, use separate equipment and insist on gowns and gloves when treating them, experts say. Despite this evidence, only 30% of hospitals in the U.S. are screening for MRSA.
Everyone has one: The co-worker who is always complaining about their workload, their boss, and, well, everything. They're often just a bit too snappy with customers and will roll their eyes behind the boss' back when they're reprimanded.
Everyone has one—even hospitals.
These "special" people can severely inhibit an organization's efforts to create a quality healthcare experience for patients, said Gerald B. Hickson, MD, director of the Center for Patient & Professional Advocacy and associate dean for clinical affairs at Vanderbilt University Medical Center in Nashville. Hickson presented VUMC's policy of no tolerance for unprofessional behavior Wednesday afternoon during Leadership Day at the annual congress of the National Patient Safety Foundation.
VUMC has had a culture of no tolerance for unprofessional behavior for the last 10 years, Hickson said. This culture includes a rule that everyone—from the physician who brings in the most revenue to the custodians cleaning patient rooms—has the responsibility of giving patients a quality experience. That means that every employee must not only watch his or her own behavior—but confront fellow employees who may be out of line.
"People need to be trained to recognize when a pattern of unprofessional behavior exists and address it," Hickson said.
Hickson emphasized that although this program has been in place for a decade, it is constantly changing as the organization's leaders learn more about their employees and the organization. Addressing cultural issues that inhibit quality care is, he said, "a marathon, not a sprint."
NPSF is not the first conference to address workplace culture. In fact, most conferences targeting hospital executives offer sessions that offer ways that leaders can get nurses and doctors to work together, inspire change, and encourage communication. From the outside, all of this culture talk may seem like it's taken from a page in Michael Scott's management manual, (If you don't watch "The Office," you should.) but hospital executives tell me that bringing the different cultures of their organization together to work for quality patient care is one of the hardest parts of their job. They're hungry for any piece of advice that might make this part of their job easier.
There will be many pieces of advice shared here at NPSF this week and I'll continue reporting on the ideas exchanged here in Nashville. Check back in and send me any questions, comments, or suggestions you might have.
Maureen Larkin is quality editor with HealthLeaders magazine. She can be reached at mlarkin@healthleadersmedia.com.
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