Hospitals and healthcare institutions have strong reason to control construction costs. A case in point: The first free-standing hospital project in New York State in more than two decades, according to the state's Department of Health, is being built using an unusual construction method to cut costs by almost a third. To build what is estimated to be a $269 million hospital, Orange Regional Medical Center chose a construction company that uses the design-build method, which differs from traditional construction because the architect and general contractor are from one company.
A hospital can be a frightening place for children, which in turn creates a barrier of distrust nurses must work through in order to provide them with adequate care. However, recently released research suggests nurses can do less scaring and more caring for their facility's pediatric patients by brightening up their wardrobe.
A study published in the April 2009 issue of the Journal of Clinical Nursing examining the effect of multicolored, nonconventional attire on hospitalized children found it improved children's and parents' perceptions of the nurses providing them care. These enhanced perceptions led to increased comfort for the pediatric patients and increased confidence among parents of the nurses' abilities.
"Our goal was to understand the perception of nurses," says Filippo Festini, BA, BSN, RN, lead author of the study and professor of nursing science at the University of Florence in Italy. "The importance of our findings is that the multicolored uniforms improve the relationship between the nurse and the child, and this helps obtain the child's compliance to the treatment and reduce anxiety and fear."
The study was conducted by Festini and his team of University of Florence researchers between July and September 2005 among children at Meyer Children's Hospital in Florence. The researchers surveyed 112 children—ranging from six to 16 years of age—before and after nurses on two pediatric hospital wards swapped their light blue, traditional scrub uniform for nonconventional attire inspired by children's drawings collected throughout the country (you can view a picture of both uniforms here).
In both instances, researchers asked the children to define the nurses using one word, discovering a higher percentage (96%) used positive words such as "pleasant," "friendly," and "helpful" for nurses wearing the new uniforms than when they wore the former (82%).
The study cites "the children also expected the nurses to be 'funny' and 'cheerful,' and to play with them" while wearing the new uniforms. Researchers concluded the children's perceptions regarding the hospital environment, however, did not improve.
While the nursing uniform has dramatically evolved over the past few decades, many nurses still shy away from those splashed with child-friendly prints for fear they detract from their professional image. Shelley Cohen, RN, BS, CEN, president of the Hohenwald, TN-based Health Resources Unlimited, LLC, recently conducted an anonymous, national survey among more than 1,000 nursing professionals to delve into the types of behaviors, attitudes, appearances, and circumstances they felt shaped their image. Respondents were asked to rate several factors based on how much they affected the image of nursing, choosing from "no effect," "little effect," or "great effect." How nurses present themselves to patients and families was reported to have the greatest effect on their image. How nurses' dress was found to have the fifth greatest effect.
Furthermore, respondents suggested individual nurses could shape a more realistic image of nursing by ridding cartoon scrubs from their wardrobe.
Still, peering back into the pediatric study, the multicolored scrubs did not worsen pediatric patients' and parents' perceptions of nurses' professionalism, yet seemed to improve it. For example, researchers asked parents to rate the nurses on a one-to-five scale. Of their findings, parents' perceptions of nurses':
Adequacy in their role increased from 4.0 to 4.7
Ability to be reassuring rose from 4.0 to 4.5
Ability to not frighten their child rose from 4.4 to 4.7
Ability to be fun improved from 2.3 to 4.6
"By wearing creative and child-friendly scrubs, nurses demonstrate respect for the patients they are caring for and send a message that they understand children and their developmental needs," says Jill Duncan, RN, MS, MPH, director of the IHI Open School for Health Professions in Cambridge, MA, who has more than 15 years of pediatric-related experience in a variety of acute care settings.
Duncan says nurses can even use their scrubs as a discussion starter with their young patients by pointing out drawings or characters and asking the child what he or she sees. "This helps engage the child as well as assure the parents that there is a confident and competent nurse caring for their child," she says.
The OIG established new requirements for the Self-Disclosure Protocol in what experts believe is an attempt to clear smaller cases from the OIG's plate. But legal experts say providers might find their own plates are filling up with violations they cannot disclose.
The OIG released an open letter to providers that put new limitations on the types of violations that could be reported using the Self-Disclosure Protocol. The OIG will no longer accept Stark Law violations that do not implicate the anti-kickback statute, and it also established a minimum settlement amount of $50,000.
"It's shocking" said Robert A. Wade, Esq., partner at Baker & Daniels, LLP, in South Bend, IN.
Wade said the new guidance seems to contradict the message the OIG originally sent when it established the Self-Disclosure Protocol in 2006. The Self-Disclosure Protocol was designed to create a means for providers to voluntarily bring violations to the government's attention without fear of further litigation.
The OIG not only allowed, but used to encourage providers to use the Self-Disclosure Protocol for Stark Law violations, according to Wade, but now the OIG has said it will not accept straight Stark violations.
That means a provider could potentially discover a multi-million dollar Stark violation, but if it doesn't also include "colorable violations of the anti-kickback statute" the provider cannot come clean to the government using the Self-Disclosure Protocol.
These changes have left some providers scratching their heads. Wade said he and a client were preparing to disclose a violation via the Self-Disclosure Protocol, but that violation no longer meets the OIG's new requirements.
However, Wade said providers have two options for violations that do not meet the new self-disclosure requirements—neither of which provide the same closure as the self-disclosure protocol.
The first option is to treat the violations like overpayments, and attempt to return the money through a Medicare carrier/fiscal intermediary.
Wade points out that carriers/fiscal intermediaries are not equipped to perform the duties necessary to ensure that the provider did its due diligences. This includes making sure the audit that discovered the violation was thorough, complete, and within an acceptable time frame. Wade said carriers/fiscal intermediaries must address this issue.
The second option providers have is to disclose the violation to the Department of Justice. This option also does not guarantee no further action, and Wade said this option is "not one you prefer to use."
Until further guidance comes advising providers what to do with theses lesser violations, they will need to either choose between these two options, or choose to do nothing and hope for the best.
Ben Amirault is an Editorial Assistant for the revenue cycle division of HCPro. He manages the Compliance Monitor e-newsletter and has developed a number of online learning modules. He can be reached at bamirault@hcpro.com.
Attendance was "off" at the HIMSS09 conference held this past week in Chicago, but the hospital, physician, and health plan executives who were in attendance were the "more serious buyers" and the "decision makers," according to the chief information officers and vendors that I spoke with during the event. Providers scaled back their attendance and some vendors had less elaborate booths for obvious budgetary reasons. However, there were still billiard tricks, a green man group, and other gimmicks on the exhibition floor. Here's a quick glance at some of the key takeaways from the conference.
There are still no real answers about the definition of "meaningful use" of certified EHR technology or what the payment schedule will be for doling out stimulus funds. HIMSS did create a discussion forum on the definition of meaningful use and you can post comments through April 17th. Here are a few of the thoughts attendees shared with me about what "meaningful use" should include:
The ability to quantify and report improved patient safety, quality outcomes, and cost reductions.
Disease management and decision support tools for patients and families.
CPOE and e-prescribing.
The ability to track and communicate public health issues.
Community health information exchanges between hospitals, clinics, physicians, and patients.
Healthcare providers should not wait until the end of the year for the definition of "meaningful use" to form their IT strategy. The general consensus was if you wait, you will be behind and probably won't qualify for the maximum reimbursement provided in the stimulus package. "It's not time to panic, but it is also not time to procrastinate," said Charles Christian, director of information systems and CIO at Good Samaritan Hospital in southwest Indiana. "We are expected to do the work and show the outcome of that work before we get a nickel," he says.
There was a lot of excitement about the interoperability showcase, which demonstrated how some 78 different products could interact in various care settings. Attendees could take a tour of patient care devices, for example, to see how the equipment that nurses, physicians, and anesthesiologists use could be connected to provide the same information about a preoperative patient in real-time to all caregivers.
Personal health records are no longer optional. HITECH includes specific requirements to provide patients with an electronic copy of their health data upon request, said John Halamka, CIO of Harvard Business School and Beth Israel Deaconess Medical Center. There is also speculation about whether data sharing between an EHR and PHR will qualify for the interoperability requirements of meaningful use, he says.
HIPAA requirements are more strict. New privacy and security regulations in the stimulus package require organizations that have a data breach to contact all of their patients, a major news outlet in their region, and the HHS secretary. In addition, business associates that process or handle patient information on behalf of providers are now subject to fines and must comply with the rules, as well. This means that the business relationship between providers and vendors that handle patient information may have to be retooled. For example, should providers only do business with partners that provide a copy of their security audit?
Interoperable EHRs and removable media devices pose new security risks for providers. With the prospect of interoperable EHRs comes a myriad of concerns regarding patient confidentiality. CIOs are also concerned about the security risks of removable media that can be mass storage devices mainly because, unlike a company laptop that goes missing, they may have no idea a removable storage device is being used or was lost.
For more coverage of HIMSS09 check out these articles:
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When Rochester (NY) General Health System determined to cut down on Methicillin resistant Staphylococcus aureus (MRSA) in its cardiothoracic unit, the organization didn't just see the number of cases shrink—there has not been a MRSA case in the unit since January of 2008.
"It's all about execution," says Linda Greene, RN, MPS, CIC, director of infection prevention and control for the New York hospital system.
The organization pursued this goal as part of the Association for Professionals in Infection Control and Epidemiology's (APIC) Targeting Zero campaign.
"Since 2006, APIC has been promoting a Targeting Zero philosophy," says Liz Garman, the association's director of communications. "In keeping with APIC's mission and vision for 2012, Targeting Zero is the philosophy that every healthcare institution should be working toward a goal of zero (healthcare-associated infections) HAIs. While not all HAIs are preventable, APIC believes that all organizations should set the inspirational goal of elimination and strive for zero infections."
Why MRSA?
The primary reason behind targeting MRSA for a zero infection rate is and was patient safety. But the secondary factors are hard to ignore: Average length of stay jumps from 7.6 days to 25.6 days for a MRSA patient, and the average case costs $40,000 more to treat than a non-infected patient.
"That's not the driving force for from a quality perspective, but this information is important," says Greene. "When you're doing a risk assessment, you're looking at those things—what is the end result and what are opportunities for improvement."
The question was: Were these infections inevitable, or preventable? A large amount of infections are preventable, says Greene. In fact, targeting MRSA in one unit had an interesting fringe benefit.
"What we did in 2008 drove all our infection rates down," says Greene. Implementing and hardwiring improved practices caused an across-the-board lowering of infection rates in the cardiothoracic unit.
The facility looked at infections from the perspective of the science of epidemiology.
"Infections are preventable. We know they're not all preventable, but how many are? Have we done enough?" says Greene.
Bi-directional change
"One of the reasons we chose this population—which is a high risk population—is that the people working in this area are innovators," says Greene. "At the beginning it is important to engage key people."
Because MRSA is such a high-profile topic, it was also easier to engage and leverage administrative support.
"We needed some early wins," says Greene. "While it's a really high-performing unit anyway, we found that it's all about execution—incorporating changes into the routine standard of care."
This sort of change is bi-directional, Greene says.
"Top down and bottom up—we need the executives on our side but also the stakeholders," she says.
To this end, they made it a point to drive home individual consequences. For example, education was provided to environmental services staff to demonstrate how their actions could eventually have an effect on the patient.
Rochester's MRSA efforts fit in with its overall accreditation activities because Targeting Zero falls in line with the Joint Commission's National Patient Safety Goals and new governmental regulations (e.g., CMS regulations reducing reimbursement if an infection occurs during a hospital stay)
"There are institutions that have managed to greatly reduce and even eliminate certain infections—showing that zero is possible," Garman says. "It's changing a mindset that these are the inevitable consequence of more complicated care to one where these can be avoided in many cases."
Although he was named the Joint Commission International's Middle East Managing Director less than a month ago, Ashraf Ismail, MD, MPH, is no stranger to quality initiatives.
His extensive resume includes a stint as president and CEO of Quality Associates, Inc., the largest healthcare quality training and consultation provider in the Middle East. He also served as a World Health Organization consultant in accreditation and healthcare quality, and is the founder of the Egyptian Society for Quality in Healthcare.
His new job at the JCI fits "perfectly" with his qualifications, experience, and career goals, Ismail says. Due to globalization and the availability of information via the Internet, improving healthcare quality and safety is no longer optional for organizations looking to improve their bottom line, he adds.
"If healthcare quality is not adequate in the nearby hospital, patients will look around for better quality," Ismail says in a recent e-mail interview. The public has become more and more aware of the safety issues. Healthcare organizations realize that if they do not improve quality and safety, they will lose their business."
The JCI's mission to improve quality and safety at healthcare organizations worldwide helps achieve these goals, he says.
"Accreditation is an excellent framework that helps organizations to achieve their quality goals in a systematic, measurable way," Ismail says. "Achieving JCI accreditation also provides the international and public recognition to organizations for their commitment to quality and safety."
Ismail admits that the healthcare industry in the Middle East "has a long way to go," and notes that accredited facilities in the region still represent a very small percentage of all hospitals.
Achieving the goals of JCI, and Ismail himself, of improving quality and safety will be vital to the development of healthcare business in the Middle East, he says.
"There is no way to develop business in healthcare without improving quality and safety, Ismail says. "Quality increases market share—hospitals build on their reputation."
To build their reputation, hospitals must put customers first and consider patient safety and quality objectives when outlining their goals, Ismail says. If they do so, market share will follow, he says, because patient safety saves lives and money, reduces costs, and in turn increases profitability.
"Quality and safety in healthcare organizations will create trust between clients and the provider," Ismail says. "This trust is the only guarantee to ensure survival in a very competitive environment."
A commitment by leadership is the key to quality and safety in any healthcare facility, Ismail says. He advises that the organization develop a strategic plan with a clear vision and mission that guides all operations.
One of the first steps is to ensure full compliance with the regulatory requirements for licensure. This is achieved by looking at the overall structure of the facility to see if it meets the standards of quality and safety—including the physical facility, its equipment, human resources, supplies, policies, and procedures.
"Quality and safety must be planned objectives," Ismail says. "Everyone in the organization is responsible and accountable for implementing those plans."
The organization should also plan and implement evidence-based practices, he says, but it is something that cannot be implemented once and forgotten about. Continuous education and training should be part of human resources development, and performance improvement "must be institutionalized in the organization."
"Measurement is essential for improvement and quality planning," Ismail says. "Patient safety must be considered the number one priority—organizations need to have effective and robust plans to implement patient safety goals and standards."
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Japan has announced its biggest-ever economic stimulus plan, a $154 billion package of subsidies and tax breaks that aims to stem a deepening recession in the world's second-largest economy. The new stimulus plan involves emergency spending of to protect jobs and retrain unemployed workers, as well as improving health and child care.
Millions of National Health Service patients in the UK are still being treated in "substandard" conditions in temporary buildings outside hospitals, according to a health spokesman for the Conservative political party, which obtained the figures under the Freedom of Information Act. In response to the findings, a spokesman for the Department of Health said: "temporary buildings are subject to the same requirements as permanent buildings in relation to safety and quality and cleanliness."
Several representatives from the South Korean government and the healthcare industry visited Kuwait to promote the medical tourism sector. Baeho Kim, Regional Director of the South Korean Tourism Organization, headed a team of medical tourism delegates from three well-known South Korean hospitals, and the group met with several Kuwaiti officials and introduced their newest Medical Tourism facilities.
The Indian tourism ministry is finalizing a plan where a tourist visiting the country for a particular medical treatment will be offered an additional treatment free of cost for a smaller ailment. The plan is part of a strategy implemented by the government to increase foreign tourist arrivals during the global slowdown, a senior official in the tourism ministry said.