Leonardo Lozada says health systems and hospitals generate benefits from connecting with the communities they serve.
Detroit Medical Center recently appointed a Kansas City–based physician executive as the organization's new chief medical officer.
Leonardo Lozada, MD, MBA, who officially began his CMO role at DMC in January, came from St. Luke's Health System, where he served as senior vice president and chief physician executive.
DMC, located in downtown Detroit, is an academic integrated health system with more than 2,000 licensed beds and 3,000 affiliated physicians.
Lozada says several duties at St. Luke's helped prepare him for the new position in Detroit, including building a primary care–focused multispecialty group from scratch, creating and operating the St. Luke's Care clinically integrated network, and managing a community-based approach to care.
"The hospitals were important, but we were embedded in the community with about 70 physician offices. We also had seven micro-hospitals that provided emergency and urgent care with eight to 10 inpatient beds to establish what we called neighborhood care," he says.
Lozada is a trained anesthesiologist. He completed his residency at Cleveland Clinic, and conducted a fellowship in neuro-anesthesiology at Mayo Clinic.
HealthLeaders recently spoke with Lozada to discuss his leadership goals at DMC. Following is a lightly edited transcript of that conversation.
HealthLeaders: There are many distressed neighborhoods in Detroit. How do you view social determinants of health?
Lozada: Good health is not something that you acquire from one day to the next. Health is something that individuals and communities work on constantly. Social determinants of health such as whether someone has electricity, running water, transportation or access to a grocery store or not—all of those elements factor in.
We focus more on health maintenance than health treatment and recuperation. That's why it is important for us to integrate into our communities, so we are a force within our communities.
HL: How do health systems and hospitals integrate with communities?
Lozada: At a high level, you participate in community boards at organizations that benefit large segments of the population. These boards include boards of education, grassroots boards related to security, and youth athletics boards. That's the easiest entrance into a community—through the leadership.
HL: Does DMC have a role to play in decreasing gun violence in Detroit?
Lozada: Health systems have to be embedded in the community to determine health, whether that health is psychological, educational, physical, or emotional. The role of health systems today is preventing any type of patient contact with healthcare providers, including gun violence.
Gun violence has gone down in Detroit, and we think it is partly because we are embedded in our communities and we are asserting a sense of awareness about how gun violence can be curbed.
HL: What are your top priorities for clinical care at DMC?
Lozada: Care coordination is a priority at DMC, but I would like to see coordination of care hardwired through electronic records and through participation in clinical excellence groups across employed physicians as well as independent physicians.
Another issue is access to care in the community. We want to have portals of entry for our patients, so they can achieve standards of health rather than receiving care for treatment of diseases.
I want to extend the information we give to the family members of our patients who are most vulnerable so they can have a better understanding of when to access our EDs and other care sites. Patients who are at the most vulnerable state require a transformation in the way they live so they can achieve and maintain health, rather than fall into a cycle of treatment-health-disease, treatment-health-disease.
We need to have a primary care strategy. We want our patients to go to their primary care offices more readily than they would go to our specialty care. We would like to have our specialty physicians more coordinated with our community physicians, so there is a mechanism to join care between the community and the hospital.
HL: In your role as CMO, how do you foster physician leadership?
Lozada: In the medical staff, leadership development is a continuous project. I see leadership in medicine as a series of areas that I work on with physician leaders who are already in place. I also work with the physicians who are coming up through the ranks, so they can become leaders in their own right.
[These leadership areas are]:
Relational leadership features physicians coordinating with other specialties. Particularly in primary care, relational leadership builds trust within the medical community.
Contextual leadership involves the role that the physician plays in the life of the patient, the life of the community, and the life of the health system. Contextual leadership is a byproduct of a sense of community.
In supportive leadership, physician leaders build a sense of initiative in the younger generation of clinicians. We want our younger physicians to constantly seek out best practices and implement those best practices day in and day out.
Inspirational leadership comes through example. As our physicians develop inspirational leadership, they provide a sense of "follow me" in the journey of healthcare. It is ever-changing like a great hike through the woods. In healthcare, there is new scenery every month. In inspirational leadership, physician leaders train other physicians to have a sense of excellence.
Responsible leadership allows us to develop a sense of stewardship within the organization. We're here for a limited amount of time; and in that time, we want to develop and create an organization that is better than when we took it over. That is the best way to pay homage to those who have preceded us.
The California-based health system shifted serious lung cancer surgery to five centers of excellence.
A regional approach to lung cancer surgery at Kaiser Permanente improved clinical outcomes and lowered cost of care, recent research shows.
The National Cancer Institute estimates there were 234,000 new lung cancer cases in 2018. Lung cancer has a high mortality rate—the condition accounts for 13.5% of all new cancer cases and 25.3% of all cancer deaths.
The research, which was presented at the 55th Annual Meeting of The Society of Thoracic Surgeons, focused on patients who had major lung cancer surgery such as lobectomy at Kaiser Permanente Northern California hospitals.
The hospitals in the study included five centers of excellence for thoracic surgery that became the sites for the Oakland, California-based health system's regionalization of lung cancer surgery.
The research found that the centers of excellence, which were launched in 2014, were associated with clinical and cost-saving benefits for lung cancer surgery.
After regionalization, patients spent 1.7 days less in the intensive care unit
Before regionalization, 13.6 % of patients had major complication and that rate fell to 9.6% after regionalization
Striving for excellence
Researcher Jeffrey Velotta, MD, of Kaiser Permanente Oakland Medical Center and the University of California San Francisco School of Medicine, told HealthLeaders that centers of excellence provide a higher level of care than other hospitals.
"When you have a center of excellence, it leads to standardization. We use protocols such as ERAS—Enhanced Recovery After Surgery programs. If you are at a center of excellence, you are going to get that enhanced recovery program," he said.
Velotta said there were primarily four factors in Kaiser Permanente's selection of sites for the thoracic surgery centers of excellence.
Distance to patients: "We selected them strategically in terms of distance because we knew distance is always a factor for patients."
Volume: "We wanted to pick the places with the highest number of thoracic surgeon specialists. Facility volume was also important. We picked hospitals where we were already doing a significant amount of lung cancer operations."
Outcomes: "Kaiser Permanente does internal auditing that gives us data analysis of our outcomes. Every month, we know per hospital or region outcomes such as ICU length of stay, regular length of stay, complications, and readmissions. We wanted centers that were getting better outcomes and were doing more surgeries, with a lot of data showing higher volume equals better care and outcomes."
Ancillary staff: "All of the centers already had ancillary staff in place, including cardiothoracic anesthesia, chest radiologists, pulmonologists, and medical and radiation oncologists.
For surgeons, performing procedures at the centers of excellence is an excellent experience, Velotta said.
"We have the same OR staff at the centers of excellence. You have the same circulating nurse and the same scrub tech. It's great have the same circulating nurse who knows where all your instruments are and the same scrub tech who knows exactly how you do things. They know exactly how to set up—it's flawless."
The health system creates a chief population health officer position to lead new division: Sutter Population Health Services.
Sutter Health has appointed its first chief population health officer.
Christopher Stanley, MD, MBA, started Monday in the new role at the Sacramento, California-based health system.
Stanley will be leading Sutter Population Health Services, a new division at Sutter that focuses on the clinical support structure needed to provide high-value care to employers, payers, and individual patients. Sutter Population Health Services is also designed to improve non-medical aspects of care that affect health.
"Dr. Stanley will closely partner with leaders and teams already employing innovative solutions to advance care coordination, eliminate duplication of services, and improve the patient experience across the full continuum of our integrated network," Rishi Sikka, MD, president of Sutter Health System Enterprises, said in a prepared statement.
Stanley is joining Sutter from Navigant Consulting, where he was a director in the Healthcare Value Transformation practice. His other experience includes working as vice president of care management at Englewood, Colorado-based Catholic Health Initiatives (CHI). He began his career as a pediatrician at Indian Crest Pediatrics in Denver.
New leadership position
In recent years, several health systems have created C-Suite roles for population health executives.
Last year, Cleveland Clinic appointed Adam Myers, MD, MHCM, FACHE, as chief of population health. Myers has a dual set of responsibilities—managing population health to increase capacity for highly complex care and leading Cleveland Clinic Community Care, a new population health approach at the organization.
Cleveland Clinic Community Care features several elements of the health system, including primary care internal medicine, primary care pediatrics, family medicine, the organization's clinically integrated network of more than 6,000 physicians, Express Care, and the Center for Value-Based Care Research.
Primary care is a crucial component of Cleveland Clinic's blueprint for population health, Myers told HealthLeaders in July.
"I have the strategic and directional role of population health that will work with our primary care-focused efforts and our specialty institute partners. Then there's Cleveland Clinic Community Care, which is the operating nuts and bolts of primary care for the communities we serve," he said.
Value-based care veteran
While he was with CHI in 2015, Stanley contributed his thoughts to a HealthLeaders magazine cover story about value-based payment models. He offered perspectives on several topics.
He said large health systems have an advantage in developing value-based care because they can experiment on their own employees in redesigning care and finding innovative ways to pay for services based on value. "We are using our own employees as a kind of a canary in the coal mine," Stanley said of the CHI rollout strategy for value-based payment models.
Patient-centered medical homes were generating patient engagement gains at CHI, he said. "We are now identifying patients who are in need of care but are not following up the way they should. Using data to identify gaps in care, we are now making direct outreach to them and conducting collaborative interviews to get patients to take more direct care ownership."
Physicians who received training in population health and patient-centered care stepped into leadership roles in the shift from volume to value at CHI, he said. "They're the champions. They're the leaders. They're the torchbearers."
Bundled payments were a popular value-based model with CHI physicians because of their relative simplicity, Stanley said. "There's a clear start and clear finish to when that episode occurs. Specialists can understand their sliver of care: procedure preparation, procedure, then procedure follow-up through a 90-day recovery period."
Mayo Clinic develops handoff tool for potentially violent patients that features exchange of behavioral information between care teams.
For violent patients, an information-rich handoff from the emergency department to inpatient care can improve safety, recent research indicates.
Workplace violence is widespread in the healthcare sector. There are nearly 25,000 workplace assaults reported annually and 75% of the incidents occur at healthcare and social service facilities, according to the Occupational Safety and Health Administration. Compared to other vocations, healthcare workers are 20% more likely to be victims of workplace violence, the National Crime Victimization Survey found.
The recent research at Rochester, Minnesota-based Mayo Clinic examines implementation of a "huddle handoff communication tool" protocol for transfers of potentially violent patients.
"The huddle handoff communication tool and other methods to facilitate the transfer of potentially violent patients have the potential to decrease the number and severity of violent incidents in the healthcare workplace," the researchers wrote.
Staff members felt safer after new handoff protocol was put in place. Nurses from the emergency department and the six inpatient units that participated in the study said they felt safe during patient transfers 100% of the time. ED staff satisfaction with the handoff protocol improved over time, from 53.3% to 75.0%.
A key element of the handoff protocol is the Potentially Aggressive/Violent Huddle Form, which features information about the patient that can be instructive for the receiving medical unit. "This tool is intended to ensure communication of behaviors and interventions that the patient had already received, which allowed inpatient teams to plan for how to respond on the receiving unit at the time the patient arrives," the researchers wrote.
Information on the huddle forms include whether the patient made aggressive statements, verbal threats, acts of physical aggression, and suicidal or homicidal ideation.
Calling violent patient huddles
The huddle handoff communication tool has five components:
The nursing staff in the ED or receiving medical unit calls for a huddle handoff process
The huddle form is completed
The receiving medical unit gathers care team stakeholders and places a conference call to the ED care team for a tele-huddle to enable a thorough handoff effort
The receiving medical unit prepares a room for the patient and puts a care management plan in place such as medications
The receiving medical unit's staff meets with the patient at time of arrival
A decrease in utilization of postacute care facilities accounted for most of the reduced spending on hip and knee replacement procedures in the CJR program.
In the first two years of Medicare's mandatory bundled payments for hip and knee replacements, spending per episode decreased slightly without increased complications, recent research shows.
Bundled payments are one of the most widespread forms of value-based reimbursement in the country, with both government and commercial programs.
The researchers focused on Medicare's Comprehensive Care for Joint Replacement (CJR) program. The mandatory hip and knee episodes of care were launched in 2016. Last year, there were about 465 hospitals in the program.
"The CJR program helps address the question of whether savings seen in previous evaluations of bundled-payment programs were attributable to the select nature of the hospitals that volunteered. Our findings suggest that the changes observed in voluntary programs may be echoed in mandatory programs," the researchers wrote.
Based on Medicare claims data from 2015 through 2017, spending on joint replacement episodes under mandatory bundles decreased more than a control group of hospitals—falling $812. The researchers found that the reduced spending was linked to a 5.9% decrease in utilization of postacute care facilities.
Hospitals benefit from engaging postacute care partners, the lead author of the research told HealthLeaders recently.
"Strategies that hospitals appear to be taking include forging closer connections with skilled nursing facilities to understand the rehabilitation needs of their populations, and having a more disciplined, systematic approach to discharge planning and rehabilitation assessment," said Michael Barnett, MD, MS, an assistant professor of health policy and management at Harvard T.H. Chan School of Public Health.
Management of postacute care paid off financially for top performers in CJR, he said.
"By far the biggest source of reductions in spending came from lower use of SNFs and inpatient rehabilitation facilities. This was counterbalanced by an increase in the use of home health services, which are naturally much less expensive. Hospitals that saved money focused on how they could send patients home who may not have needed the intensity of rehabilitation," Barnett said.
Mandatory bundled payments programs appear to generate significant spending reductions, he said. "As long as patients continue to receive the highest quality care, saving money is a big advantage of mandatory bundles because we know that growth in Medicare spending continues to squeeze the entire federal budget."
More effective management of postacute care is another benefit of mandatory bundles, Barnett said.
"A large advantage is if patients begin receiving more deliberately coordinated and organized care to provide the right level of care to have excellent outcomes. If someone can spend time at home recovering from surgery instead of a nursing home, I think most patients would view that as a success."
A framework of knowledge competencies for trustees and an assessment tool to gauge board performance is anticipated by the IHI to improve health system quality and safety.
Boards that prioritize quality have been linked to higher performance in primary quality measures, but IHI research indicates there is a wide range of variability in board quality efforts.
According to research conducted by an IHI thinktank, some boards desire to have a clear framework to ensure they are on the right track.
"Most people on volunteer boards want to make sure they are working on the right things, and this is an easy tool for them to assess whether they are. It's also a great tool for discussion between the board quality chair and the CEO. We are hopeful this assessment will allow boards to identify their current state and track their progress over time," Beth Daley Ullem, faculty lead at IHI, said at last month's IHI National Forum on Quality Improvement in Health Care.
Trustees should play a major leadership role in quality and safety, Tejal Gandhi, MD, MPH, chief clinical and safety officer of IHI, said at the forum.
"Boards of trustees are critical to advance a culture of safety, establish the direction for organizations, and hold CEOs accountable. So, if the board is not engaged in quality and safety, it will be hard for organizations to reach their ultimate quality and safety goals," she said.
Assessment tool crafted
The GQA is robust and patient-centered, Daley Ullem said.
"The assessment covers all the dimensions of quality. It looks at the health system versus just the hospitals, and it uses a tactical and tangible framework envisioning quality through the eyes of the patient, which is actionable to board members," Daley Ullem said.
The GQA features a relatively simple format.
It includes queries that target care settings both inside and outside the hospital walls.
It is designed to generate a snapshot of 30 core processes organized in six categories.
Core board processes include reviewing metrics related to care access, reviewing performance in risk-based contracts, and regular tracking of performance of primary safety metrics
The scoring system allows performance review overall, by category, and by the 30 core processes.
The highest possible score for the assessment is 60.
Scores 40 to 60 are rated "advanced board commitment to quality." Scores 25 to 40 are rated "standard board commitment to quality." Scores 0 to 25 are rated "developing board commitment to quality."
IHI recommends that health system CEOs should use the GQA to track board performance annually.
Board quality framework forged
The new governance framework for health system quality and the board assessment tool are complementary—with the assessment measuring performance of some elements of the framework, Gandhi said.
The IHI governance framework features three core areas that are quality-related terminology and competencies for board members.
1. Core quality knowledge ensures that board members are adequately familiar with medical terminology, healthcare oversight, and clinical care to address quality and safety issues.
Continuous education about healthcare quality should be a top goal to enable guardianship of quality and safety
2. Core improvement system knowledge ensures familiarity with how healthcare leaders manage improvement of clinical care.
Trustees must know their organization's improvement methodology, which allows them to determine the adequacy of staffing, processes, and infrastructure
Trustees must be acquainted with how healthcare leaders manage quality planning, quality control, and quality improvement
Boards and executives should identify elements of quality improvement work in their organization and assign accountability for those elements
Trustees should have analytical skills sufficient to participate in examining data and working with executives
Boards should hold executives accountable for quality and participate in quality improvement activity
3. Board culture and commitment to quality
Ensuring quality at the healthcare organization should be a preeminent issue for all board members—not just members of the quality committee.
Boards should foster knowledge and target oversight expertly. With structured oversight, educated board members can provide effective participation in quality initiatives. Boards and executives should decide which issues are assigned to the quality committee and the entire board.
Well-executed inquiry is an essential skill for trustees to participate in quality and safety oversight. Without interfering with the executive leadership, board members should make inquiries to leaders to verify that performance matches expectations.
Boards should make a visible and vocal commitment to quality such as conducting rounds.
To personalize data and humanize quality, boards should hear patient stories.
This simple framework helps guide clinicians through condition diagnosis, prescribing, patient monitoring, and deciding therapy duration.
A four-phase approach to prescribing and managing antibiotics focuses on critical time points to achieve effective antibiotics stewardship, a recent article in JAMA says.
Appropriate prescribing of antibiotics by healthcare providers is essential to help avoid the development of antibiotic-resistant infections, which the Centers for Disease Control and Prevention calls one of the most severe public health problems in the country. About 23,000 Americans die annually from an antibiotic-resistant infection, the CDC says.
The lead author of the JAMA article, Pranita Tamma, MD, MHS, of Johns Hopkins University School of Medicine, is a co-creator of the 4 Moments of Antibiotic Decision-Making concept.
"The 4 Moments concept is a simple construct that clinicians can incorporate into their daily decision making to decide whether antibiotics are needed in the first place; and if they are needed, making sure the right antibiotic for that particular patient is being administered and for only as long as necessary," Tamma told Healthleaders recently.
In the acute care setting, the 4 Moments approach creates a simple framework for comprehensive administration of antibiotics, she said.
"Our hope would be that the Four Moments are discussed on a daily basis— depending on the moment relevant to the particular patient—during clinical rounds with team care involving nursing, pharmacy, and clinicians to ensure the best possible outcomes for patients."
Moment 1
At the first step of care, Moment 1 is when prescribers should decide deliberately on whether a noninfectious process is at play. In dyspnea patients, several noninfectious conditions could be an underlying cause such as aspiration pneumonitis, atelectasis, congestive heart failure, and pulmonary embolism.
At Moment 1, clinicians should assess relevant patient information to gauge the likelihood of an infection and advisability of prescribing antibiotics.
Moment 2
There are a pair of considerations at Moment 2.
First, cultures should be obtained when advisable before antibiotics are administered. Second, after antibiotics have been ordered the care team should administer the medication promptly.
To facilitate Moment 2 decision making, there should be hospital treatment guidelines for common inpatient infections.
Moment 3
A day or two after antibiotics have been administered, clinicians should consider whether to continue the medication, narrow the therapy, or change from intravenous to oral antibiotics. Review of a patient's antibiotics treatment should be conducted daily and documented in progress notes, including indications to continue antibiotics, plans to narrow therapy, and anticipated therapy duration.
Moment 4
Therapy duration is the focus of Moment 4.
Studies indicate that therapy duration should be shorter than previously practiced for many of the infections treated in the acute care setting such as community-acquired pneumonia, ventilator-associated pneumonia, intra-abdominal infections, and urinary tract infections.
Adopting best practices
Part of good antibiotics stewardship is breaking bad habits, Tamma said.
"Very often as clinicians, it becomes practice to start antibiotics as a reflex. For example, if a hospitalized patient has a fever, antibiotics are administered. If the same patient was at home, we would probably suggest he or she monitor symptoms for some time before considering antibiotics," she said.
Monitoring the administration of antibiotics in the inpatient setting is crucial, Tamma said.
"After antibiotics are started for a hospitalized patient, clinicians often get consumed with other aspects of the patient's medical care and sometimes forget that antibiotics are still onboard or forget to review whether the antibiotics can be changed to less toxic agents or switched from intravenous to oral antibiotics."
CPOs impact health systems on several crucial fronts, including patient safety, cost containment, and standardization.
Chief pharmacy officers play a leadership role in key areas for health systems such as standardization, says the new CPO at West Virginia University Health System.
Pharmacy is a critical component of an integrated health system, with significant financial and clinical considerations. Financially, medication costs are rising, and precision medicine is likely to extend that burden. Clinically, medications are often pivotal to achieving good outcomes, but they pose patient safety risks.
Todd Karpinski, PHARMD, is set to join WVU Medicine in Morgantown on Feb. 18. CPO is a newly created position at the health system.
He is currently national director of ambulatory pharmacy at The Resource Group—a business consulting division of St. Louis-based Ascension Healthcare.
HealthLeaders recently spoke with Karpinski about the CPO role. Following is a lightly edited transcript of that conversation.
HL: What are the key responsibilities of a CPO?
Karpinski: The role of the chief pharmacy officer has evolved over the past five to 10 years as health systems have come together, merged, and acquired new facilities. There has been a strong push around standardization of medication processing across all of a health system's sites.
It’s the primary responsibility of the chief pharmacy officer to help lead the strategy and effort to bring the facilities together and standardize how medications are being used, what types of medications are being purchased, and how we are ensuring safe medication practices across all facilities.
A growing concern we see in healthcare is rising costs of drugs. It's imperative for chief pharmacy officers to work with physicians and clinicians to ensure that we are using the most cost-effective medications while targeting good clinical outcomes.
HL: How can CPOs manage standardization processes?
Karpinski: From a safety standpoint, there are key recommendations from the Institute for Safe Medication Practices to prevent patient harm. You need to implement all of those recommendations.
In pharmacy operations, we try to reduce waste utilizing lean methodologies to reduce variation and decrease waste. In using lean, you also improve quality and safety. You look methodically at how every piece of pharmacy operates and apply lean principles to get the most efficient operation possible. Standardizing our processes helps keep our patients safe.
HL: How does having a CPO benefit a health system?
Karpinski: Each hospital tends to have a director of pharmacy who traditionally has reported to a vice president or the chief operating officer. The goal for each individual pharmacy may or may not be aligned with the overarching goals of the health system and achievement of quality outcomes, clinical outcomes, and finance outcomes.
It's imperative to have one individual in an executive pharmacist role to bring the directors together to make sure that everyone is pulling in the same direction.
The chief pharmacy officer is now considered an executive leadership position, so you are at the table with the CEO, COO, CFO, chief nursing officer, and chief medical officer to help set strategy for the health system, particularly for how medications are going to be utilized to promote good outcomes for patients.
HL: How does a CPO add value to the C-Suite?
Karpinski: Number One, you get to be part of setting the overall strategy for the organization. You get to hear the key concerns that other executives are facing, and you can work with them to develop strategies as pharmacists to meet their goals or to alleviate some of their anxieties. You can work with the CFO on how much money is being spent on medication and revenue opportunities with the growth of specialty pharmacies, creating your own pharmacy benefit manager capability, and development of retail pharmacies.
Secondly, reporting directly to the CEO puts the chief pharmacy officer in a top-level position within the organization, which hopefully removes barriers to getting things done, when you work through several executives.
Patient safety deficiencies are spotlighted in a new documentary.
One of the most influential reports on patient safety has inspired the production of a documentary film.
In 1999, the Institute of Medicine published "To Err Is Human: Building a Safer Health System," which included the alarming statistic that as many as 98,000 Americans were dying annually due to medical errors. Estimates of annual patient deaths due to medical errors have since risen steadily to 440,000 lives, which make medical errors the country's third-leading cause of death.
This week, the son of patient safety pioneer John Eisenberg, MD, is making the general public release of To Err Is Human, a documentary film inspired by the Institute of Medicine report.
"One of the reasons we felt the film was important right now is it's been 20 years since 'To Err Is Human' was published and patient safety has taken a back seat to other issues in healthcare, but it's paramount to the success of the healthcare system," filmmaker Mike Eisenberg told HealthLeaders.
Eisenberg said his father, who served as director of the Agency for Healthcare Research and Quality and died in 2002, was a guiding force for the documentary.
"It always came back to what my father would have wanted people to know about this issue and how he would have told this story. That guided us down the path of trying to stay positive and solutions-oriented. We wanted to show healthcare at its best rather than presenting medical error as a monster that is unbeatable," said Eisenberg, who is the director, editor, and co-producer of the documentary.
Eisenberg said three of the major themes of the film are zero-harm healthcare, maximizing the gains of patient engagement, and generating benefits from simulation.
The film, which is available on Amazon and iTunes, features interviews with three dozen healthcare leaders on patient safety issues and the heart-wrenching story of the Sheridans.
Medical catastrophe struck the Sheridans twice. First, a medical error after birth resulted in son Cal developing cerebral palsy. Second, father Pat lost his battle with cancer after a pathology report that showed a deadly malignancy languished and delayed care.
The delayed pathology report was hard for Pat Sheridan to bear, his wife said in the film. "I remember Pat crying. To think that another error had taken place—this time with him—that was difficult for us to witness."
The Sheridans' story, told by mom Sue, is interspersed between the healthcare expert interviews, which include prominent figures such as Don Berwick, MD, former administrator of the Centers for Medicare & Medicaid Services.
Extending the documentary's reach
In addition to this week's general public release, To Err Is Human has been viewed at dozens of screenings at healthcare organizations, with 75 screenings held last year and 30 booked for this year so far.
"A really effective way to make change is to have a screening with a panel discussion afterward in which local or national experts talk about the film and what we can do to keep the momentum going forward. It's not enough to make a film, do a good job, and be patient," Eisenberg said.
He hopes the documentary will accelerate the drive to transform patient safety.
"This film needs to serve as a motivational tool for healthcare to keep going and keep doing better, and for patients to understand the problems so they can engage with that process."
Editor's note: This story was updated Monday, January 28, 2019, for added clarity.
The academic health system in New Jersey has taken several specific steps toward workplace violence prevention and designated leaders to continue problem-solving.
Workplace violence is a widespread problem within the healthcare setting that must be prevented for the safety of clinicians and patients.
That's why RWJBarnabas Health in New Jersey is taking a stand against workplace violence at its hospitals and clinics. The academic integrated healthcare system has launched or enhanced efforts to curb workplace violence in several key ways.
"Nurses, nursing assistants, and security guards are more likely to encounter violent behavior, but it is not limited to them. You can find violent incidents in all areas of a health system's facilities," says Nancy Holecek, RN, MHA, MAS, senior vice president and chief nursing officer of RWJBarnabas Health's Northern New Jersey Region.
Here are five things that RWJBarnabas is doing to thwart workplace violence:
1. Created facility safety assessments
Facility safety assessments seek to ensure buildings are as safe as possible, Holecek says.
"We have been looking at our technology, looking at our visitor access system, and looking at our security workforce to ensure that we have the most updated technology and that we have our entrances covered and locked down at the appropriate time," she says.
A major facility challenge is aligning safety and service, she says. "We have to always make sure that we balance the security piece with open access for anyone who needs our services."
2. Instituted quick reporting technology for violent incidents
RWJBarnabas focused on ease of reporting largely because workplace violence incidents are underreported, Holecek says.
"If it's an event that results in a serious injury, then it gets reported. If it's something minor or a threat, unless staff members truly feel they are in danger, they generally treat the incident as part of the symptoms or disease that a patient is presenting," she says.
The health system has adopted reporting technology that allows staff members to click on a computer desktop icon and quickly file reports on workplace violence, she says.
Eased reporting has created a data opportunity, she says. “We have seen an increase in reported events, which was to be expected. The trending of this data related to number, severity, location, and person—patient, visitor or other—will allow us to better track, respond, and strategize our efforts.”
3. Raised awareness among staff
Raising awareness about workplace violence boosts safety and increases the likelihood of reporting, Holecek says.
"Oftentimes, [violent behavior] is something a patient can't control [because of] dementia or a behavioral health issue. Our staff understand this and make excuses for it. The problem with that is we can't collect data and we can't intervene; so, we are encouraging our staff to report," she says.
4. Enhanced training
RWJBarnabas is improving its Behavioral Emergency Safety Training (BEST) with the help of a consultant.
"The focus is to de-escalate the behavior—not to pin the person against a wall. This has been very successful. It works a large percentage of the time," Holecek says of BEST.
The consultant is adding a new layer to the BEST training—instructing staff about duty to warn, duty to act, and duty to respond.
"The consultant is training trainers who will go out to work with our security workforce, behavioral health workforce, and emergency workforce, and then expand to make sure all of our employees are trained," she says.
5. Added violent incidents to daily debriefings
Addressing incidents of workplace violence has become part of a larger high-reliability initiative at RWJBarnabas.
The initiative includes 15-minute leadership huddles in the morning at each of RWJBarnabas's 11 hospitals to review facilitywide issues from the previous 24 hours. Workplace violence incidents are among the topics discussed.
The CEO usually leads the morning huddle, with about 45 participants ranging from the C-suite to the department director ranks.
"This informs the entire senior team and department heads so they know what has transpired. It helps us stay abreast of any incidents of workplace violence that may have occurred," Holecek says.
In addition to those initiatives, the health system formed a steering committee—an interdisciplinary group with representatives from compliance, emergency management, HR, legal, nursing, physicians, IT, and security—to lead workplace violence prevention efforts.
This article is based on an earlier HealthLeaders article.
