Current status: Archaic tools and an over-reliance on EHRs for quality data
Co-authored by Justin Wolinski at Readiness Rounds
The typical hospital is making approximately 400,000 quality observations a year. It’s important to note that I am referring to data that is not pulled from the electronic health record (EHR). The EHR is unable to effectively collect and aggregate data such as observations of safety and compliance of the physical environment, evaluation of staff knowledge on hospital policy/emergency response, the gathering of patient feedback relating to their experience while they are still within the continuum of care, or measurements of evidence-based guideline adherence during the performance of routine hospital procedures.
The 400,000 quality observations I mentioned above are happening (or should be if they are not) in many different areas of the hospital, among various departments and disciplines. The Pharmacy is checking the compliance of the storage of medication; the Environment of Care team is making sure the physical environment is compliant and safe; Leadership is rounding for patient experience purposes; the Quality department is conducting tracers; Infection Control is examining processes around CAUTI, CLABSI, High Level Disinfection etc.; and Nurse Managers are conducting Open Medical Record reviews. With only these few examples, you can see that most hospitals are amassing an incredible amount of potential performance improvement (PI) data!
But, the common theme throughout is “data rich, information poor” as the data is oftentimes not available for review and discussion. More often than not, this is due to:
Manual data collection
Paper checklist and manual follow up. This process has proven to be inefficient and leaves an incredible amount of room for mistakes due to inter-reviewer reliability and the probability of leaving issues unresolved.
Data manually aggregated
Like the manual data collection, the manual aggregation of data is inefficient, open to human error, and substantially difficult in consistently showing the data for PI. Hospital staff, including those at the director-level, are spending hours upon hours developing and inputting data into spreadsheets every month.
Data viewed in a silo
All the aforementioned departments that are collecting this data are only seeing quality from their perspective. It is difficult, if not impossible, for executive leadership to have a concise global summary of quality and accreditation data.
Not used for PI or data is not usable for PI
Oftentimes, rounds are done just for documentation and finding issues and by using archaic means of collecting and aggregating the data, hospitals are finding that their reports are not very usable for PI efforts. While documentation and finding issues are critical, hospitals are missing a gigantic learning opportunity.
Most hospitals don’t proactively check as much or as thoroughly as they should on a routine basis unless TJC, CMS, etc., is expected. Reasons often heard include being understaffed, lack of efficiency tools, confusion surrounding accountability and responsibility, and a lack of leadership support.
- Example: Pharmacy thinks storage of medication outside of the pharmacy is nursing’s responsibility, nursing thinks its pharmacy. Rounds aren’t conducted and patients are exposed to potential medication safety risks, leaving the hospital open to negative regulatory findings and liability risk.
- Executive Leadership rounds are not done by the C-Suite consistently and are done on the back of a napkin. This is a missed opportunity to collect crucial PI data, as they wait for the hospital’s HCAHPS score to see what they should have known and taken action on months before.
- Front-line staff only sees executive leadership on their units when something is wrong (Hawthorn Effect), which demonstrates a lack of executive support and involvement and overall prolongs the transition to a culture of safety.
Why do hospitals need to upgrade to digitally-based tools for quality observation data collection?
As many other industries have already determined, moving past archaic and inefficient processes and becoming a digital enterprise has numerous benefits. Specifically switching to a single digital High Reliability rounding platform to collect all of your organization’s quality observations offers numerous benefits:
Streamlines effort to collect and aggregate data
Creates capacity (less time spent by staff on rounding and creating reports), reduces likelihood of human error in closing the loop on issues and manual report creation.
Takes the noise out of prioritizing PI projects and leadership can quickly determine if PI projects are having the desired effect
- “What are our challenges as health system? As a hospital? On each unit? What TJC/CMS regulations do we struggle with the most?”
- “Did that education initiative we started four months ago fix our poor hand hygiene performance?” All of these questions can be answered with the implementation and proper use of the right tool.
When used for PI, digitally-based tools allow for regulatory compliance to become a byproduct of proactive checking
Your hospital will continuously be survey ready!
High reliability actually becomes feasible
A robust, enterprise wide, digital high reliability-focused rounding platform allows you to measure quality and safety data, allowing leadership to continually improve and sustain performance in real time. Waiting for old, reactive, less relevant data from the Leapfrog Group or HCAHPS will become a thing of the past.
A worthy evaluation
A hospital wanting to improve the safety and care of its patients, eliminate inefficient and wasteful processes, mitigate risk, and improve patient experience would be well-served to explore options to move to a platform as described. Enterprise health systems have hundreds or thousands of applications that work together or, in the worst, case don’t work together. As we progress down the path of having data and information everywhere, how can we use the data to provide the best quality of care for the patient? This is the challenge that we are all facing. What is your solution to this problem?
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