the u.s. health disadvantage: clinical quality & infection ......the danger is not just on your...

Clinical Quality & Infection Control

May 2013 • Vol. 2013 No. 2

INSIDEThe U.S. Health Disadvantage: UC Davis’ Claire Pomeroy on A Crisis That We Must Address Together p. 14

Top 10 Most Common Sentinel Events Find Out Where to Focus Your QI Efforts p. 21

13 Practical Steps to Prevent HAIs p. 18

What’s the Secret to Better Infection Control Compliance? Why to Move Beyond Secret Shoppers p. 17

INDEXImproving HCAHPS and CAHPS Scores p. 15

Infection Prevention & Hand Hygiene p. 17

Reducing Readmissions p. 19

How Can Healthcare Organizations Measure “Soft” Aspects of Patient Safety?By Sabrina Rodak

One of the keys to performance improvement is collecting and analyz-ing data on different measures. To determine quality and patient safety, hospitals track several measurements, including complication, mortality and readmission rates. Capturing data on specific events, such as deaths, is relatively straightforward. But what about other, “softer” determinants of quality and patient safety, such as patient safety culture and patient en-gagement? These concepts are complex; there are several indicators of patient safety, and they are often abstract, such as having a “just” culture in which people feel comfortable reporting adverse events.

Turning Healthcare in to a High Reliability Industry: Memorial Hermann Shares 5 StepsBy Heather Punke

High reliability industries are everywhere; most people just don’t realize it — they range from amusement parks and zoos to oil drilling rigs, air traffic control and nuclear submarines. High reliability is the ongoing safe operation of an organiza-tion or entity without a mishap or adverse event. “They have to be high reliability: If they’re unsafe, people wouldn’t work or go there,” says M. Michael Shabot, MD, FACS, FCCM, FACMI, the CMO of Me-morial Hermann Healthcare in Houston.

While many organizations and industries classified as high reliability have operated that way for years, the concept has been slow to catch on in the healthcare indus-try. In healthcare, being a high reliability organization means having no preventable harm incidents and causing no harm to pa-tients. “Hospitals just hadn’t thought they could be one,” Dr. Shabot says. “We, and other hospitals, are trying to change that.”

50 Experts Leading the Field of Patient SafetyBy Sabrina Rodak

Becker’s Hospital Review has named “50 Experts Leading the Field of Patient Safety,” which includes individuals at national organizations, universities and healthcare organizations working to improve patient safety. The patient safety leaders listed here consist of advocates, pro-fessors, researchers, administrators and healthcare providers who have won awards, published articles, spoken out and led initiatives to reduce harm and ensure safety.

Jason Adelman, MD, MS. Patient Safety Officer at Montefiore Medical Center (New York City). Dr. Adelman is the patient safety officer at Montefiore Medical Center and assistant professor of medi-cine at Albert Einstein College of Medicine in New York City. Dr.

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Patient Experience Roundtable: How to Raise and Maintain Patient Satisfaction p. 15

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Clinical Quality & Infection Control

May 2013 Vol. 2013 No. 2

FEATURES 1 50 Experts Leading the Field of Patient Safety

1 How Can Healthcare Organizations Measure “Soft” Aspects of Patient Safety?

1 Turning Healthcare in to a High Reliability Industry: Memorial Hermann Shares 5 Steps

14 The U.S. Health Disadvantage: A Crisis That We Must Address Together Today

Special Focus: Improving HCAHPS and CAHPS scores

15 Patient Experience Roundtable: Raising and Maintaining Patient Satisfaction

Special Focus: Infection Prevention & Hand Hygiene

17 The Secret to Better Infection Control Compliance: Move Beyond Secret Shoppers

18 Study: Hand Hygiene Poster Increased Likelihood of Washing Hands

18 13 Practical Steps to Prevent HAIs

Reducing Readmissions

19 Report: U.S. Made Little Progress on Readmission Rates 2008-2010

19 Study: Income Inequality Linked to Higher Readmissions

19 Avoidable Readmissions by Numbers: 8 Statistics

20 Palliative Care: Why It Has Become a Growing Specialty Within Hospitals

21 Top 10 Most Common Sentinel Events

22 Top 58 Hospitals Patients Rated 9 or 10 in HCAHPS

23 Advertising Index

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Adelman was awarded the American Hospital Association-National Patient Safety Foundation Comprehensive Patient Safety Leadership Fellow-ship for 2010 to 2011, and is a senior fellow of the Health Research & Educational Trust.

David W. Bates, MD, MSc. Senior Vice Presi-dent for Quality and Safety and Chief Qual-ity Officer of Brigham and Women’s Hospital and the Brigham and Women’s Physicians Organization (Boston). Dr. Bates became se-nior vice president for quality and safety and chief quality officer at Brigham and Women’s Hospital and the Brigham and Women’s Physicians Organi-zation in 2011. He serves as executive director of the Center for Patient Safety Research and Practice at Brigham and Women’s Hospital and as external program lead for research in the World Health Or-ganization’s Global Alliance for Patient Safety. In addition, Dr. Bates co-directs the program in clini-cal effectiveness at the Harvard School of Public Health and is medical director of clinical and qual-ity analysis at Partners HealthCare in Boston.

Donald M. Berwick, MD, MPP. Former CMS Administrator (Baltimore). Dr. Berwick served as administrator of CMS for nearly a year and a half, during which the agency launched the nationwide Partnership for Patients initia-tive to improve patient safety. He previously co-founded and led the Institute for Healthcare Im-provement for more than 20 years. Dr. Berwick was recently appointed as chair of the National Patient Safety Advisory Board by U.K. Prime Minister David Cameron to help the National Health Serve reduce harm.

Leah F. Binder, MA, MGA. CEO of The Leapfrog Group (Washington, D.C.). Ms. Binder serves as president and CEO of The Leapfrog Group, a national organization aiming to improve the safety, quality and affordability of healthcare. The Leapfrog Group awards pa-tient safety scores to hospitals based on publicly available metrics. Ms. Binder joined the organi-zation in 2008, before which she served as vice president of Franklin Community Health Net-work in Farmington, Maine, for eight years.

Maureen Bisognano, RN. President and CEO of the Institute for Healthcare Im-provement (Cambridge, Mass.). Ms. Bisog-nano is president and CEO of the Institute for Healthcare Improvement. She previously served as executive vice president and COO of the organization for 15 years. Ms. Bisognano is an elected member of the Institute of Medi-cine and was appointed to The Commonwealth Fund’s Commission on a High Performance Health System.

Doug Bonacum. Vice President of Quality, Safety and Resource Management, at Kaiser Permanente (Oakland, Calif.). Mr. Bonacum

serves as vice president of safety management at Kaiser Permanente, where he has worked since 1994. In 2006, he received the National Patient Safety Foundation’s inaugural Chairman’s Medal, which recognizes emerging leadership in patient safety. He served for eight years on active duty in the U.S. Submarine Force, where he was respon-sible for weapons’ and ship’s safety and nuclear power plant operations.

Richard Boothman, JD. Chief Risk Officer of University of Michigan Health System (Ann Arbor). Mr. Boothman is chief risk of-ficer of University of Michigan Health System. He has participated in the Agency for Health-care Research and Quality’s National Advisory Committee Subcommittee for Patient Safety and Medical Liability Reform. Mr. Boothman is also a member of the board of governors at the Na-tional Patient Safety Foundation and the board of directors at the Michigan Hospital Associa-tion Patient Safety Organization.

Helga Brake, PharmD, CPHQ. Patient Safe-ty Leader at Northwestern Memorial Hospi-tal (Chicago). Ms. Brake serves as patient safety leader at Northwestern Memorial Hospital. She was named an American Hospital Association-National Patient Safety Foundation Patient Safety Leadership Fellow for 2011 to 2012 for a project on eliminating harm from failures in medication continuity. Ms. Brake is a member of the American Society of Professionals in Patient Safety, a membership program established by the National Patient Safety Foundation.

Darrell A. Campbell Jr., MD. CMO of the University of Michigan Health System (Ann Arbor). Dr. Campbell is CMO of the Universi-ty of Michigan Health System and Henry King Ransom Professor of Surgery in the department

of surgery. He has worked with Blue Cross Blue Shield of Michigan to develop a surgical quality improvement program in 52 Michigan hospitals and has been selected to participate in the Nation-al Quality Forum’s National Voluntary Consensus Standards for Patient Safety project.

Mark R. Chassin, MD, FACP, MPP, MPH. President of The Joint Commission and the Joint Commission Center for Transform-ing Healthcare (Oakbrook Terrace, Ill.). Dr. Chassin is president of The Joint Commission and the Joint Commission Center for Trans-forming Healthcare. He previously served as the Edmond A. Guggenheim Professor of Health Policy and founding chairman of the department of health policy at Mount Sinai School of Medi-cine and executive vice president for excellence in patient care at Mount Sinai Medical Center in New York City. Dr. Chassin was a member of the Institute of Medicine committee that published the groundbreaking article “To Err is Human: Building a Safer Health System” in 1999.

Carolyn M. Clancy, MD. Outgoing Direc-tor of the Agency for Healthcare Research and Quality (Rockville, Md.). Dr. Clancy an-nounced in January that she will step down as di-rector of the Agency for Healthcare Research and Quality after leading the organization for nearly 10 years. As director, she created the first annual report to Congress on healthcare disparities and healthcare quality. Dr. Clancy previously served as director of AHRQ’s Center for Outcomes and Effectiveness Research and was awarded the William B. Graham Prize for Health Services Re-search in 2009.

Michael R. Cohen, RPh, MS, ScD. President of the Institute for Safe Medication Prac-tices (Horsham, Pa.). Dr. Cohen is president

50 Experts Leading the Field of Patient Safety (continued from page 1)

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of the Institute for Safe Medication Practices and vice chair of the patient safety advisory group for The Joint Commission. He is also editor of the textbook “Medication Errors” and co-editor of the ISMP “Medication Safety Alert!” publications. He was named a MacArthur Fellow in 2005.

Robert Connors, MD. President of Helen DeVos Children’s Hospi-tal (Grand Rapids, Mich.). Dr. Connors, a practicing pediatric surgeon, is president of Helen DeVos Children’s Hospital, part of Grand Rapids-based Spectrum Health. Before joining the system in 2005, he established Pediatric Surgeons of West Michigan, a group of pediatric surgeons, in 1990. In 2011, he received the National Patient Safety Foundation Chair-man’s Award in recognition of his emerging leadership in patient safety.

William A. Conway, MD. Executive Vice President and Chief Qual-ity Officer of Henry Ford Health System and CEO of Henry Ford Medical Group (Detroit). Dr. Conway serves as executive vice president and chief quality officer of Henry Ford Health System as well as CEO of Henry Ford Medical Group, which he joined as a senior staff physi-cian in 1977. He played an integral role in the health system’s “No Harm Campaign,” which received the 2011 John M. Eisenberg Patient Safety and Quality Award for innovation in patient safety and quality at the local level. Dr. Conway received the Keystone Center Patient Safety and Quality Lead-ership Award from the Michigan Health and Hospital Association in 2006.

Jeffrey B. Cooper, PhD. Executive Vice President of the Anesthesia Pa-tient Safety Foundation (Indianapolis). In addition to being co-founder and executive vice president of the Anesthesia Patient Safety Foundation, Dr. Cooper is a professor of anesthesia at Harvard Medical School and founder and executive director of the Center for Medical Simulation in Boston. Dr. Cooper received the John M. Eisenberg Patient Safety and Quality Award for lifetime achievement in 2003. In 2009, the department of anesthesia, critical care and pain medicine at Massachusetts General Hospital in Boston created the Jeffrey B. Cooper Patient Safety award in his honor.

Ilene Corina. President of PULSE of New York (Wantagh). Ms. Co-rina is founder and president of PULSE of New York, a patient safety ad-vocacy group. She is a member of the board of governors of the National Patient Safety Foundation and a member of the board of commissioners of The Joint Commission. In 2010 Ms. Corina won the MITSS HOPE award, which recognizes individuals and organizations that demonstrate the mission of Medically Induced Trauma Support Services: “Supporting Healing and Restoring Hope to patients, families and clinicians impacted by adverse medical events.”

Janet M. Corrigan, PhD, MBA. Former President and CEO of the National Quality Forum (Washington, D.C.). Dr. Corrigan was ap-pointed a member of The Lucian Leape Institute at the National Patient Safety Foundation in July 2012 after retiring as president and CEO of the National Quality Forum. She led NQF since 2006, helping expand its standard-setting program for performance measures. Before that role, she served as senior board director at the Institute of Medicine, where she provided leadership in its pivotal 1999 report, “To Err Is Human: Building a Safer Health System.”

Charles Denham, MD. Chairman of Texas Medical Institute of Technology (Austin). Dr. Denham is chairman of the Texas Medical Institute of Technology, which he founded to drive adoption of health-care performance improvement solutions. He is also CEO and founder of HCC Corp., a business development accelerator. In addition, Dr. Denham is editor-in-chief of Journal of Patient Safety and co-founder of the Global Patient Safety Forum.

Jay Deshpande, MD, MPH. Senior Vice President, Chief Qual-ity Officer and Associate Medical Director of Arkansas Children’s Hospital (Little Rock). Dr. Deshpande was named senior vice president, chief quality officer and associate medical director of Arkansas Children’s Hospital in 2010. He is also a professor of pediatrics and anesthesiology at the University of Arkansas for Medical Sciences. He previously served

as pediatric anesthesiologist-in-chief and executive physician of pediatric quality and safety at Monroe Carell Jr. Children’s Hospital at Vanderbilt in Nashville, Tenn., and vice chair for pediatric anesthesiology at Vanderbilt University Medical Center department of anesthesiology.

Scott J. Ellner, DO, MPH. Vice Chairman of Surgery and Director of Surgical Quality at Saint Francis Hospital and Medical Center (Hartford, Conn.). Dr. Ellner is vice chairman of surgery and director of surgical quality at Saint Francis Hospital and Medical Center. He also serves as an assistant professor of surgery at the University of Connecticut Medi-cal School. He was an American Hospital Association-National Patient Safety Foundation Patient Safety Leadership Fellow for 2010 to 2011, and researches culture changes in surgical settings to improve patient outcomes. Dr. Ellner is also founder and past chair of the Connecticut Surgical Qual-ity Collaborative, which aims to improve the quality of surgical care.

Tejal K. Gandhi, MD, MPH. Chief Quality and Safety Officer of Partners HealthCare (Boston). Dr. Gandhi, a board-certified internist, is chief quality and safety officer of Partners HealthCare and assistant pro-fessor of medicine at Harvard Medical School. In addition, she is chair of Partners HealthCare’s High Performance Medicine initiative on patient safety and fellowship director of Harvard Medical School’s Fellowship in Patient Safety and Quality. She previously served as executive director of quality and safety at Brigham and Women’s Hospital in Boston.

Atul Gawande, MD, MPH. Surgeon at Brigham and Women’s Hos-pital (Boston). Dr. Gawande is a surgeon at Brigham and Women’s Hos-pital, a professor at Harvard Medical School and Harvard School of Public Health and a lead advisor for the World Health Organization’s Safe Surgery Saves Lives program. Dr. Gawande has been a staff writer for the New Yorker since 1998, and he has published several influential books on patient safety, including “Complications,” “Better” and “The Checklist Manifesto,” which revealed the ability of surgical checklists to reduce patient harm.

Vicki Good, RN, MSN, CENP. Administrative Director of Patient Safety at CoxHealth (Springfield, Mo.). In addition to serving as ad-ministrative director of patient safety at CoxHealth, Ms. Good is presi-dent-elect of the American Association of Critical-Care Nurses for 2012 to 2013. She previously served in management roles in critical care, patient safety and education at Baylor Health Care System in Dallas and Baylor All Saints Medical Center in Fort Worth, Texas. She is a member of the American Organization of Nurse Executives, the Association for Profes-sionals in Infection Control and Epidemiology and the American Society of Professionals in Patient Safety.

Patricia S. Grant, RN, BSN, MS, CIC. Director of Infection Preven-tion and Quality at Methodist Hospital for Surgery (Addison, Texas). Ms. Grant is director of infection prevention and quality at Methodist Hos-pital for Surgery and president of the Association for Professionals in Infec-tion Control and Epidemiology. She has served as an infection preventionist for 20 years in different hospitals and has been actively involved in patient safety organizations. She is a past president of the Texas Society of Infection Control and Prevention and received an APIC Leadership award in 2011.

Linda Groah, RN, MSN, CNOR, CNAA, FAAN. Executive Direc-tor and CEO of the Association of periOperative Registered Nurses (Denver). Ms. Groah has served as executive director and CEO of the As-sociation of periOperative Registered Nurses since March 2007. She previ-ously served as COO and nurse executive at Kaiser Foundation Hospital in San Francisco, where she piloted patient safety initiatives such as admin-istration walking rounds and introduced the concept of a “just” culture. Ms. Groah is the immediate past treasurer for the Nursing Organization Alliance and the vice chair of the Nursing Alliance for Quality Care.

Stephen R. Grossbart, PhD. Senior Vice President and Chief Quality Officer of the Center for Patient Safety and Clinical Transformation at Catholic Health Partners (Cincinnati). Dr. Grossbart is senior vice president and chief quality officer of the Center for Patient Safety and


Clinical Transformation at Catholic Health Partners. He served on the Na-tional Quality Forum’s Hospital Measure Workshop that recommended the NQF’s initial set of National Voluntary Consensus Standards for Hospital Care, co-chaired the NQF’s Consensus Standards Maintenance Committee for Pulmonary Measures and was a member of NQF’s Consensus Stan-dards Maintenance Methods Committee. He previously served as director of clinical analytics at Charlotte, N.C.-based Premier.

Leigh S. Hamby, MD, MHA. CMO and Chief Quality Officer of Piedmont Healthcare (Atlanta). Dr. Hamby serves as CMO and chief quality officer of Piedmont Healthcare. He previously served as a Mal-colm Baldrige National Quality Award examiner for several years and as director of healthcare quality and evaluation at the Veterans Affairs Atlanta Network. In addition, Dr. Hamby is an associate professor at the Rollins School of Public Health at Emory University in Atlanta, where he teaches quality improvement strategies.

Michael Henderson, MD. Chief Quality Officer of Cleveland Clinic. Dr. Henderson is chief quality officer of Cleveland Clinic and founder and chairman of the system’s Quality and Patient Safety Institute. The institute coordinates quality, regulatory and risk management activities across the sys-tem. He previously served as chair of the American College of Surgeons National Surgical Quality Improvement Program advisory board.

Brent C. James, MD, MStat. Chief Quality Officer and Executive Director of the Institute for Health Care Delivery Research at Inter-mountain Healthcare (Salt Lake City). Dr. James serves as chief quality officer and executive director of the Institute for Health Care Delivery Research at Intermountain Healthcare. He has trained more than 3,500 healthcare professionals in clinical management methods through the In-termountain Advanced Training Program in Clinical Practice Improve-ment. He previously served as assistant professor in the department of biostatistics at the Harvard School of Public Health.

Gary S. Kaplan, MD, FACP, FACMPE, FACPE. Chairman and CEO of Virginia Mason Health System (Seattle). Dr. Kaplan has served as chairman and CEO of Seattle-based Virginia Mason Health System since 2000, during which he led implementation of the Virginia Mason Production System to improve efficiencies, quality and safety. He is also a clinical profes-sor at the University of Washington and has served on the boards of numer-ous organizations, including the Institute for Healthcare Improvement. Dr. Kaplan won the 2009 John M. Eisenberg Patient Safety and Quality Award.

Edward Kelley, MD, PhD. Coordinator and Head of Strategic Pro-grammes of Patient Safety at the World Health Organization (Ge-neva, Switzerland). Dr. Kelley is coordinator and head of Strategic Pro-grammes of Patient Safety at the World Health Organization, where he leads a global healthcare safety initiative. He previously served as director of the first U.S. National Healthcare Reports for HHS in the Agency for Healthcare Research and Quality, where he examined healthcare quality and disparities. He was also director of the Health Care Quality Improvement Project of the Organization of Economic Cooperation and Development.

Donald Kennerly, MD, PhD. Vice President and Associate Chief Quality Officer of Baylor Health Care System (Dallas). Dr. Kennerly serves as vice president and associate chief quality safety officer of Baylor Health Care System. He began at Baylor as medical director of the Center for Quality and Care at Baylor University Medical Center at Dallas in 1999 and became Baylor University Medical Center’s first patient safety officer in 2002. Dr. Kennerly also helped develop Baylor’s Office of Patient Safety.

Lucian Leape, MD. Chairman of the Lucian Leape Institute at the National Patient Safety Foundation (Boston). Dr. Leape is chairman of the eponymous institute at the National Patient Safety Foundation and an adjunct professor of health policy at the Harvard School of Pub-lic Health. Dr. Leape is one of the founders of NPSF, the Massachusetts Coalition for the Prevention of Medical Error and the Har vard Kennedy

School Executive Session on Medical Error. Dr. Leape won the Lifetime Achievement Award from the Institute for Safe Medication Practices in 2001 and the John M. Eisenberg Patient Safety and Quality Award in 2004.

Jennie Mayfield, BSN, MPH, CIC. Clinical Epidemiologist at Barnes-Jewish Hospital (St. Louis). Ms. Mayfield is a clinical epidemi-ologist at Barnes-Jewish Hospital and president-elect of the Association for Professionals in Infection Control and Epidemiology. She has worked in infection prevention for more than 26 years and has been a member of APIC for 24 years. She won the Advanced Practice Infection Control Pro-fessional Award from the Society for Healthcare Epidemiology of America in 2005 and the APIC Hero of Infection Prevention Award in 2007.

Gregg Meyer, MD, MSc. Executive Vice President for Population Health and Chief Clinical Office at Dartmouth-Hitchcock (Leba-non, N.H.). Dr. Meyer became Dartmouth-Hitchcock’s first executive vice president for population health and chief clinical officer in May 2012. In this role, he oversees clinical operations across the health system. He is also senior associate dean for clinical affairs and the first Paul B. Batalden Chair in Health Care Leadership Improvement at the Audrey and Theodor Geisel School of Medicine at Dartmouth. Dr. Meyer previously served as senior vice president of the Edward P. Lawrence Center for Quality and Safety at Massachusetts General Hospital in Boston.

Julianne M. Morath, RN, MS. Senior Vice President of Patient Safety and Quality at the California Hospital Association and CEO of the California Hospital Quality Institute (Sacramento). Ms. Morath is se-nior vice president of patient safety and quality at the California Hospital Association and CEO of the California Hospital Quality Institute. She previously served as chief quality and patient safety officer of Vanderbilt

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University Medical Center in Nashville, Tenn. She was the first recipient of the John M. Eisenberg Patient Safety and Quality Award for individual lifetime achievement in patient safety.

Elizabeth Mort, MD. Vice President of Quality and Safety and As-sociate CMO of Massachusetts General Hospital (Boston). Dr. Mort, a practicing general internist, serves as vice president of quality and safety of Massachusetts General Hospital and Massachusetts General Physicians Organization, as well as associate CMO of Massachusetts General Hos-pital. She also holds the position of senior medical director of Partners HealthCare in Boston. Dr. Mort co-chairs the Massachusetts Medical Soci-ety’s committee on the quality of medical practice.

Jonathan B. Perlin, MD, PhD. President of Clinical and Physician Services and CMO of Hospital Corporation of America (Nashville, Tenn.). Dr. Perlin serves as president of clinical and physician services and CMO of Hospital Corporation of America. He previously served as Under Secretary for Health in the U.S. Department of Veterans Affairs and chief quality and performance officer at the Veterans Health Administration. Dr. Perlin has served on boards of several organizations, including the Nation-al Quality Forum. In 2010 he won the National Patient Safety Foundation’s Chairman’s Medal in recognition of his efforts in improving patient safety.

Diane C. Pinakiewicz, MBA, CPPS. Former President of the Na-tional Patient Safety Foundation (Boston). Ms. Pinakiewicz retired as president of the National Patient Safety Foundation in November after leading the organization for nine years. She is a member of the Lucian Leape Institute at NPSF after serving as its president. Ms. Pinakiewicz led NPSF’s programmatic expansion, including new accredited continuing education and continuing medical education resources and the creation of the Certification Board for Professionals in Patient Safety.

Peter J. Pronovost, MD, PhD, FCCM. Senior Vice President for Pa-tient Safety and Quality and Director of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins Medicine (Baltimore). Dr. Pronovost, a practicing anesthesiologist and critical care physician, serves as senior vice president for patient safety and quality and director of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins Medicine. Dr. Pronovost led a program in Michigan that used a checklist to dramatically reduce the rate of catheter-related bloodstream infections. Dr. Pronovost won the 2004 John M. Eisenberg Patient Safety and Quality Award for research and was named a MacArthur Fellow in 2008.

Gina Pugliese, RN, MS. Vice President of the Premier Safety In-stitute (Charlotte, N.C.). Ms. Pugliese is vice president of the Premier Safety Institute, part of the Premier healthcare alliance. She is also editor of the institute’s SafetyShare online newsletter and the journal Infection Con-trol and Hospital Epidemiology. She previously served as director of safety for the American Hospital Association for eight years and has participated in many national committees for CMS, the Agency for Healthcare Research and Quality and other organizations.

Regina Robinson, RN, MBA, CMPE, CASC. Director of Peninsula Surgery Center (Newport News, Va.). Ms. Robinson is director of Pen-insula Surgery Center, where she leads efforts in continuous improvement. She previously served as a legal nurse consultant. She is a member of the editorial advisory board at SurgiStrategies and has written several articles on infection control.

Michael Rose, MD. Vice President of Surgical Services at McLeod Health (Florence, S.C.). Dr. Rose, a practicing anesthesiologist, serves as vice president of surgical services at McLeod Health and is a member of the McLeod Health board of trustees. In addition, he is chairman of the South Carolina Safe Surgery 2015 leadership team, which helps hospitals implement a surgical safety checklist to prevent errors. Dr. Rose received the 2012 Lewis Blackman Patient Safety Champion Healthcare Executive Award for his role in improving hospitals’ safety.

M. Michael Shabot, MD. CMO of Memorial Hermann Healthcare System (Houston). Dr. Shabot is CMO of Memorial Hermann Health-care System, which received the 2012 John M. Eisenberg Patient Safety and Quality Award for innovation in patient safety and quality at the national level. He previously served as Memorial Hermann’s chief quality officer and held several leadership positions at Cedars-Sinai Medical Center in Los Angeles. Dr. Shabot is also chairman of the board of the Memorial Hermann Accountable Care Organization and an adjunct professor at the University of Texas School of Biomedical Informatics.

Rita Shane, PharmD, FASHP, FCSHP. Director of Pharmacy Ser-vices at Cedars-Sinai Medical Center (Los Angeles). Dr. Shane is di-rector of pharmacy services at Cedars-Sinai Medical Center and assistant dean of clinical pharmacy services at the University of California, San Francisco School of Pharmacy. In 1983 she developed a clinical pharmacy intervention program to document pharmacists’ role in preventing adverse drug events. She received the 2012 Harvey A.K. Whitney Lecture Award in recognition of her commitment to patient safety and her work expanding clinical pharmacy services at Cedars-Sinai.

Susan E. Sheridan, MIM, MBA. Co-Founder and Past President of Consumers Advancing Patient Safety (Chicago). Ms. Sheridan is co-founder and past president of Consumers Advancing Patient Safety as well as Parents of Infants and Children with Kernicterus. She also serves as deputy director of patient engagement at the Patient-Centered Outcomes Research Institute, and led the World Health Organization’s Patients for Patient Safety initiative from 2004 to 2011.

John S. Toussaint, MD. CEO of the ThedaCare Center for Health-care Value (Appleton, Wis.). Dr. Toussaint is CEO of the ThedaCare Center for Healthcare Value and CEO emeritus of ThedaCare. He was a pioneer in using the Toyota Production System and Lean principles to improve healthcare. He was the founding chair of the Wisconsin Collab-orative for Healthcare Quality and of the Wisconsin Health Information Organization. He was inducted into the Association of Manufacturing Ex-cellence Hall of Fame in 2012 and was named a lifetime member of the Shingo Academy in 2011.

Robert M. Wachter, MD. Chief of Medical Service and Chief of the Division of Hospital Medicine at UCSF Medical Center (San Francisco). In addition to serving as chief of the medical service and chief of the division of hospital medicine at UCSF Medical Center, Dr. Wachter is professor and associate chairman of the department of medi-cine at the University of California, San Francisco. He is editor of Agency for Healthcare Research and Quality WebM&M and AHRQ Patient Safety Net-work. Dr. Wachter coined the term “hospitalist” in a 1996 New England Journal of Medicine article and is a past president of the Society of Hospital Medicine.

Saul N. Weingart, MD, PhD. Vice President for Quality Improve-ment and Patient Safety at Dana-Farber Cancer Institute (Boston). Dr. Weingart is vice president for quality improvement and patient safety at Dana-Farber Cancer Institute. He received the 2012 John M. Eisenberg Patient Safety and Quality Award for his commitment to patient safety. He developed one of the earliest medication reconciliation programs and developed curricula for patient safety. In addition, Dr. Weingart is an as-sociate professor of medicine at Harvard Medical School and chair of the board of governors of the National Patient Safety Foundation.

Ronald Wyatt, MD, MHA. Medical Director in the Division of Healthcare Improvement at The Joint Commission (Oakbrook Ter-race, Ill.). Dr. Wyatt is medical director in the division of healthcare im-provement at The Joint Commission, where he serves as a resource for patient safety information and promotes patient safety and quality im-provement. He previously served as director of the Patient Safety Analysis Center at the Department of Defense, where he created the DoD Patient Safety Registries to track and analyze adverse patient safety events. n

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Why should healthcare organizations measure “soft” aspects of patient safety?While much of healthcare data are “hard” measures — measures that are concrete and easily quantifiable — there is a growing awareness of the importance of “soft,” more qualitative measures, such as patient safety cul-ture, in improving the U.S. healthcare system. In fact, what has typically been viewed as a soft measure — patient satisfaction — now factors into hospitals’ reimbursement under CMS’ Value-Based Purchasing program. It is important to measure and benchmark these multifactor concepts to identify opportunities for improvement.

Patient safety culture speaks to healthcare providers’ intrinsic motivation, according to Peter J. Pronovost, MD, PhD, senior vice president for pa-tient safety and quality and director of the Armstrong Institute for Patient Safety and Quality at Baltimore-based Johns Hopkins Medicine. Dr. Pro-novost is well known for developing a checklist for intensive care units that has dramatically reduced central line-associated bloodstream infections in Michigan, saving an estimated 1,500 lives and $100 million annually. “Our work in reducing ICU infections was almost entirely driven by intrinsic mo-tivation. The softer side — this intrinsic motivation, the way we speak to each other, empowerment of the front-line — is the magic sauce of what it takes to improve safety and quality,” he says.

How can healthcare organizations measure “soft” aspects of patient safety?Unlike patient satisfaction, which hospitals have been required to report using the Hospital Consumer Assessment of Healthcare Providers and Systems survey for roughly six years, standardized patient safety culture measures are not widespread in the U.S.

However, there are some surveys of patient safety culture that are gaining ground among hospitals. The Agency for Healthcare Research and Quality released the Hospital Survey on Patient Safety Culture in 2004 to help hos-pitals assess their safety climate. AHRQ benchmarks data from all hospitals who submit data from the survey. In the 2012 User Comparative Database Report, AHRQ compares results from 1,128 hospitals, compared with 1,032 hospitals in 2011. HSOPS includes 42 items designed to measure 12 areas of patient safety, including teamwork within units and supervisor/manager expectations and actions promoting patient safety.

“AHRQ has developed and offers the use of validated surveys, as well as benchmarking data. This is a huge step in the attempt to measure a com-plex construct,” says Marti Beltz, PhD, LSSMBB, a faculty member and senior healthcare quality consultant at the American Society for Quality.

Another survey, the Safety Attitudes Questionnaire, was developed by Bryan Sexton, Eric Thomas and Bob Helmreich with funding from the Robert Wood Johnson Foundation and Agency for Healthcare Research and Quality. This survey includes items designed to measure factors such as teamwork climate and job satisfaction.

Do surveys accurately measure culture?Although surveys can reveal hospital employees’ perceptions of safety, they have flaws that prevent a completely accurate picture of an organiza-tion’s culture. “While validated (particularly those offered by [AHRQ]), these instruments are only proxies used to estimate the degree to which a facility is committed to safety at all levels,” Dr. Beltz says. “In addition, significant variations in safety culture may exist within an organization (e.g., between leadership and frontline workers, between one unit and another) so institutional level scores may mask these significant differences.”

Conducting the survey at the unit level can be more useful than a hospital-wide survey in identifying where patient safety culture is successful and

where it faces challenges. Dr. Pronovost says variation in survey results can vary as much as six- to eight-fold across a hospital. To gain a more accurate assessment of patient safety culture in the hospital, Johns Hopkins Medi-cine issues the surveys to individual units.

However, measuring safety culture at the unit level also presents challenges because physicians often work in many units. To include physicians in the surveys, Johns Hopkins surveys all physicians as one unit.

In addition, response rates for patient safety culture surveys can be low, which diminishes its validity as a measure of the organization’s culture. Dr. Pronovost says hospitals should aim for at least a 60-percent response rate to attain representative data. “You have to be cautious about using these [data] too quantitatively,” he says.

Case example: Johns Hopkins MedicineTo improve the safety culture at Johns Hopkins Medicine, the system con-ducts HSOPS surveys at the unit level, provides feedback on results and uses the responses to begin a discussion on safety. “By far the biggest benefit of the surveys is they start the conversation,” Dr. Pronovost says. Johns Hop-kins leaders work with staff at the unit level to address items in the survey.

Typically, leaders ask staff about the three highest-scored questions on the survey and the three lowest-scored items. For example, when presenting the high-scoring items, leaders can determine the unit’s best practices that improved its culture and that can be spread to other units. Similarly, when discussing a low-scoring item, a leader may say, “Only 30 percent of nurses on the unit said they were able to speak up. Is that what it feels like?” Dr. Pronovost says.

“You ask staff their perceptions of how well they work together, and if they feel comfortable speaking up about mistakes — that’s the superficial side. What we care about is the [underlying] values, beliefs and ultimately, behaviors,” he says. “The survey takes a vague concept like safety culture and translates it into specific questions with responses we can then have a conversation with staff about.”

He suggests having more in-depth discussions on safety culture through smaller focus groups. “It’s different saying ‘Safety culture is important; we have to improve it,’ than saying ‘Only 20 percent of nurses felt comfort-able speaking up.’ It allows you to get into these issues in a much more real and concrete way than if you didn’t have these conversation starters,” Dr. Pronovost says.

Tips for measuring patient safety cultureAs evident from Johns Hopkins’ experience, measuring patient safety cul-ture can still be valuable despite the flaws of the measurement tool. Dr. Beltz says, “The best piece of advice I can offer to leaders is acknowledge that there is no one measure of patient safety culture and that all measures are only proxy indices of the construct.” She suggests two best practices for measuring the softer aspects of patient safety:

1. Measure the root cause, not the symptom. Hospitals should con-duct root cause analyses to determine the reason for adverse events to make long-lasting change. For example, to measure a commitment to safety, leaders should go beyond just counting the number of fall risk assessments conducted, according to Dr. Beltz. If a patient passed a fall risk assessment but fell anyway, the root cause may be that although the patient knew he or she needed help walking, the wait time for a response to the call light was too long, Dr. Beltz says.

Leaders need to identify the root cause, implement a targeted interven-tion and measure its effectiveness. To address the root cause in the patient fall example, a hospital may decrease call light response time or increase patients’ accessibility to the call button and personal items, Dr. Beltz suggests. Hospitals can then measure the rate at which call lights are responded to and the rate at which patients use the call light to

How Can Healthcare Organizations Measure “Soft” Aspects of Patient Safety? (continued from page 1)


retrieve personal items. “If an RCA improvement action is still work-ing in six months, that measure would be a more robust indication of commitment to safety,” Dr. Beltz says. Responding to 100 percent of call lights within three minutes would be a stronger sign of safety com-mitment than distributing a certain number of fall risk assessments.

2. Be creative in developing measures of safety culture and en-gagement. Since there is no single measure of patient safety culture or patient engagement, leaders should look at several measures that can combine to reflect culture or engagement. Dr. Beltz says some creative measures she has seen for safety culture include the number of responses to a safety culture survey and the number and kind of dis-ciplines represented in root cause analyses. Some examples of creative patient engagement measures include the number of patients partici-

pating in process improvement teams, community attendance at health fairs and educational events and the number of “hits” on the quality measures tab of the hospital’s website, Dr. Beltz says.

It’s the journey that mattersMethods to measure soft aspects of patient safety such as patient safety culture and patient engagement are far from perfect; they rely on staff perceptions and often have low response rates. However, measuring soft patient safety constructs can be useful in launching discussions about safe-ty, identifying areas for improvement and increasing awareness of patient safety. “The commitment to trying to measure (albeit imperfectly) [safety culture] in the face of its complexity is in itself an indication of the orga-nization’s commitment to safety,” Dr. Beltz says. n

Dr. Shabot has led the charge for Memorial Her-mann to become a high reliability organization through the High Reliability: Journey from Board to Bedside Initiative. After its implementation in 2006, the Board to Bedside Initiative has led to the healthcare system receiving the 2012 John M. Eisenberg Patient Safety and Quality Award in the category “Innovation in Patient Safety and Qual-ity at the National Level” from the National Qual-ity Forum and The Joint Commission.

Root of high reliabilityThe transformational high reliability program began at the 12-hospital system because the C-suite and board realized change was necessary. “To be honest, the high reliability program grew out of a series of adverse events that occurred in 2006,” Dr. Shabot explains. “There was a real-ization in the system that, in spite of the quality measures [already] undertaken, there was a need to totally change the approach to safety and quality in the healthcare system.”

From there, the system’s leadership and board de-veloped the high reliability initiative late in 2006.

Steps to high reliability transformationSince then, the high reliability initiative has grown from being implemented just in Memo-rial Hermann’s hospitals to being used in all of the system’s nearly 150 facilities. The following are steps to develop and implement a healthcare high reliability program, based on the formula Dr. Shabot and Memorial Hermann developed.

1. get the board’s support. As the name of Memorial Hermann’s initiative suggests, a successful high reliability program has to start with the board.

“Our board members are learning this along with us,” Dr. Shabot says. Board members go to safe-ty and quality conferences and take educational courses to learn how to improve patient safety measures. Some board members are even in high

reliability industries — the board chair is the CEO of the Houston zoo, for example. Ultimately, the board’s support and funding has made the From Board to Bedside Initiative possible.

2. Make patient safety a core value. Many hospitals and health systems have sets of priorities and values along with a mission statement. Like many other systems, Memorial Hermann has sev-eral priorities; however, the system has just one core value: patient safety. “That represented a change,” says Dr. Shabot. “Patient safety had been a prior-ity among other priorities.” But since 2007, patient safety has been at the heart of everything the sys-tem does, which helps promote high reliability.

3. Put employees through a high reli-ability education program. As part of the program, every single employee — about 20,000 individuals — went through a high reliability educational program off of their job site. “We taught nurses, pharmacists, cooks, maintenance personnel and secretaries, among others, how to do their job safer and ensure the safety of all patients and visitors in our facilities,” Dr. Shabot explains. The training program is ongoing, with new-hires also receiving high reliability training upon joining the system.

Through the educational program, employees re-ceive high reliability training and learn techniques from leaders in other high reliability fields, such as airline pilots and nuclear engineers.

4. Follow safety checklists. To prevent various risk events, Memorial Hermann devel-oped safety checklists in departments such as the intensive care unit and the operating room to en-sure high reliability and reduce patient risk. For in-stance, prior to any procedures or surgeries, nurses and physicians run through a checklist with various steps, including verifying the patient’s identifica-tion, the operation being performed, the specific body part and materials necessary for the proce-dure. Additionally, before a blood transfusion or administering a high-risk medication, two licensed providers complete a double-check to ensure safe-ty. Also, all medications are bar-coded and checked against a patient arm band and computerized med-ication list before they are given.

The checklist system has helped prevent patient harm by eliminating human error and ensuring patient safety.

5. Reward success. Becoming a high reli-ability organization doesn’t just take work from leadership and the board, the success of the ini-tiative relies on every employee in each Memo-rial Hermann facility. To recognize and reward hospitals and other facilities that embrace the program and achieve excellent results, the sys-tem created the High Reliability Certified Zero Award. The award is presented to hospitals that have gone 12 or more months without a patient harm event such as blood stream infections, falls with injuries and other adverse events.

The award certificate is presented with much fanfare at employee gatherings. In the last two years, Memorial Hermann has presented 91 Cer-tified Zero awards.

ResultsAs a result of the award-winning From Board to Bedside Initiative, the rate of preventable harm incidents in Memorial Hermann’s facilities has dropped significantly. For example, since Janu-ary 2007, more than 775,000 blood transfusions have been given with no transfusion reactions, a vast improvement since 2006. Hospitals in the system have also gone for years at a time with-out a single pressure ulcer, retained object during surgery or medicine-related safety event, which used to be common, according to Dr. Shabot. And, the hand hygiene program has an audited compliance rate of 92 percent.

Despite the success of the high reliability pro-gram, Dr. Shabot says he and the rest of the sys-tem cannot rest on their laurels when it comes to patient safety. “The program will never stop. Patient safety is not something you can take your eyes off of or declare, ‘we’ve solved that prob-lem, we can go on to the next one.’ Achieving safety is [an] all-day, every-day process,” he says. So, the system will continue to strive toward the goal of zero safety events across the system through its High Reliability: Journey from Board to Bedside Initiative. n

Turning Healthcare in to a High Reliability Industry: Memorial Hermann Shares 5 Steps (continued from page 1)


The U.S. Health Disadvantage: A Crisis That We Must Address Together TodayBy Claire Pomeroy, Vice Chancellor for Human Health Sciences and Dean of the School of Medicine at the University of California, Davis

A new report from the National Research Council and Institute of Medicine provides a bleak outlook for the country’s health. The report shocked many Americans and confirmed the worst fears of

others. The U.S. has a three-decade-long protracted and pervasive “health disadvantage” that causes Americans to die and suffer from injury and ill-ness at “rates that are demonstrably unnecessary.” The report is more than a call for public- and private-sector action; it is a call for awareness among all Americans that the nation’s health and economic well-being are danger-ously at risk. It is time to come together to end the downward trajectory of the country’s health status!

What’s the problem?The problem is as simple as it is perplexing. The U.S. spends far more per capita on healthcare than other high-income countries, yet the nation has fallen in relative standing because it has the worst health outcomes. For example, compared to the average country in the NRC/IOM study, the U.S. ranks the worst for infant mortality and low birth weight, obesity, dia-betes, heart disease, chronic lung disease, disability, adolescent pregnancy and sexually transmitted infections, HIV and AIDS, drug-related deaths, injuries and homicides. As the report title aptly states: “U.S. Health in Inter-national Perspective: Shorter Lives, Poorer Health.”

Moreover, studies confirm that poor health outcomes in the U.S. have dis-proportionate impact based on factors such as ethnicity, education, race, geography, sexual orientation, socioeconomic circumstance and immigra-tion status. The result is unconscionable health disparities among popula-tion sub-groups that reflect shameful underlying healthcare injustices. For example, African-American women are more than twice as likely as white women to die of cervical cancer and have the highest rate of breast cancer death of any racial or ethnic group. People with less than a high school education are more than four times as likely as those with a college degree to report poor or fair health. Rural residents are less likely to have health insurance and have fewer doctor visits and preventive tests.

What’s the solution?The NRC/IOM report found that “no single factor can fully explain the U.S. health disadvantage … [It] has multiple causes and involves some com-bination of inadequate healthcare, unhealthy behaviors, adverse economic and social conditions, and environmental factors, as well as public policies and social values that shape those conditions.” This means the challenge is multifaceted and requires a new paradigm that focuses on these three new pieces to help solve the puzzle:

1. Reform what matters. The Patient Protection and Affordable Care Act’s expansion of health insurance to millions of uninsured in-dividuals is a step forward, but could overburden a broken healthcare system that is struggling to meet current needs. The system must be fundamentally transformed — from a disease-based system to one that emphasizes wellness and prevention, from hospital-based acute intervention and crisis care to an approach driven by primary care and population health, and from fragmented health services to a co-ordinated continuum of care across the life span. Today’s medical model of healthcare must be replaced with a more inclusive social determinants model.

2. Focus on the real drivers of health. Contrary to what many Americans believe, medi-cal care influences only 10 percent of premature mortality and health sta-tus. The truly powerful determinants of health are genetics, behaviors and social circumstances such as income, hous-ing, transportation, safe neighborhoods, job secu-rity, education and access to healthy foods. Sustain-able improvements in health and the elimina-tion of health disparities will occur only when so-ciety removes the silos between medical care and other social services. The nation must embrace an approach that addresses these upstream determinants of health.

3. Spend where it counts. The U.S. needs to follow peer nations that spend less money and get better results because they spend money on the right things at the right time. U.S. healthcare funds must be redirected upstream on social services that help prevent disease and promote wellness, instead of waiting downstream for high-cost disease to develop. For example, a recent report from the National Health Foundation illustrates the significant cost savings that have been achieved through programs that use special centers to provide housing for homeless patients who are not sick enough to stay in hospitals, yet are too sick for shelters. The centers offer homeless patients a clean and safe place to recover and receive medical assistance, help with ap-pointments and information about support services.

What’s the next step?A key to addressing the nation’s “health disadvantage” is a new perspective that focuses on “health,” rather than just “healthcare.” The country needs a renewed sense of social responsibility that asks difficult questions about health disparities and finds sustainable answers by addressing the social determinants of health. This new direction requires all sectors of society — academia, community leaders and the public — to come together for the common cause of securing our nation’s health.

The NRC/IOM report clearly warns that “of particular concern … is whether the public is fully aware of the U.S. health disadvantage. The depth and breadth of the problem … came as a surprise to many of us.” The situ-ation is dire. The time to act is now. The U.S. is a great nation in many ways. It is time to add health to the country’s sphere of greatness. n

Claire Pomeroy is vice chancellor for human health sciences and dean of the School of Medicine at the University of California, Davis. She chairs the Board of Directors of the Association of Academic Health Centers and the Council of Deans of the Associa-tion of American Medical Colleges

Claire Pomeroy

15Special Focus: Improving HCAHPS and CAHPS scores

Patient Experience Roundtable: Raising and Maintaining Patient Satisfaction By Anuja Vaidya

One of the driving forces behind the changes taking place in the healthcare industry is the in-creasing importance of patient experience. The Patient Protection and Affordable Care Act and other changes in healthcare have led patients to take a more consumerist approach to deciding where to receive care. It is thus essential for hos-pitals and health systems to ensure that patient satisfaction at their organizations remain high.

Here, leaders and patient experience coordi-nators from various organizations with high scores on the Hospital Consumer Assessment of Healthcare Providers and Systems survey of-fer advice on how to improve patient experience and maintain high patient satisfaction.

Question: What are some of the strate-gies your hospital has implemented to improve patient experience and satis-faction?

Michelle breitfelder, Senior Vice Presi-dent of Clinical transformation, Colum-bus (ga.) Regional Healthcare System: Our CEO meets patients in the holding area for surgeries before they are taken back in for sur-gery almost every day. We have interdisciplinary work groups that help us identify opportunities for improving patient satisfaction — we involve everyone that handled the patient from the vari-ous departments. We even give out freshly baked cookies to every patient that leaves the hospital. The cookies have the hospital logo on them, and it is our way to bid a fond farewell to the patient. We also make sure that that our employees are recognized for their achievements by the entire staff of the hospital. We feel that happy employ-ees make happy patients.

Maureen broms, MS, Rn, Chief Infor-mation Officer and Vice President, Health Care Quality and Compliance, new England baptist Hospital (bos-ton): I would say that maintaining patient sat-isfaction is a cultural initiative. You need to have a very strong culture that is focused on serving the patient. This includes the CEO. If the CEO is not focused on the patient having a good ex-perience, then it remains an initiative and does not become part of the culture. We also have a hiring process that focuses on looking for people who are committed to giving the patient the best possible experience that they can have. We do our best to create a welcoming and in-viting atmosphere. We have a hands-on process for responding to patient letters or complaints. Our CEO, vice president and physician chair-man are all involved. We try to learn from those complaints, and we differentiate between facts and patient experience. Even if we are did ev-erything correctly clinically, it might still mean that the patient didn’t feel cared for. You need to take patient experiences as they are without trying to make it about validating your processes and proving the patient wrong. It is important to figure out whether or not there was a gap in your processes, but it is more important to work with the patients and address their issues.

Randy Yust, CFo, Coo, Iu Health north Hospital (Carmel, Ind.): We frequently re-view data and information that is related to pa-tient experience and the patient satisfaction sur-veys at our manager’s meeting, and at monthly meetings to check progress and make changes. We regularly recognize associates, departments and, when appropriate, volunteers for outstand-ing service and achievements. We do this through

Michelle Breitfelder

Maureen Broms, MS, RN

Joy Graves-RustPaul Calkins, MDRandy Yust

16 Special Focus: Improving HCAHPS and CAHPS scores

internal awards such as the Lasting Impressions Award, department baskets filled with goodies for associates to share and the DAISY Award for Extraordinary Nurses. There are other com-ponents as well, such as writing thank you notes to associates in recognition of a job well done, notes to patients thanking them for the privilege to provide their care and rounding that helps re-inforce our service standards. Joy Graves-Rust, our patient satisfaction coordinator, is dedicated to working with leadership to interpret the data in a way that is meaningful and understandable. She helps them identify behaviors and activities that are indicated as having a direct impact on improving the overall patient experience.

Paul Calkins, Md, Interim Chief Medical Officer, IU Health North Hospital (Car-mel, Ind.): IU Health North has intentionally introduced certain behaviors as expectations. These include behaviors such as greeting indi-viduals with a smile and accompanying visitors and guests to their destination whenever pos-sible instead of simply directing them.

Q: What are the most important factors influencing patient satisfaction?

Ms. broms: First, make sure that all the pa-tients’ expectations are met, from how they want their meals served to the kind of environment they want to receive care in. Learning what those expectations are and creating a plan around that is important. Creating a warm and welcoming environment is also important, particularly be-cause patients are anxious when they come to a hospital. Another important factor is how the physicians communicate with them and how nurses communicate with them.

dr. Calkins: Treating patients as people, and making sure they know you consider them a person and not only a medical case or customer is important. So is hiring individuals who genu-inely care and enjoy what they do.

Joy graves-Rust, Coordinator, Patient Satisfaction Measures, Iu Health north Hospital (Carmel, Ind.): One of the greatest

strengths of IU Health North Hospital has been doing what’s right for the patient and family be-cause it’s the right thing to do. When done auto-matically with an intention that is authentic and not mandated, the experience has the potential to become transformational. From the begin-ning, executive leadership has lived the culture and has extended service not only to our visitors and guests but also to associates and volunteers. The impact of this must not be underestimated as it sets a standard and expectation that has become ingrained in the culture of IU Health North Hospital.

Q: What are some of the challenges of improving patient experience?

Ms. breitfelder: I think all hospitals in the U.S. have to do more with less. All hospitals have to be very efficient with staffing, for example. The bar is also being raised because everyone is trying to improve patient satisfaction scores — you can’t just meet expectations anymore, you have to exceed them. Patients are really looking for a 5-star hotel experience when they come to the hospital now. And the final challenge is keep-ing all your employees engaged.

Mr. Yust: Changes are not immediate and in-stant. Improving the patient experience takes initiative, dedication and time.

Ms. graves-Rust: In the world of regulatory compliance, documentation and gadgets, it can be difficult to maintain perspective or take a step back and examine processes. Individuals from all areas of the facility — clinical care to sup-port services — are busy providing the best in service and clinical care each and every day. The challenge then becomes how we identify im-provement initiatives, and introduce or change behaviors that will allow us to step up our level of service in a way that’s easily adopted, under-stood and integrated into the everyday routines the associates impacted.

Q: How would you recommend over-coming these challenges?

Ms. breitfelder: First, you have to stay fo-cused and keep an eye on your scores. Look at them weekly, if not more often. And I think you need to share the scores with all of your em-ployees. Keep it transparent. Communication is key, and so is keeping your front-line employees engaged through celebrating successes not only at the hospital level but also at the unit level.

Ms. broms: It is really important that health-care organizations take out processes that do not add value. Being creative in terms of new processes so as to keep patient satisfaction high is essential. We use the patient experience as a lit-mus test. If we are going to make change and if we quantify that it will result in a negative patient experience then we don’t implement that change until we have a found a way to mitigate the nega-tive patient experience, even if it is something that might save us money.

Q: What advice do you have for health-care organizations trying to improve patient experience?

Ms. breitfelder: One of the easiest things you can do is talk to hospitals with great scores. See what works for them and what you can incor-porate into your own organization. The support needs to start at the C-suite level to improve pa-tient experience. Then you need to set expecta-tions for your facility and communicate the same message to everyone. When you do roll out pro-cess changes, you need to keep an eye out for consistency and continue to get employee input. At Columbus Regional, we have a value system put into place called ACE IT, which stands for attitude, commitment, enthusiasm, innovation and teamwork. We tell our employees the im-portance of ACEing IT every day.

Jonathan goble, CEo, Iu Health north Hospital (Carmel, Ind.): Organizations should stop focusing on the patient survey num-bers and genuinely focus on the corporate culture of their staff because doing so fosters a sense of respect and value from the organization. When the staff feels respected and valued by their or-ganization, they respect and value the patient. n

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17Special Focus: Infection Prevention & Hand Hygiene

The Secret to Better Infection Control Compliance: Move Beyond Secret ShoppersBy Sabrina Rodak

When North Shore University Hospi-tal in Manhasset, N.Y. increased its hand hygiene compliance rate in an

intensive care unit from less than 10 percent to more than 85 percent in less than four weeks and maintained that rate for three years, it knew it hit upon something big: It had discovered a superior way to monitor and improve infection control compliance.

The importance of monitoringMonitoring physicians’ and staff ’s adherence to infection control guidelines is crucial for prevent-ing infections and ensuring patient safety. Surveil-lance also helps leaders identify barriers to non-compliance. Donna Armellino, vice president of infection prevention at Great Neck, N.Y.-based North Shore-Long Island Jewish Health System, says when monitors identify failures to adhere to infection control policies, it is crucial to have dis-cussions with the individuals involved.

“You can’t just make the assumption that the individual is deliberately not performing or disregarding protocols. Sometimes there’s a re-straint in the environment that prohibits staff from performing the action desired. By talking to the individual, you can identify and remove barriers,” she says. For example, she says a staff member may not comply with hand hygiene standards because the type of hand soap causes irritation to the staff member’s skin.

Why secret shoppers aren’t so secretThere are several ways to monitor infection con-trol compliance, including reviewing charts, in-vestigating cases and openly or secretly observ-ing behaviors. “Secret shoppers” — individuals who pose as patients or colleagues in order to monitor staff behaviors — are used to deter-mine staff ’s true compliance rate, not a rate that is artificially increased due to an awareness of being watched. Unfortunately, this technique has several flaws, the first of which is that secret shoppers aren’t secret for long.

“With secret shoppers, sooner or later the indi-viduals being observed recognize the secret, so [the monitors] are no longer undercover,” Ms. Armellino says. Consequently, the compliance rate that is recorded does not reflect the average compliance rate when staff are not observed. Direct observation typically has the same effect

on compliance rates, but without the pretense of being secret. For example, NSUH used direct observation to determine hand hygiene adher-ence levels in 2008; this method yielded an ad-herence rate of 60 percent. When the hospital used an objective monitoring system that pro-vided constant observation and feedback, how-ever, it found the rate to be less than 10 percent.

NSUH’s surveillance experienceNSUH, part of North Shore-LIJ Health System, participated in a study (which was later published in Clinical Infectious Diseases) to determine the ef-fect of a new monitoring system on hand hygiene compliance in its 17-bed ICU. The ICU imple-mented remote video auditing, in which video cameras placed in a room record behavior 24/7 and send information to third-party auditors, who determine compliance to a standard. The compli-ance data is then sent to an electronic scoreboard.

In NSUH’s case, the cameras were set up to view every sink and hand sanitizer dispenser in the ICU, and the auditors monitored for hand hygiene compliance. From a baseline of less than 10 percent in 2008, the ICU increased its compliance to more than 85 percent in 2010 and sustained that rate over time. The hospital attributed its success largely to the remote video auditing system, which provided continuous monitoring and real-time feedback to leaders and employees.

Expanding infection control compliance surveillanceNow, NSUH has expanded the RVA system to monitor adherence to personal protective equip-ment protocols in its isolation rooms. Personal protective equipment are barriers to prevent the spread of bacteria between patients and health-care staff, and include gowns, gloves, masks and respirators. In addition, the hospital has implemented RVA in a pilot program to monitor processes in the operating room, such as room turnover times, sterilization and “time outs” — a discussion among members of the OR team im-mediately preceding the surgery to ensure safety.

Feedback spurs improvementOne of the drivers of hand hygiene compliance improvement at NSUH was constant feedback visually displayed in the unit. An electronic scoreboard showed the current shift’s compli-

ance rate, which motivated staff to improve. The compliance rate was reported in aggregate as opposed to individually to avoid an associa-tion of punishment with the compliance effort. “You can get people to rally around achieving excellence by highlighting success stories and not signaling out failures,” says Adam Aronson, CEO of Arrowsight, which supplies the RVA technology.

In addition to displaying the rate of compliance, NSUH posted positive messages for high com-pliance rates, such as “Great shift!” or “Keep it up!” according to Mr. Aronson. These positive reinforcements helped motivate staff to per-form at the highest level.

Donna Armellino

Adam Aronson

18 Special Focus: Infection Prevention & Hand Hygiene

Communicate with employees to gain buy-inWhile visual, constant feedback on performance can spur improvement, hospital leaders first need to gain buy-in for the technology. “It’s not the kind of program you can install and it will magically work,” Mr. Aronson says. “There’s a fair amount of work that needs to be done at all lead-ership levels to get staff to embrace it and not be highly suspicious and dismissive of it,” he says.

Explaining what the technology does and why the hospital chose it can ease concerns and suspicions. Emphasizing that the technol-ogy is a tool to improve patient care and that it is an objective measure of performance is also effective in gaining buy-in. “The message should be, ‘We’re in this business to do the very best we can, and we’re going to be able to use this tool to collect data to highlight how terrifically we can perform and give us recog-

nition that no one can question,’” Mr. Aron-son says.

Why leaders should careAccurate infection control surveillance is criti-cal for making real improvements in quality care and patient safety. Hospital leaders need to care-fully consider their monitoring methods to en-sure providers are compliant and performing at the top of their ability. n

13 Practical Steps to Prevent HAIsBy Sabrina Rodak

Public and private sector healthcare-as-sociated infection prevention partners discussed ways to enhance the HAI data

supply chain — collecting, reporting and analyz-ing HAI data — at HHS’ 2012 HAI Data Sum-mit May 30-31 in Kansas City, Mo.

HHS released a report, “HAI Data Summit Summary,” which describes the proceedings of the summit, including participants’ ideas of practical steps to meet common goals in the HAI Action Plan, which is designed to prevent and ultimately eliminate HAIs:

Relationships and communication1. HHS should hold regular meetings to “clarify the vision of the HAI Action Plan, discuss HAI measurement and provide ongoing training to [CDC National Healthcare Safety Network].”

2. Vendors should visit smaller facilities, espe-cially in rural areas, to determine their needs for reporting HAIs.

Common threads and standards3. Vendors should be engaged in “establishing NHSN data-sharing rules and definitions and incorporating them into their systems, as well as a certification process for EHR products.”

4. Hold forums for electronic health record vendors, data miners and infection prevention-ists to ensure vendor transparency and develop vendor-neutral standards.

5. HHS should establish a national standard for the number of IPs required per facility bed size.

Data sharing6. Amend regulations such as the Health Insur-ance Portability and Accountability Act to facili-tate data-sharing across different types of facili-ties and regional structures of care.

Reporting7. HHS should require hospital data in addition to aggregate data to be reported.

8. Reports of data should be clear and accessible to consumers.

9. HHS should consider different formats of data for different audiences, such as consumers and providers.

Resources10. Funding and expertise for sustaining the HAI Action Plan should be channeled through state health departments.

11. Provide guidance to facility administrators on the level of resources needed by IP programs to meet mandates.

Education12. Provide education and training to states to support their efforts to prevent and reduce HAIs.

13. Provide education to health professionals and the public on preventing, recognizing and treating or caring for HAIs. n

Study: Hand Hygiene Poster Increased Likelihood of Washing HandsBy Sabrina Rodak

A hand hygiene poster increased the likeli-hood men would wash their hands, ac-cording to a study in Human Communica-

tion Research.

Researchers studied the hand washing behavior of 252 men aged 18 to 62 who used a men’s restroom at a large college campus in the Mid-western U.S. Researchers assessed the effect of different posters on participants’ hand washing. The poster depicted five male college students in a restroom facing a urinal with one of two descriptive norms — that four of every five college students (high-prevalence) or one of every five college students (low-prevalence) wash(es) their hands every time they use the bathroom.

Data showed that 70 percent of participants in the control group, in which no poster was pres-ent, washed their hands, compared to 88 percent of participants in the low-prevalence group and 81 percent of the high-prevalence group. The difference in hand washing rates between the low-prevalence and high-prevalence groups was not significant, suggesting that the mere pres-ence of a poster about hand washing increased the likelihood of hand washing, according to the authors. n

Chris Van Gorder

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clinicalquality

19Reducing Readmissions

The readmission rates in hospitals across the U.S. have not changed significantly from 2008 to 2010, according to a report from the Robert Wood Johnson Foundation based on data from the Dart-

mouth Atlas Project.

The report, “The Revolving Door: A Report on U.S. Hospital Readmis-sions,” includes new data from the Dartmouth Atlas Project as well as interviews conducted by PerryUndem Research & Communication with patients, caregivers and healthcare providers.

The Dartmouth Atlas Project examined readmission data for Medicare beneficiaries in 306 Dartmouth Atlas hospital referral regions from 2008 to 2010. Researchers looked at five categories of readmissions: all medi-cal discharges, all surgical discharges and discharges for acute myocardial infarction, congestive heart failure and pneumonia.

The researchers made several important findings. First, the rate of readmis-sions has not improved significantly from 2008 to 2010 in most regions and hospitals. Only six of 92 academic medical centers studied had statistically significant changes in 30-day readmission rates for medical discharges, and only seven academic medical centers had statistically significant changes in 30-day readmission rates after surgery; in both groups, at least one hospi-tal’s readmission rates increased.

Secondly, readmission rates vary widely across geographic regions. For ex-ample, the readmission rate following medical discharges in 2010 ranged from a low of 11.4 percent in Ogden, Utah, to 18.1 percent in Bronx, N.Y. Similarly, for surgery discharges, the 30-day readmission rate varied from 7.6 percent in Bend, Ore., to 18.3 percent in Bronx, N.Y. n

Report: U.S. Made Little Progress on Readmission Rates 2008-2010By Sabrina Rodak

Study: Income Inequality Linked to Higher ReadmissionsBy Sabrina Rodak

U.S. states with the highest income inequality have an estimated 40,000 extra readmissions than states with the lowest income in-equality, according to a study in the British Medical Journal.

Researchers examined the association between income inequality, measured by the Gini coefficient, and the risk of mortality and readmission within 30 days post-hospital admission and discharge, respectively. Researchers stud-ied Medicare patients in the U.S. hospitalized in 2006 to 2008 with a prin-cipal diagnosis of acute myocardial infarction, heart failure or pneumonia.

The risk of readmission for all three diagnoses was greater in states in the three highest quarters of income inequality compared with states in the lowest quarter. The authors estimated that from 2006 through 2008, there were an additional 7,153 readmissions for acute myocardial infarc-tion; 17,991 readmissions for heart failure; and 14,127 readmissions for pneumonia associated with income inequality in states in the three highest quarters of income equality compared with states in the lowest quarter.

However, the risk of mortality within 30 days of hospital admission did not differ between states based on income inequality. n

Avoidable Readmissions by Numbers: 8 StatisticsBy Molly Gamble

Potentially avoidable readmissions make up 10 percent to 14 per-cent of all admissions for most hospitals, or roughly 45 percent of them, according to Objective Health. Here are seven more statis-

tics on the associated costs of avoidable hospital readmissions.

1. Based on 220 hospitals in 2011, the average avoidable readmission rate in the United States was 12.6 percent.

2. Potentially avoidable readmissions equated to $9.5 million in annual at-risk profit for an average 300-based hospital in 2011.

3. The most common conditions for avoidable readmissions are:

• Congestive Heart Failure (30 percent)

• Bacterial Pneumonia (24 percent)

• COPD or Asthma in Older Adults (13 percent)

• Urinary Tract Infection (10 percent) and

• Diabetes with Short-term Complications (9 percent). n

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and best practices on operating room clinical quality, safety, infection control and accreditation.

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Palliative Care: Why It Has Become a Growing Specialty Within HospitalsBy Bob Herman

There are few certainties in healthcare, but one is that hospitals will generally be facing an increasingly older population. And with age comes more chronically and severely ill patients.

According to statistics from the federal government, the number of people in the United States who will be older than 85 by 2030 is expected to dou-ble to 8.5 million. To complicate matters for hospitals, most of those older, critically ill patients will be in hospitals, as nearly all Medicare beneficiaries spend at least some time in a hospital during their last year of life. In fact, about 27 percent of Medicare dollars are spent on patients in their last year of life, and roughly 25 percent to 32 percent of patients die in hospitals.

This is a large responsibility for today’s hospitals and health systems, and will be an even bigger issue in the future. Diane Meier, MD, director of the Center to Advance Palliative Care, the national authority on palliative care programs in U.S. hospitals, says hospital executives need to recognize that only 5 percent of their patients drive 50 percent of all spending. Many within this highly concentrated group of people need some type of care management, and within that, palliative care could play a huge role.

“As we move away from fee-for-service and toward capitation, global bud-get and population management strategies, the business model requires management of that 5 percent,” Dr. Meier says. “If you can’t manage that 5 percent, you will go under financially. They drive so much of the spend-ing and are such big users of the healthcare system.”

Palliative care — what it is and is notPalliative care is still a relatively new movement, considering the long his-tory of healthcare. Jim Risser, MD, medical director and head of palliative care at St. Paul, Minn.-based Regions Hospital, says the specialty has really galvanized in the past five to 10 years, and the actual definition of palliative care revolves around the comforts and desires of the patient.

More specifically, he says palliative care is a service carried out by a multi-disciplinary team to help patients who have advanced, though not neces-sarily imminently terminal, illnesses such as cancer, congestive heart failure and Alzheimer’s disease. A hospital with a palliative care program gives those types of patients various patient- and family-centered options to help cope with the serious illness, and usually there is a major emphasis on pain management, advanced care planning and the patient’s quality of life. The palliative care team is made up of its core members — physicians, nurse practitioners, social workers and chaplains — and incorporates other dis-ciplines like pharmacy, nutrition, ethics, hospice and complementary care as deemed necessary.

Dr. Risser has been at Regions Hospital, part of HealthPartners, for several years, and in October 2011, Regions became one of the first hospitals to have its palliative care program certified by The Joint Commission. He has seen his hospital’s program grow over the past eight years, and he says it’s vital to not confuse palliative care with hospice care.

“We continue to challenge these notions that our patients are dealing with end-of-life issues in the immediate future,” Dr. Risser says. “That situation is more consistent with a hospice-type of care. I think a lot of times we get lumped into the hospice movement — and we share a lot of the phi-losophies, such as spending a lot of time with the patient and making them more comfortable — but palliative care is farther upstream than hospice. With palliative care, if you want to pursue more aggressive medical proce-dures, let’s sit down and describe the benefits and burdens.”

In addition, he says it is a misconception that palliative care teams are “agenda-driven” or try to limit care to people. “From personal experience, that is just not what we do,” Dr. Risser says.

A typical day for the Regions Hospital palliative care team involves morn-ing rounds on the patient census. The team goes through their patients and discusses each patient’s needs — medical, social, spiritual. From there, the team will go see patients as a group (if time permits, individually if not) to get a sense of what care should be coordinated and what the patient and family want.

Joe Contreras, MD, chairman of the Pain & Palliative Medicine Institute at Hackensack (N.J.) University Medical Center, agrees with Dr. Risser. Dr. Contreras helped HackensackUMC become the first Joint Commission-certified palliative care program in New Jersey in January, and he says pal-liative care in hospitals is not synonymous with hospice, nor is it a care-lim-iting panel. Further, palliative care is not just about dissecting the situation of a disease or illness. It’s about providing quality care and symptom man-agement along with all other treatment measures, whether aggressive or comfort-based.

“It is important to understand palliative care is very different from other subspecialties of medicine. It is person-based and not disease- or organ-system-based,” Dr. Contreras says. “It’s a new paradigm for hospitals be-cause we [palliative care specialists] are of the mind-body-spirit approach. We are not being asked to remove an organ or consult because the kidney is not functioning well. We’re being called in because we are trying to improve an ill person’s quality of life and address their suffering.”

The case for palliative careDr. Meier has led the Center to Advance Palliative Care since the late 1990s, when it started as a program of the Robert Wood Johnson Foundation. Dr. Meier, who also founded (and until 2011) served as director of the Hertzberg Palliative Care Institute at The Mount Sinai Hospital in New York City, says palliative care has gained traction in the hospital arena for a couple reasons.

First, many patients who had suffered severe and chronic illnesses had looked for alternative ways to treat their pain and better manage symptoms and daily care needs at home, but hospitals and health systems have not always offered an alternative. Instead, hospitals may have focused their ef-forts on what they can do immediately in the acute-care setting.

As mentioned earlier, Medicare and healthcare costs rise significantly for those who are older and for those who suffer severe and chronic illnesses in the acute-care environment, and that is another major reason why pal-liative care has grown. Dr. Meier believes palliative care has caught on at hospitals and health systems because there is “so much excess spending on the acute-care side.”

In fact, Dr. Meier and CAPC officials say patient-centric palliative care — through improving quality of care and person-driven care — can actually save hospitals and the healthcare system money in the long run due to shorter length of stay or lower costs per day. For example, in a given hos-pital with 20,000 to 30,000 admissions per year, roughly 2 percent end in death. Dr. Meier says if roughly four or five times that number are com-plex cases that are vulnerable to readmission, roughly 8 to 10 percent of patients may have palliative care needs and can be more effectively treated in a more appropriate setting.


Dr. Meier adds that as CMS’ Value-Based Purchasing program continues to emphasize quality metrics and patient satisfaction measures, palliative care becomes a natural offshoot.

However, Dr. Contreras of HackensackUMC says hospitals that invest in palliative care programs today must keep the specialty’s goal in mind: to put patients’ wants and needs first and to guide them through comfortable care coordination. The result could lead to improved clinical outcomes, the eas-ing of burdens on staff, increased retention, increased peace of mind for patients and their families, and finally, improved resource utilization.

“When starting palliative care, you make the argument that you’re improv-ing patient satisfaction, improving quality of care, improving bedside care and then discuss, by the way, there might better resource allocation as well,” Dr. Contreras says.

Overall, the number of hospitals with palliative care programs has risen rap-idly over the years. The Joint Commission’s Advanced Certification Program for Palliative Care, which Dr. Risser and Dr. Contreras have gone through at both of their hospitals, started in September 2011 and is growing.

Dr. Meier says the number of hospitals that have recorded the presence of a palliative care team has more than tripled over 10 years. In 2000, roughly 500 hospitals had a palliative care program, and in 2011, that number bal-looned to more than 1,900. Palliative care programs also tend to be more common in larger, tertiary care hospitals, whereas smaller rural hospitals and some safety-net facilities are late adopters, Dr. Meier says.

How to formulate the right programBecause palliative care is still growing as a patient specialty — and involves several challenges — building the right program takes a lot of continuous effort and attention. Here are four basic steps any hospital leader must con-sider before the organization starts a palliative care program.

Identify a palliative care champion. Dr. Contreras says every hos-pital-based palliative care program needs a leader who has experience in understanding how a multidisciplinary palliative care program functions.

Dr. Risser adds that at Regions Hospital, hospitalists were the largest cham-pions of palliative care, and they led the charge to become a “transdisci-plinary” team, as well as multidisciplinary.

“Transdisciplinary is the fact that any given practitioner does not stay en-tirely within the bounds of his or her title, and there is a sharing of respon-sibility,” Dr. Risser says. “Physicians may end up doing some spiritual triage, and chaplains may sit in on care coordination. That is really part and parcel of a high-functioning team: sharing responsibility of getting the story of the patient and getting a care plan that makes sense for that person.”

Assemble a committee and team to educate stakeholders. Af-ter a hospital is able to identify a palliative care leader or leaders, it must put together a committee to identify the appropriate stakeholders, Dr. Contre-ras says. Educating these stakeholders, leadership, patients and the com-munity at large about what palliative care services provide is essential to get a program off the ground.

“Education is a big part of this,” Dr. Contreras says. “Palliative care is a service that works in concert with integrated patient care at any level, in harmony with what the patient wants and what the doctor believes the treatment plan should be. It’s about respecting the values of patients and guiding them through what can be a very daunting process.”

Expand palliative care to home settings. When hospitals are able to craft their palliative care programs within their walls, they must be able to reach out to their patients who can be more effectively and safely cared for at home, Dr. Meier says. Instead of a patient calling for 911 or asking a relative to take them to the hospital, the hospital or health system should dispatch a palliative care team member to the home. Palliative care will

eventually expand to become a home-based model, Dr. Meier says, and hos-pitals that practice patient-centered medical homes and accountable care organizations are on the right track.

“Transition planning recognizes the needs of patients, families and the community. We need to improve capacity and flow and make beds avail-able for people who really need to be in the hospital, like those who need a bone marrow transplant or an operation,” Dr. Meier says. “The home is much better for most patients with multiple and complex conditions or any serious illness, who are usually more vulnerable, older people. Hospitals are the worst places for them because it increases the risks of hospital-acquired infection, mortality and other adverse-outcome measures.”

Focus on quality and certification. The Joint Commission and CAPC have become the main organizations to provide hospitals guidance on their palliative care endeavors. When it comes to establishing the right palliative care quality, Dr. Meier says NationalConsensusProject.org, a proj-ect of all major U.S. palliative care organizations, serves as a platform for hospitals to reach standardized quality guidelines, which is the next step for the movement.

“The next 10 years have to be about quality and standardization of guide-lines,” Dr. Meier says. “Just like you have a stroke program, you have to meet quality guidelines. We need to improve penetration and quality in the next 10 years, and we have to bring doctors on board.” n

Top 10 Most Common Sentinel Events By Sabrina Rodak In 2012, The Joint Commission reviewed a total of 901 sentinel events.

The 10 most common sentinel events reviewed by The Joint Commission in 2012 include the following:

1. Unintended retention of a foreign body

2. Wrong-patient, wrong-site, wrong-procedure

3. Delay in treatment

4. Suicide

5. Op/Post-op complication

6. Fall

7. Other unanticipated event (includes unexpected additional care/extend-ed care and psychological impact)

8. Criminal event

9. Medication error

10. Perinatal death/injury

The Joint Commission noted, “The reporting of most sentinel events to The Joint Commission is voluntary and represents only a small proportion of actual events. Therefore these data are not an epidemiologic data set and no conclusions should be drawn about the actual relative frequency of events or trends in events over time.” n


Top 58 Hospitals Patients Rated 9 or 10 in HCAHPSBy Sabrina Rodak

Here is a list of 58 non-specialty, acute-care hospitals with the highest percentage of pa-tients who rated their hospitals a nine or 10

on a zero-to-10 scale in the Hospital Consumer As-sessment of Healthcare Providers and Systems survey.

Note: The list is based on HCAHPS survey results re-ported in CMS’ Hospital Compare database and covers the period April 2011 through March 2012. HCAHPS allows patients to rate line items relating to their patient care experience. This particular metric covers “the per-cent of patients who gave their hospital a rating of 9 or 10 on a scale from 0 (lowest) to 10 (highest).” Some hospitals were excluded from this list for a variety of reasons, including but not limited to having fewer than 100 patients complete the HCAHPS survey. Surgical and specialty hospitals are not included on the list.

1. Patients’ Hospital of Redding (Calif.) — 95 percent

1. Bigfork (Minn.) Valley Hospital — 95 percent

3. Southwestern Regional Medical Center (Tulsa, Okla.) — 92 percent

4. Sacred Heart Hospital on the Gulf (Port Saint Joe, Fla.) — 91 percent

4. Mariners Hospital (Tavernier, Fla.) — 91 percent

4. Doctors Hospital at Deer Creek (Leesville, La.) — 91 percent

7. Stewart Memorial Community Hospital (Lake City, Iowa) — 90 percent

7. Ouachita Community Hospital (West Monroe, La.) — 90 percent

7. The Physicians Centre (Bryan, Texas) — 90 percent

10. Hughston Hospital (Columbus, Ga.) — 89 percent

10. Treasure Valley Hospital (Boise, Idaho) — 89 percent

10. Fairway Medical Center (Covington, La.) — 89 percent

10. Bellville (Texas) General Hospital — 89 percent

10. Texas Health Harris Methodist Hospital (Southlake) — 89 percent

10. W. J. Mangold Memorial Hospital (Lockney, Texas) — 89 percent

10. Columbia Center (Mequon, Wis.) — 89 percent

10. USMD Hospital at Fort Worth (Texas) — 89 percent

18. Indiana University Health North Hospital (Carmel) — 88 percent

18. Evendale Medical Center (Cincinnati) — 88 percent

18. Patewood Memorial Hosptal (Greenville, S.C.) — 88 percent

18. St. Luke’s Lakeside Hospital (The Woodlands, Texas) — 88 percent

22. Sutter Davis (Calif.) Hospital — 87 percent

22. Midwestern Regional Medical Center (Zion, Ill.) — 87 percent

22. Floyd Valley Hospital (Le Mars, Iowa) — 87 percent

22. Mercy Hospital (Moundridge, Kan.) — 87 percent

22. Ortonville (Minn.) Area Health Services — 87 percent

22. Franklin Woods Community Hospital (Johnson City, Tenn.) — 87 percent

22. University of Texas Health Science Center at Tyler — 87 percent

22. Whitman Hospital and Medical Center (Colfax, Wash.) — 87 percent

30. Via Christi Hospital on St. Teresa (Wichita, Kan.) — 86 percent

30. Westlake Regional Hospital (Columbia, Ky.) — 86 percent

30. Physicians Medical Center (Houma, La.) — 86 percent

30. Dublin (Ohio) Methodist Hospital — 86 percent

30. University Hospitals Conneaut (Ohio) — 86 percent

30. Magruder Memorial Hospital (Port Clinton, Ohio) — 86 percent

30. Choctaw Nation Health Care Center (Talihina, Okla.) — 86 percent

30. Mount Pleasant (S.C.) Hospital — 86 percent

30. Bear River Valley Hospital (Tremonton, Utah) — 86 percent

30. Orem (Utah) Community Hospital — 86 percent

30. Upland Hills Health (Dodgeville, Wis.) — 86 percent

30. Mountain View Regional Hospital (Casper, Wyo.) — 86 percent

42. St. Anthony Summit Medical Center (Frisco, Colo.) — 85 percentTO

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Advertising Index42. Medical Center of the Rockies (Loveland, Colo.) — 85 percent

42. Gibson Community Hospital (Gibson City, Ill.) — 85 percent

42. Richland Parish Hospital-Delhi (La.) — 85 percent

42. York (Maine) Hospital — 85 percent

42. New England Baptist Hospital (Boston) — 85 percent

42. United Hospital District (Blue Earth, Minn.) — 85 percent

42. Ohio Valley Medical Center (Springfield) — 85 percent

42. Henry County Hospital (Napoleon, Ohio) — 85 percent

42. Chickasaw Nation Medical Center (Ada, Okla.) — 85 percent

42. Hill Country Memorial Hospital (Fredericksburg, Texas) — 85 percent

42. East Texas Medical Center Gilmer (Texas) — 85 percent

42. Park City (Utah) Medical Center — 85 percent

42. St. Mary’s Hospital (Madison, Wis.) — 85 percent

42. Our Lady of Victory Hospital (Stanley, Wis.) — 85 percent

42. Memorial Hospital Lafayette City (Darlington, Wis.) — 85 percent

42. Black River Memorial Hospital (Black River Falls, Wis.) — 85 percent n

REGISTER TODAY!11th Annual orthopedic, Spine and

Pain Management-drive ASC ConferenceJune 13-15, 2013

in ChicagoFeaturing keynote speakers Mike Krzyzewski (Coach K), Geoff Colvin,

Brad Gilbert, Forrest Sawyer and more than 135 speakers.

For more information visit www.beckersspine.com.

Note: Ad page number(s) given in parentheses beutlich Pharmaceuticals, llC. [email protected] / www.beutlich.com / (800) 248-8542 (p. 11)

Clorox. www.cloroxhealthcare.com / (800)234-7700 (p. 5)

ImageFIRSt Healthcare laundry Specialists. [email protected] / www.imagefirstmedical.com / (800) 932-7472 (p. 9)

Palmero Healthcare. [email protected] / www.palmerohealth.com / (800) 344-6424 (p. 4)

Purthread technologies Inc. www.purthread.com/bcqic / (800) 673-5939 (backcover)

Special Pathogens laboratory, Inc. [email protected] / www.specialpathogenslab.com / 877-775-7284 (p. 7)

Steril-Aire. [email protected] /steril-aire.com/WCHOB.htm / (800) 278-3745 (p. 3)

Surgical directions. [email protected] / www.surgicaldirections.com / (312) 870-5600 (p. 2)

www.purthread.com/bcqic

1.7 million HAIs annually1 99,000 deaths2

Introducing PurThreadTM Antimicrobial Textiles.PurThread’s fabrics continuously protect privacy curtains, scrubs, lab coats and other soft surfaces against bioburden. As part of a multifaceted infection control strategy, protected fabrics can help increase profitability and reduce risk as they enhance patient and staff safety. Learn how at purthread.com/bcqic.

1,2,3,4,5 References available at purthread.com/references/

Klebsiella Pneumoniae

Acinetobacter

Staph Aureus

Escherichia Coli

HAIs KILL MORE AMERICANS

than AIDS, car accidents and

breast cancer combined3

$28-45 billion in annual hospital costs4 You won’t feel the difference.

But the pathogens surely will.

the u.s. health disadvantage: clinical quality & infection ......the danger is not just on your...

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