1. The Culture of Healthcare Sociotechnical 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.

2. 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) 2 Health 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

3. 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) 3 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Sociotechnical Aspects: Clinicians and Technology Lecture b

4. 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 4 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Sociotechnical Aspects: Clinicians and Technology Lecture b

5. 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 5 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Sociotechnical Aspects: Clinicians and Technology Lecture b

6. 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 6 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Sociotechnical Aspects: Clinicians and Technology Lecture b

7. 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 7 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Sociotechnical Aspects: Clinicians and Technology Lecture b

8. Some Leapfrog Members Employers 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 8 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Sociotechnical Aspects: Clinicians and Technology Lecture b

9. 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 9 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Sociotechnical Aspects: Clinicians and Technology Lecture b

10. 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 10 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Sociotechnical Aspects: Clinicians and Technology Lecture b

11. 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 11 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Sociotechnical Aspects: Clinicians and Technology Lecture b

12. 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 12 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Sociotechnical Aspects: Clinicians and Technology Lecture b The Culture of Healthcare Summary – Lecture b

13. 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 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=0309068371http://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 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) http://www.jointcommission.org/assets/1/18/hh_monograph.pdf Universal protocol at http://www.jointcommission.org/assets/1/18/UP_Poster.pdfhttp://www.jointcommission.org/assets/1/18/UP_Poster.pdf 13 Health IT Workforce Curriculum Version 3.0/Spring 2012 The Culture of Healthcare Sociotechnical Aspects: Clinicians and Technology Lecture b The Culture of Healthcare References – Lecture b