Bob Laszewski at Healthcare Policy and Marketplace Review hosts this week’s edition of Health Wonk Review. Stop by to check out the best posts on healthcare policy and administration.
I was reviewing my professional Continuing Education list the other day when it occurred to me that next year when it’s time for me to recertify my CPCS (Certified Provider Credentialing Specialist) and CPMSM (Certified Professional Medical Services Management) credentials through NAMSS, I will need to submit 45 credits.
So as we consider our education opportunities for the coming year, here’s a reminder for all of us who hold dual certification; if you will be recertifying dual credentials in 2010, you will need to submit 45 credits (at least 25 of which must be NAMSS approved) obtained between November 1, 2007 and October 31, 2010.
My how time flies!
Bad things happen to good patients, and good caregivers for that matter. The complex arena of medicine offers many opportunities for systems and processes to go awry, and at times they do just that. When serious injury, or even significant risk of serious injury is the end result, the event is generally identified as Sentinel.
The Joint Commission defines Sentinel Event as:
“An unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. Serious injury specifically includes loss of limb or function. The phrase, “or the risk thereof” includes any process variation for which a recurrence would carry a significant chance of a serious adverse outcome. Such events are called “sentinel” because they signal the need for immediate investigation and response.”
The Joint Commission web site provides statistics, including a table of Sentinel Events reviewed by the organization since 1995. (See image below.) The numbers are relatively low, however, it is important to note that reporting SE’s to the Joint Commission is voluntary, and most hospitals and providers choose not to self-report the majority of events.** That having been said, the JC does require all accredited hospitals to establish a process for identifying and investigating events that meet the definition of Sentinel, and also requires that a root cause analysis and action plan for preventing recurrence be developed within 45 days.
Not surprisingly, the individuals charged with the initial investigation and designation of significant events in the healthcare setting often struggle with whether or not a particular event meets the definition of Sentinel. For example, serious physical or psychological injury may be difficult to determine early in an investigation. A injury that appears permanent may resolve over time, and one that initially seems minor may worsen. However, if identification is not made promptly investigation becomes more difficult. Interviewing caregivers days or weeks after an event occurs will almost certainly diminish the number of accurate details that can be recalled.
It also becomes far more challenging to develop meaningful action plans after time has passed. Initially those involved in a difficult case are usually emotionally engaged and anxious to determine what happened and prevent it from happening again. However, teams called together weeks or months after an event have often lost their emotional engagement and have, perhaps by necessity, put the incident behind them. They may in fact be actively resistant to dredging up old memories. Obviously, time is of the essence.
Hospital leadership must take an active role in monitoring and supporting the investigation, root cause analysis, and action planning for serious events. Performed well, the process is a significant driver toward improved patient safety, patient satisfaction, risk mitigation, and protection of the organization’s financial assets. It also provides the organization an opportunity to offer support to staff members who may be highly distressed over participation in care that did not result in the desired outcome.
John G. Marsh from HealthCare Voice adds this thought in his post A Culture of Hiding Mistakes? “It is important for the CEO – the leader – to own the results, to make quality care and patient safety more than a program or an initiative but a way of EVERY day life in their health system, hospital, nursing home, or healthcare delivery venue.”
What would happen if patients could visit a doctor at the touch of a button, no waiting, without leaving their home or workplace? Starting this fall, Blue Cross and Blue Shield of Minnesota hopes to find out.
The insurance company plans to offer its 10,000 employees the chance to use a “virtual clinic,” an Internet site that can connect them with a doctor for a live 10-minute consultation for a flat fee.
Read the rest in the Star Tribune
While browsing the Wall Street Journal Health blog this morning I came across this intriguing post: How Quality-of-Care Rules Can Lead Doctors Astray. It opens with:
“Rating doctors and hospitals and paying them based on the quality of care they provide can have dangerous consequences — especially when the issue of how to define “quality” is up in the air.”
That’s the take of Jerome Groopman and Pamela Hartzband, two doctors at Boston’s Beth Israel Deaconess Medical Center. Dr’s Groopman and Hartzband take an even stronger approach in an article entitled Why Quality Care is Dangerous.
At first blush that may seem like an oxymoron; isn’t the delivery of quality care a fine goal? In fact, isn’t it included in most hospital mission statements? The Wall Street Journal article opens with:
“The Obama administration is working with Congress to mandate that all Medicare payments be tied to “quality metrics.” But an analysis of this drive for better health care reveals a fundamental flaw in how quality is defined and metrics applied. In too many cases, the quality measures have been hastily adopted, only to be proven wrong and even potentially dangerous to patients.”
Metrics are certainly not evil; measuring compliance, targets, and outcomes can provide insights not otherwise gained. Peter Pronovist, M.D., Medical Director, Center of Innovations in Quality Patient Care at Johns Hopkins Hospital, made the statement that “without valid measurement tools we believe that we are safer than we are.”
Metrics are quite the “in” thing in healthcare at the moment. Most leadership meetings contain a review of various bar charts, line graphs, and scatter diagrams promulgating the organization’s current quality initiatives. As a database designer I admit to being a contributor to the growing body of healthcare metrics. The results can be enlightening; if, and here’s the rub, the methodology and process for obtaining those metrics is well thought out, well controlled, and based on worthwhile targets.
The analogy of a bus comes to mind. When the process of obtaining and reviewing metrics is well designed and managed the results can simultaneously move a large number of people in the right direction. On the other hand, when the process is not so well “driven” the end result may simply be an out-of-control vehicle that advances relentlessly forward, mowing down anyone in its path. Ouch!
Buckeye Surgeon has a lovely and thought-provoking post about healthcare rationing. A poignant reminder that it’s not all about the numbers.
He relates a conversation with a 97 year old patient about his nursing home-bound 95 year old wife.
-She gets the dialysis three times a week, he said. Her kidney doctor told me last week that he didn’t think the dialysis was doing any good. …
-He wants me to think about stopping it. The dialysis.
-Anyway, I’ll have to decide. I’ll miss her. Even though she’s not the same, I like going to see her.
What positions are “mission-critical” in today’s economy? Career Builder weighs in on that question with a list of six job categories that remain “bright spots“ in today’s job market.
One of Career Builder’s picks is Administrative Healthcare positions, and, as you’ll see one of the listed sub-specialties in high demand is credentialing.
Are you a blogger with something to say? Consider submitting a speaker application for the upcoming BlogWorldExpo/New Media Expo 09 to be held October 15-17 in Las Vegas.
Speaker guidelines and and an on-line application are available here.
The 2009 conference will feature more than 150 speakers covering all areas of the blogosphere, podcasting, new media world, including:
- Social Media
- Social Networking
- Online / Citizen Journalism
- Online Video and TV
- Internet Radio
- Special Interest/Community-focused Blogging or Podcasting (Tech, Military, Sports, Political, Pop Culture, Family & Mommy-Blogging, God Blogging, Business, Marketing, PR)
- Online Entertainment (Games, TV, Radio, Film and Music)
- Search Engine Marketing / Optimization
- Monetization, Online Advertising, Affiliate Programs, Paid Content
- Enterprise-level New Media communications (internal collaboration, consumer marketplace engagement, marketing, etc.)
“What must we look like to passersby? Just a pile of bricks and stone, housing the sick? But in here lives are changing. In one window there might be a nurse pounding on someone’s chest, trying to defy death. In another, a mother weeping tears of joy over a baby just minutes old. In yet another, an anesthesiologist looking out at the world, missing her family, and thinking of a patient who’s hanging on to life by a thread. An ordinary night at the hospital, in other words; just another night.”
So ends a recent post by the Anesthesioboist, a student of the oboe who also happens to be an anesthesiologist, according to the author.
Click here to read the rest; it’s a thoughtful commentary about the life-changing work of healthcare.