clarion group 6 presentation 3
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BRANFORD MEDICAL CENTERCASE EVALUATION
Katie Faella Matt Morrisette
Joe Gandy Christine Cameron
ACME Health Care Consulting, LLC
How it all began…
Jason Prescott-Passed away at age 35
secondary to a MVA September 25, 2010
-Toxicology screen was + for alcohol & narcotics
PmHx: Chronic neck, low back, and shoulder pain following a
motorcycle accident at age 25High volume of narcotics for
chronic pain were prescribed by physician at Branford Medical Center
More pain…
Mary Backus-Passed away at age 40
secondary to an accidental prescription overdose at the end of July, 2010
-Toxicology screen was positive + for narcotics and benzodiazepines
PmHx:-Severe anxiety and chronic
low back pain- High volume of prescriptions
written by physician at Branford Medical Center
“No snowflake in an avalanche ever feels responsible.”
-George Burns
“In recent years, prescription drug poisoning has surpassed automobile accidents as the leading cause of unintentional injury death among people between the ages of 35 and 54...”
http://www.aboutlawsuits.com/fentanyl-overdose-wrongful-death-lawsuit-15551/
“In 2007, there were 38,371 drug overdose deaths reported in the U.S., outnumbering gun and alcohol-related deaths.”
http://www.aboutlawsuits.com/pill-mill-verdict-16012/
“…There was 65% increase in prescription drug overdoses between 1999 and 2005, commonly involving overdoses of morphone, OxyContin, and fentanyl.”
http://www.aboutlawsuits.com/fentanyl-overdose-wrongful-death-lawsuit-15551/
Overview of catalysts for these outcomes:
Root Cause Analysis
Overview of catalysts for these outcomes:
Deaths of Jason
Prescott and Mary Backus
Recommendations
Plan of Action
Unhealthy Work Environment
http://mentalselfhelp.net/blog/wp-content/uploads/2010/10/anger_2.jpg
Changing the Health System Culture
http://www.ismp.org/newsletters/acutecare/articles/20040325.asp
Changing the Health System Culture
http://www.ismp.org/newsletters/acutecare/articles/20040325.asp
Employee Implementation
-Collaborative Skills for Teams
Goals of program: Create more effective team performance Reconcile differences in team member personalities Reduce team conflict Reduce miscommunication Give meetings a purpose Manage time efficiently
http://www.corexcel.com/idX/team-collaboration.htm
Oversight and Effectiveness
Quality Manager Onsite point of contact Oversees behavior
Contract an outside consulting group Unbiased employee satisfaction surveys Monitor from a third person standing
http://www.pinnacleqi.com/products/
Outcomes
http://www.qaproject.org/training/ipc/ref.pdf
Financial Impact
Collaboration Skills Training Program- $995
Human Resources Officer- avg $65,000/year
Consulting Group- price to come
http://www.corexcel.com/idX/team-collaboration.htm
Financial Reward
Quantitative Results General improvement in patient
satisfaction$500,000-$1.2 million in additional revenue annually
Avoided lawsuitssave $53,000 in preparation and $173,000 in payments
http://findarticles.com/p/articles/mi_m3257/is_10_62/ai_n31329893/?tag=content;col1
Financial Balance
- $$$....
+$$$$$$$$$....
Lack of Infrastructure
EHR-Oversight Committee
-24/7 Reporting System
EHR -Amend Bylaws-Pain Committee
Sync BylawsEHR
Unify Communication
Absence of Accountability
Continuing Education
New legislature Bylaws of BMC
Ensure each employee is aware of what is expected of them
Article II, Section 3
“What you permit, you promote”
Recommended additions: System for ensuring this event never happens
again Mandatory patient medication reviews quarterly No prescribing narcotics for chronic pain in ED
Strict guidelines for dealing with substance abuse problems Standard protocol for situations involving substance
abuse Establish standards of behavior for all
employees Have each employee sign off showing understanding
Physician Prescribing Monitoring Require electronic documentation of
each prescription prescribed by physicians at BMC Incorporate system in EMR
Evaluation of prescribing practices are performed monthly and reported quarterly at committee level as per Article XI 3.1.3 Quality and Peer Review specialist in
conjunction with the CEO handles instances that arise
Standard protocol for evaluation and management of illegal prescribing practices
Peer Review
Establish a system of peer review Establish a separate position for Quality Care and
Peer Review specialist Leads and organizes peer review program Position is a part of the executive committee
Article XI 1.1.6 Allows for a continuous review of each employee
The medical staff Executive Committee meets monthly (Article XI 1.3)
At monthly meeting, discuss and evaluate situations with peer review
Upholds Article II, Section 2 of bylaws
Confidential Reporting
A 24/7 system for confidential reporting Allows for anonymous reporting of
problems/situations within the medical center (include hospital and clinic)
Headed by administrator and situations handled by the Quality and Peer Review position
**Details on how system will work Goal for short term: promote/increase
reporting from employees
Monitoring the system
AHRQ’s culture and safety survey Take a baseline measurement for
comparison Helps uphold Article XI 3.1 of bylaws **Add details about the survey
Voluntary employee satisfaction survey Offered quarterly
www.ahrq.gov
A New Day For Branford Medical Center
Market to the community Branford Medical Center’s new approach to healthcare: The patients interests are number 1 BMC’s main focus is to increase the quality of care
offered to each patient – Article II, Section 1 Start by creating a friendly, welcoming environment
for the patient Free healthcare for citizens of Branford to market
new goals and vision of BMC
A New Day For Branford Medical Center
Tell the employees of BMC that their interests are a major concern as well. Show them you are on their side by implementing a
plan to help create a more pleasant, safe, employee friendly work environment
**Add details here Make it known that all employees are looked upon
as equals no matter what position they hold Each employee is a critical component in providing
the best healthcare possible to each patient of BMC
Cost Analysis – Current Costs to BMC
Cost Analysis
Incurred Costs EMR EPA Quality and Peer Review specialist Free public healthcare
Cost Neutral Employee evaluations Confidential reporting system
Savings Lawsuit Rise in malpractice premiums
Timeline for Success
Implementation
Monitoring Progress
** Previous Clarion winners developed a timeline here, explaining how at set future timepoints they would evaluate for improvement of these intervening measures
Cost-analysis
Benefits/ Gains:
Statement of ‘Core Values’
Prev Clarion winners made a statement of ‘Core Values’, which seems to be more of a Mission Statement, something we may want to consider
Overall Vision
References
Image 1- http://www.world-english.org/friends6.htm
Image 2-http://www.motherinc.com.au/magazine/everything-for-mum/life-balance/pamper-me/7-skin-through-the-agestaking-care-of-you
http://www.google.com/images?hl=en&biw=1280&bih=615&gbv=2&tbs=isch%3A1&sa=1&q=fear+eye&aq=f&aqi=g1&aql=&oq=
http://semstreetcred.com/wp-content/uploads/2009/07/4622501_blog-300x300.jpg
Joe’s resources
Hire a human resources officer http://www.payscale.com/research/US/Job=Human_Resources_(HR)_Manager/Salary Outside consulting group - http://www.pinnacleqi.com/
Training resources http://www.corexcel.com/idX/team-collaboration.htm
Monitoring outcomes http://findarticles.com/p/articles/mi_m3257/is_n2_v45/ai_10328657/?tag=content;col1 Surveys and inspections
Financial rewards Rush University Medical Center, Chicago, calculated that improving patient satisfaction scores
resulted in $2.3 million in additional revenues annually from repeat customers (Garman, A.N., Garcia, J., and Hargreaves, M., "Patient Satisfaction as a Predictor of Return-to-Provider Behavior: Analysis and Assessment of Financial Implications," Quality Management in Health Care 13, no. l, 2004).
REVIEWING THE NUMBERS: PATIENT SATISFACTION PAYSImproving patient satisfaction has a clear and direct impact on organizational results:* For a hospital with annual revenues of $120 million, improving patient satisfaction generates an estimated $2.2 million to $5.4 million in additional revenue every year.* For every 10 patients who complain to hospitals, there are up to 200 who do not and will tell their family, friends, co-workers, and physicians.* For every lawsuit avoided by improving patient satisfaction, hospitals save approximately $53,000 in costs to prepare cases and $173,000 in payments.Source: Press Ganey ROI Calculators. Used with permission.Melvin F. Hall, PhD, is president and CEO, Press Ganey Associates, Inc., South Bend, Ind. (mhall@pressganey.com).
http://findarticles.com/p/articles/mi_m3257/is_10_62/ai_n31329893/
Recommendations Infrastructure:- EMR, iPads- Pain management group- Hospital education committee- keep employees up to date- Sync bylaws between clinic and hospital, sync operations
-create institutional framework
Accountability:- Bylaws- Quality & Risk Management Committee, edit drug use policies- Define roles of each employee--- each person should know that he/she is accountable- Create culture of higher standards/ ie.) like MUSC’s ‘Culture of Compliance’- E-value-like system for evaluation from administration and peer evaluation- EMPLOYEE ASSISTANCE PROGRAM- oversee drug, alcohol program for impair workers
Hostile Work Environment:- Edit bylaws to reinforce employee’s rights ie.) to report wrongdoings- Resource line for reporting problems- Conflict resolution, team building retreat, individual empowerment- Make board meetings available to all employees- both through the ‘minutes’ for each meeting
and attendance- create transparency
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