comp2 unit10b lecture slides

The Culture of HealthcareSociotechnical Aspects:

Clinicians and Technology

Lecture b

This material (Comp2_Unit10b) was developed by Oregon Health and Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number

IU24OC000015.

• Describe the concepts of medical error and patient safety (Lecture a, b)

• Discuss error as an individual and as a system problem (Lecture a)• Compare and contrast the interaction and interdependence of social

and technical “resistance to change” (Lecture c)• Discuss the challenges inherent with adapting work processes to

new technology (Lecture c)• Discuss the downside of adapting technology to work practices and

why this is not desirable (Lecture c)• Discuss the impact of changing sociotechnical processes on quality,

efficiency, and safety (Lecture a, b)

2Health IT Workforce Curriculum Version 3.0/Spring 2012

The Culture of Healthcare Sociotechnical Aspects: Clinicians and Technology

Lecture b

Sociotechnical Aspects: Clinicians and Technology

Learning Objectives

Patient Safety Goals

• The National Patient Safety Goals (NPSGs)– Promoted by the Joint Commission – Set of regulations addressing safety issues

including:• Infections by antibiotic-resistant microorganisms • Catheter-related bloodstream infections (CRBSIs)• Surgical site infections (SSIs)



Lecture b

Improving Patient Safety By Implementing a “Do Not Use” List

• In 2001, The Joint Commission issued a Sentinel Event Alert on the topic of medical abbreviations

• In 2002 a National Patient Safety Goal was approved, that required accredited organizations to develop and implement a “do not use” list of abbreviations

• In 2004 The Joint Commission created its “do not use” list as part of the requirements

• In 2010, NPSG.02.02.01 was integrated into The Joint Commission Information Management standards



Lecture b

Infection Control As A Patient Safety Measure

• Examples of methodologies used to control infection in the inpatient setting – Emphasis on hand hygiene– Immunizing healthcare professionals to avoid the spread of

disease– Using antibiotics appropriately to reduce antibiotic resistance– Identifying and appropriately isolating patients with infectious

pathogens– Revising training and competency assessments– Using safer medications



Lecture b

Universal Protocol For Preventing Patient Harm During Surgery

• In 2003, the Joint Commission approved the Universal Protocol for Preventing Wrong Site, Wrong Procedure and Wrong Person Surgery

• Since 2004, protocol required for all accredited facilities• Components of Universal Protocol:

– Conducting a pre-procedure patient/site verification process

– Marking the procedure site prior to surgery– Performing a pre-procedure time-out



Lecture b

Other Promoters Of Patient Safety

• Patient safety promoted by organizations • Example: Leapfrog Group – voluntary program

initiated by large employers and organizations of purchasers

• Leapfrog Initiatives include the Leapfrog Hospital Survey, and a number of initiatives that improve patient safety



Lecture b

Some Leapfrog MembersEmployers

• The Boeing Company• Chrysler• FedEx Corporation • General Motors Corporation • Goodwill Industries Central IN • IBM • Intel Corporation• Lockheed Martin• Maine State Employee Health Commission• Motorola, Inc. • Ohio Public Employees Retirement System • Sprint• Toyota • UPS • United Technologies Corporation

Organizations of Purchasers• Colorado Business Group on Health• Indiana Employers Quality Health Alliance• Iowa Buyers Health Alliance• Lehigh Valley Business Coalition on Health• Las Vegas Health Services Coalition• Maine Health Management Coalition• Massachusetts Healthcare Purchaser Group• Nevada Healthcare Coalition• New Hampshire Purchasers Group on Health• New Jersey Healthcare Quality Institute• New York Business Group on Health• Niagara Health Quality Coalition• Pacific Business Group on Health• Savannah Business Group on Health• South Carolina Business Coalition on Health

8Health IT Workforce CurriculumVersion 3.0/Spring 2012


Lecture b

Other Promoters Of Patient Safety• Nonprofit organizations• Example: National Quality Forum (NQF)• Goals:

– Sets national priorities and goals– Endorses national consensus standards– Promotes the attainment of national goals



Lecture b

Other Promoters Of Patient Safety• Consumer organizations

– Example: Consumer Reports• Rates hospitals, cardiac surgical groups,

treatments, natural medicines• Multiple methodologies for rating

– Performance data– Patient ratings



Lecture b

Patient Ratings Of Hospitals• HCAHPS questions ask about:

– Communication– Pain control – Assistance– Cleanliness and quietness– Medication and discharge information– Whether the patient would recommend the hospital to

family and friends – The patients’ overall rating of their experience



Lecture b

• Patient safety is promoted by using enhancements in technology coupled with improvements in how people work

• This sociotechnical process is assisted by agencies such as the Joint Commission

• Organizations such as the Leapfrog Group, the National Quality Forum, and consumer organizations promote patient safety



Lecture b

The Culture of HealthcareSummary – Lecture b

References• Fonarow, G., Abraham, W., et al. (2007). Association between performance measures and clinical outcomes for

patients hospitalized with heart failure. Journal of the American Medical Association, 297: 61-70.• Fowles, J., Kind, E., et al. (2008). Performance Measures Using Electronic Health Records: Five Case Studies.

Washington, DC, Commonwealth Fund. http://www.commonwealthfund.org/publications/publications_show.htm?doc_id=685103

• Institute of Medicine (2000). "To Err Is Human: Building a Safer Health System (2000)". The National Academies Press. http://books.nap.edu/openbook.php?isbn=0309068371

• Joint Commission Do Not Use List at http://www.jointcommission.org/assets/1/18/Official_Do%20Not%20Use_List_%206_10.pdf

• Landon, B., Normand, S., et al. (2003). Physician clinical performance assessment: prospects and barriers. Journal of the American Medical Association, 290: 1183-1189.

• Leape LL. Error in Medicine. JAMA. 1994;272(23):1851-1857.• Lindenauer, P., Remus, D., et al. (2007). Public reporting and pay for performance in hospital quality

improvement. New England Journal of Medicine, 356: 486-496.• Lynn, J., Baily, M., et al. (2007). The ethics of using quality improvement methods in healthcare. Annals of

Internal Medicine, 146: 666-673.• Measuring hand hygiene monograph from the Joint Commission at

http://www.jointcommission.org/assets/1/18/hh_monograph.pdf (would assign only portion of this document for reading)

• Universal protocol at http://www.jointcommission.org/assets/1/18/UP_Poster.pdf



Lecture b

The Culture of HealthcareReferences – Lecture b

comp2 unit10b lecture slides

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