1 why quality & patient safety matter to your ob/gyn practice: now and in the future albert l....
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Why Quality & Patient Safety Matter to Your OB/GYN
Practice: Now and in the Future
Albert L. Strunk, JD, MD, FACOGDeputy Executive Vice-President &
Vice-President, Fellowship ActivitiesAmerican Congress of Obstetricians and Gynecologists
MGMA, April 22, 2012
Learning Objectives
Describe how quality measure and outcomes will be important for physician compensation in the future.
Determine whether the Office Patient Safety Assessment (OPSA), a voluntary self-assessment, is right for your practice.
Examine ACOG’s Safety Certification for Outpatient Practice Excellence (SCOPE) program for defining quality and safety indicators for women’s health care in the office setting.
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A Business Case for Quality?
High quality care costs less
“It is possible to improve care and dramatically lower costs.” Don Berwick: Annals of Internal Medicine, Feb 1998
Costs are reduced through:
Standardization of the processes of care
Elimination of “waste”
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OB/GYN Offices and Quality
Quality = improvement in measurable outcomes
Value = desired outcomes at reduced cost
Reduced cost = elimination of “waste”
Improved outcomes = evidence based medicine
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OB/GYN Offices and Quality
OB/GYN Offices must demonstrate to purchasers and
health plans that they can deliver improved outcomes at
reduced cost by the application of process improvement
tools and evidence-based medicine to everyday practice
at the point of care to reduce unexplained clinical
variation.
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Evolving Applications of Measurement
Passive Monitoring
Incentives for High Performance
Tiering Preferred Providers
“Never” Events/No Payment
Required Ongoing Practice Evaluation
Reduced Reimbursement
Active Quality Improvement and Accountability
Public Reporting
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What is the greatest “enemy” of quality?
Unexplained
Clinical
Variation
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Unexplained Clinical Variation
Necessary Clinical Variation
Necessary variation in medical practice is that which is required to adjust to the differing needs of individual patients
Unexplained Clinical Variation
Differences in medical care and patient management that are not accounted for by differences in patient symptoms or objective findings
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Sources of Unexplained Variation
Lack of valid clinical knowledge Poor evidence
Reliance on subjective judgment Enthusiasm for unproven methods If it might work, do it… Quality = Spare no expense Human error Complexity
“The complexity of modern American medicine exceeds the capacity of the unaided human mind”
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Probability of a Complex System Performing Perfectly: Just do the math…*
# o
f st
eps
100
40
1
25
0.6%
12%
95%
28%
37%
66%
99%
78%
90%
96%
99.9%
97.5%
99%
99.5%
99.99%
99.7%
95% 99% 99.9% 99.99%
Probability of success, each step:
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Driving Value
Reducing quality waste and efficiency waste
Analyze the process of care
Develop change ideas
Implement change ideas and measure results in successive PDSA cycles
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Who does ‘quality and safety’ well?
Highly complex and technologically hazardous systems which operate essentially without mishaps over long periods of time
The potential for catastrophic accidents is great and consequences severe
Repetitive tasks are performed thousands of times with a very low-error rate
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Characteristics of High Reliability Organizations
Safety-oriented culture
Operations are a team effort
Communications are highly valued and rewarded
Emergencies are rehearsed & the unexpected practiced
“Top brass” devotes appropriate resources to safety training
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Adapting HRO Characteristics to Health Care Organizations:
Effective communication
Time-outs
Awareness of technology
Flattening hierarchy
Stop the line
Teamwork
Drills and simulations
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WHO Surgical Checklist
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ACOG’s
Office Surgery
Checklist
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Office Patient Safety Assessment(OPSA)
An opportunity for members to evaluate the quality and safety of the care they are providing for their patients.
Voluntary self-assessment for ACOG members regarding safety in their own outpatient practices.
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OPSA Results Approximately 80 responses received for 2010 Still available to members to complete Analyzing 2011 responses now. Participants receive:
Customized report of practice responses, with comparisons to national results
Recommendations for improving care with reference to ACOG and non-ACOG resources
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OPSA National Results Areas for possible improvement
Granting of surgical privileges and monitoring competency (41% compliance)
Quarterly drills for emergency response to untoward events (39% compliance)
Logging of dispensed medication samples (43% compliance)
Tracking whether patients referred to other physicians were actually seen and a report received (43% compliance)
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ACOG SCOPE: ACOG ahead of the group!
1/9/2012 AMA “widespread patient safety problems in ambulatory care such as incorrect prescribing, misdiagnosis, and poor communication”
NQF action to expand its serious-reportable events list to cover office-based settings
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Safety Certification for Outpatient Practice Excellence
Key goals of the SCOPE Program:
Promote the highest quality of women’s health care
Provide a trusted solution to meet the external demand for quality and safety activities
Reduce redundant review programs for physicians and offices
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Developed to evaluate and certify high-quality, safe women's health care processes in the outpatient setting.
NOT JUST FOR outpatient surgery! ANY women’s health office setting.
Two‐step process: Application with data submitted and Site Review to document Quality and safety measures in practice
Safety Certification for Outpatient Practice Excellence
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Application: Demographics Office management and administration Documentation and reporting Medication Safety Office surgical procedures/ procedures Equipment Quality Improvement Modules Simulations and DRILLS
Safety Certification for Outpatient Practice Excellence
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Office Management & Administration Does the practice have a designated medical director
for patient safety issues?
Is formal education, training, licensure, and board certification of staff verified?
Is there a system in place to allow staff to report if they observe potentially unsafe practices?
Upon arrival to the office, do office staff verify two patient identifiers (i.e. patient name and date of birth) for each patient?
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Documentation & Reporting
Is there is an electronic health record system?
Are referrals to health care providers tracked?
Is there a system for documenting all incoming patient phone calls (and emails, if applicable) and responses?
Is there documentation of depression screening?
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Office Surgical Procedures and Emergencies
Are written preoperative and post-operative instructions provided and discussed?
When a procedure is performed, is a checklist used that includes a time out
Do staff and providers conduct quarterly drills on emergency response to untoward events that may happen during a procedure and log these drills?
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On-Site Validation
SCOPE reviewer will validate the procedures and programs described in the application
Provide on site education in patient safety as needed by the individual practice
SCOPE reviewer will make a recommendation regarding certification
ACOG SCOPE staff will decide to award certification using: information from application and visit
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Lessons Learned
We have variable policies and procedures
We don’t have standard credentialing/proctoring practices
We don’t have standard “emergency” kits or plans (with or without surgeries in office)
We need drills and simulations for the office
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What’s in store? Certification will be: approved, pending, or deferred
after completion for 3 years (5 years when completed two 3 year cycles)
Ongoing yearly data collection, limited but benchmarked Reported in Obstetrics & Gynecology Sharing of BEST PRACTICES (skills lab, drills, etc.) Letter for negotiations with malpractice and health
insurers Interface with MOC IV for patient satisfaction surveys
or other reporting Seal for use in materials/ marketing 31
Pilot Site Comments
“Process made a difference” (universal)
“Identified KEY areas of safety the office was not attending to”
“IT WAS FUN!”
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For more information on ACOG’s Women’s Health SCOPE Program, please visit
www.scopeforwomenshealth.org
SCOPE listserv: monthly updates about the progress of the SCOPE program
http://suse.acog.org/mailman/listinfo/scope
202-863-2482
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