Statewide Patient Safety Culture: North Carolina HSOPS and Medical Office SOPS
|
|
- Margaret Watson
- 5 years ago
- Views:
Transcription
1 Statewide Patient Safety Culture: North Carolina HSOPS and Medical Office SOPS
2 What is safety culture? The safety culture of an organization is the product of individual and group values, attitudes, perceptions, competencies, and patterns of behavior that determine the commitment to, and the style and proficiency of, an organization's health and safety management. What we believe Value communication Trust each other Perceive the importance of safety Are prepared and confident What we do Practice patterns of behavior that support health and safety Source: Organising for Safety: Third Report of the ACSNI (Advisory Committee on the Safety of Nuclear Installations) Study Group on Human Factors. Health and Safety Commission (of Great Britain). Sudbury, England: HSE Books, Accessed 1/11/16 at
3 Sentinel Events Linked to Safety Culture Most Frequently Identified Root Causes of Sentinel Events Reviewed by The Joint Commission Q 2015 Human Factors (n=635) Human Factors (n=547) Human Factors (n=464) Communication (n=563) Leadership (n=517) Leadership (n=382) Leadership (n=547) Communication (n=489) Communication (n=343) The culture of safety the attitudes, beliefs, perceptions, and values that employees share in relation to safety that exists in most health care organizations is weak compared to many other high-risk, complex businesses. Source: Summaries.pdf p.14
4 Correlations between Safety Culture and Clinical Outcomes
5 Strong safety culture correlated with better clinical outcomes in NC NCQC replicated methods from national studies correlating safety culture (HSOPS) with good clinical outcomes NC hospitals are 7 times more likely to have a few patient safety events if they are also top HSOPS performers NC hospitals with high HSOPS scores have lower rates of infections after colon or abdominal hysterectomy surgeries
6 Correlation between HSOPS and Patient Safety Composite (PSI-90) National data shows correlation between HSOPS percent positive scores and clinical outcomes. NC data also shows safety culture scores related to clinical outcomes. 60% 50% 40% 30% 20% 10% 0% Hospitals with good culture scores Hospitals with bad culture scores Hospitals with few patient safety events Hospitals with many patient safety events PSI 90: Agency on Healthcare Research and Quality s Patient Safety Indicator 90 (PSI-90), a component of the HAC reduction program, which aggregates 11 key patient safety indicators. Defined at: *Mardon, Khanna et al. Exploring Relationships Between Hospital Patient Safety Culture and Adverse Events. Journal of Patient Safety, Vol.6 No.4. Dec *NC Quality Highlights, November 2015.
7 Correlation between HSOPS and Surgical Site Infection Ratios COLCO/HYST SIR (lower is better) NC Hospitals with Strong Patient Safety Culture Have Better Performance on Surgical Infection Measures % 62% 64% 66% 68% 70% 72% 74% 76% 78% NC Hospitals with Strong Patient Safety Culture Have Lower Infection Ratios (COLO/HYST SIR) 0.46 Average HYST/COLO SIR Among Hospitals with Good Culture Scores (HSOPS 71%- 76%) 0.95 Average HYST/COLO SIR Among Hospitals with Poor Culture Scores (HSOPS 60%- 65%) Data from NC analyzed in a method similar to national study at:
8 Analysis of NC Hospital Survey on Patient Safety Culture (HSOPS)
9 NC Hospital Survey on Patient Safety Culture (HSOPS) Results Analysis includes ~97 hospitals ~50,000 respondents 80 unique surveys completed June 2014 June 2016 (some surveys cover multiple facilities) Source: The Patient Safety Group
10 NC HSOPS Key Results NC HSOPS average scores mirror US average Front-line staff report more challenges to patient safety culture than administrators do Staff say they are excellent at reporting patient safety events, but number of events reported matches the national average NC hospitals have strengths in Anesthesiology, Pediatrics work areas and in Organizational Learning composite
11 Percent Positive Responses NC HSOPS Composite Percent Positive Scores Mirror National Average NC HSOPS June June % 90% 82% 78% 80% 74% 72% 66% 68% 67% 70% 63% 60% 60% 53% 50% 46% 44% 40% 30% 20% 10% 0% NC HSOPS June June 2016 NC Average US 50th Percentile US 90th percentile
12 NC Administrators Report Higher HSOPS Scores Than Staff Report 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 91% 89% 82% 78% NC HSOPS Comparing Staff to Administrative Percent Positive June 2014-June % 86% 73% 71% 78% 81% 65% 67% 77% 74% 71% 67% 61% 59% 62% 53% 50% 46% 43% 63% Staff N=21399 Admin N=1549 NC administrators report scores 4% - 20% higher than staff, an average of 12% higher per composite.
13 NC HSOPS Discrepancy between Perceptions of Event Reporting and Number of Events Reported Question Level Responses on Frequency Of Events Reported, NC HSOPS When a mistake is made, but is caught and corrected before affecting the patient, how often is this reported? (D1) (47675 of 49911) When a mistake is made, but has no potential to harm the patient, how often is this reported? (D2) (47537 of 49911) When a mistake is made that could harm the patient, but does not, how often is this reported? (D3) (47339 of 49911) NC Hospitals 63% 62% 64% 63% 74% 74% 55% 60% 65% 70% 75% AHRQ Benchmark 60% 50% 40% 30% 20% 10% 0% Staff perceive reporting to be stronger than data shows. Frequency of Events Reported is 67% positive above national average. However, 57% of staff report they have not submitted any event reports in the last year. NC Number of Events Reported: In the past 12 months, how many event reports have you filled out and submitted? 57% No event reports 25% 1 to 2 event reports 11% 3 to 5 event reports 4% 2% 1% 6 to 10 event reports 11 to 20 event reports 21 event reports or more
14 NC HSOPS Work Areas Compared to National Benchmarks 3% or more above national benchmark for unit in green; 3% or more below national benchmark in red Dimension Anesthesi ology n=370 Emergenc y Departme nt n=3,109 Intensive Care Unit Laborator Medicine n=2,537 y n=1,660 n=5,795 Obstetrics Pediatrics Pharmacy n=1,905 n=932 n=1,343 Psychiatry /Mental Health Radiology n=1,148 n=2,518 Rehabilita tion n=2,132 Surgery n=5,516 Other Composit n=18,802 e Teamwork within units 90% 80% 88% 78% 83% 85% 90% 84% 79% 86% 89% 82% 79% 82% Supervisor promoting patient safety 86% 73% 77% 81% 80% 75% 80% 84% 75% 80% 85% 78% 78% 78% Organizational learning 80% 69% 72% 75% 78% 72% 76% 81% 73% 76% 80% 76% 71% 74% Hospital mgmt support for patient safety 69% 66% 63% 77% 71% 69% 70% 75% 67% 76% 79% 73% 73% 72% Overall perceptions of safety 73% 56% 61% 73% 64% 62% 67% 71% 60% 76% 79% 67% 65% 66% Feedback & communication about error 74% 63% 66% 68% 71% 64% 68% 72% 66% 70% 77% 69% 66% 68% Communication openness 75% 58% 64% 63% 64% 62% 70% 67% 58% 65% 73% 65% 60% 63% Frequency of events reported 66% 62% 63% 74% 70% 68% 67% 64% 71% 68% 71% 68% 66% 67% Teamwork across hospital units 59% 53% 59% 55% 60% 59% 63% 59% 55% 65% 65% 60% 61% 60% Staffing 67% 46% 52% 56% 52% 57% 57% 62% 53% 63% 65% 54% 50% 53% Hospital handoffs & transitions 47% 51% 53% 36% 46% 57% 52% 33% 44% 51% 45% 46% 44% 46% Non-punitive response to error 52% 36% 44% 41% 47% 40% 51% 57% 46% 46% 62% 48% 41% 44% Total Percent Positive 70% 59% 64% 64% 65% 64% 68% 67% 62% 69% 72% 65% 63% 64% NC strengths are in Anesthesiology, Pediatrics and Organizational Learning, with greater than 6 areas more than 3% above national average.
15 NC Hospital Survey on Patient Safety Culture (HSOPS) Trends and Comparison to National Trends
16 NC HSOPS Trends ~86 hospitals; 69 unique surveys ~51,000 in most recent survey group; ~44,000 respondents previous survey group Most-recent survey completed compared to previous survey completed Mirrors national average of 23 months between surveys Source: The Patient Safety Group
17 Percent Positive Responses NC HSOPS Composite Scores Show Minor Decrease Over Time NC HSOPS 2-Year Comparison 100% 90% 80% 82% 82% 79% 70% 78% 76% 74% 75% 72% 60% 67% 66% 68% 67% 68% 68% 63% 62% 61% 60% 50% 55% 53% 40% 44% 44% 30% 20% 10% 0% 47% 46% NC HSOPS (1st instance, administered in ) NC HSOPS (2nd instance administered in ) US 50th Percentile US 90th percentile
18 NC Worsening in Comparison to National Benchmarks Changes from Changes from AHRQ Benchmark change 2014 to 2016 Composite Overall perceptions of safety 1% -1% 1% Frequency of events reported 1% -1% 0% Supervisor/manager expectations a 0% -1% 2% Organizational learning - Continous 1% -2% 0% Teamwork within units 1% 0% 1% Communication openness 2% -1% 2% Feedback & communication about 2% 0% 1% Non-punitive response to error 3% 0% 1% Staffing -1% -2% -1% Hospital management support for 0% -3% 0% Teamwork across hosptial units 2% -1% 0% Hospital handoffs & transitions 2% -1% 1% Changes are small, but concerning. NC HSOPS scores have worsened in 9 dimensions between 2012 and 2016, whereas national benchmarks have improved in 7 dimensions and worsened in one dimension.
19 NC Medical Office Survey on Patient Safety Culture (MSOPS)
20 NC Medical Office Survey on Patient Safety Culture Analysis includes: 44 unique surveys/ ~12,000 respondents April 2014 Oct 2015 Key results: Averages mirror US average Survey of interest to ACO and system-wide work. Important to promote culture of safety across healthcare settings.
21 MSOPS Components 100% 80% 60% 40% 20% 0% Overall Rating on Patient Safety NC Medical Office SOPS June June 2016 Excellent Very Good Good Fair Poor Grade AHRQ Benchmark 100% 80% 60% 40% 20% 0% MSOPS grades medical offices on: Patient Centered Care Effective Care Timely Care Efficient Care Equitable Care Overall Rating Grade on Equitable Care NC Medical Office SOPS June June 2016 Excellent Very Good Good Fair Poor Grade AHRQ Benchmark
22 NC MSOPS Composite Scores Mirror National Average 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 88% 88% NC Medical Office SOPS Composite Percent Positive June June % 82% 78% 78% 61% 84% 73% 50% Medical Office % Positive AHRQ Benchmark % Positive
Nexus of Patient Safety and Worker Safety
Nexus of Patient Safety and Worker Safety Jeffrey Brady, MD, MPH & James Battles, PhD Agency for Healthcare Research and Quality October 25, 2012 Diagnosing the Safety Problem is One Challenge The fundamental
More informationAn Overview of the AHRQ Hospital Survey on Patient Safety Culture TM (SOPS TM ) and Value and Efficiency Supplemental Item Set
An Overview of the AHRQ Hospital Survey on Patient Safety Culture TM (SOPS TM ) and Value and Efficiency Supplemental Item Set Using the SOPS Toolkit for Patient Safety Improvement Theresa Famolaro, MPS,
More informationHospital Survey on Patient Safety Culture: Debrief and Action Planning
Hospital Survey on Patient Safety Culture: Debrief and Action Planning August 7, 2018 A partnership of the Healthcare Association of New York State and the Greater New York Hospital Association 1 Three
More informationMeasuring Patient Safety Culture Manual, Part I: Getting Started & Planning Your Survey Process
The Armstrong Institute for Patient Safety and Quality Measuring Patient Safety Culture Manual, Part I: Getting Started & Planning Your Survey Process This manual has been adapted from the publically available
More informationHSOPS Analysis and Interpretation. Using The Pa,ent Safety Group (PSG)
HSOPS Analysis and Interpretation Using The Pa,ent Safety Group (PSG) Objectives Describe post-survey activities Explain how to generate reports from PSG Identify HSOPS interpretation strategies Results,
More informationAssessment of patient safety culture in a rural tertiary health care hospital of Central India
International Journal of Community Medicine and Public Health Goyal RC et al. Int J Community Med Public Health. 2018 Jul;5(7):2791-2796 http://www.ijcmph.com pissn 2394-6032 eissn 2394-6040 Original Research
More informationPatient Safety Assessment in Slovak Hospitals
1236 Patient Safety Assessment in Slovak Hospitals Veronika Mikušová 1, Viera Rusnáková 2, Katarína Naďová 3, Jana Boroňová 1,4, Melánie Beťková 4 1 Faculty of Health Care and Social Work, Trnava University,
More informationA Study to Assess Patient Safety Culture amongst a Category of Hospital Staff of a Teaching Hospital
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 13, Issue 3 Ver. IV. (Mar. 2014), PP 16-22 A Study to Assess Patient Safety Culture amongst a Category
More informationComposite Results and Comparative Statistics Report
Patient Safety Culture Survey of Staff in Acute Hospitals Report April 2015 Page 1 Table of Contents Executive Summary 3 1.0 Purpose and Use of this Report 8 2.0 Introduction 8 3.0 Survey Administration
More informationMHA Patient Safety Organization
MHA Patient Safety Organization Membership Benefits 2014 Copyright ECRI Institute PSO MHA PSO does more than analyze reported events and near misses. They provide members with tools and resources to help
More information2017 Good Catch Program: Blueprint Companion Guide
2017 Good Catch Program: Blueprint Companion Guide EXECUTIVE SUMMARY The following document provides guidance to accompany the recommended strategies listed within the Blueprint for Success, a comprehensive
More informationJourney to an Effective Safety Culture Part I of III Exploring the Role of Culture in Safety Outcomes. Embracing Patient Safety Culture
White Paper Journey to an Effective Safety Culture Part I of III Exploring the Role of Culture in Safety Outcomes Embracing Patient Safety Culture What is the Purpose of this Series? The purpose of this
More informationFacilitating Change in the Patient Safety Culture of the Clinical Learning Environment
Facilitating Change in the Patient Safety Culture of the Clinical Learning Environment Andrew R. Buchert, MD Dept. of Pediatrics Gregory M. Bump, MD Dept. of Medicine Associate Medical Directors for GME
More informationMeasure what you treasure: Safety culture mixed methods assessment in healthcare
BUSINESS ASSURANCE Measure what you treasure: Safety culture mixed methods assessment in healthcare DNV GL Healthcare Presenter: Tita A. Listyowardojo 1 SAFER, SMARTER, GREENER Declaration of interest
More informationHCAHPS, HSOPS, HACs and HIQRP Connecting the Dots
HCAHPS, HSOPS, HACs and HIQRP Connecting the Dots Sharon Burnett, R.N., BSN, MBA Vice President of Clinical and Regulatory Affairs Missouri Hospital Association Objectives Discuss how the results of the
More informationPatient Safety: Where are we and where do we want to go?
Patient Safety: Where are we and where do we want to go? Denice Stewart, DDS, MHSA Senior Associate Dean, Clinical Affairs Professor, Community Dentistry We re moving! Occupancy July 1, 2014 As of October,
More informationCreating a Culture in Support of Patient Safety
Session: L11 Ms. Ching has nothing to disclose Ms. Derheimer is an employee of the Virginia Mason Institute; a not-for-profit organization that provides education and training in the Virginia Mason Production
More informationGood Catch: The Story of a Near-Miss Reporting System
Good Catch: The Story of a Near-Miss Reporting System Muskie School of Public Service Patient Safety Academy University of Southern Maine, Portland, ME September 29, 2017 Overview WISER Project in Maine
More informationat OU Medicine Leadership Development Institute August 6, 2010
Effective Patient Handovers at OU Medicine Leadership Development Institute August 6, 2010 Quality and Patient Safety Realize OU Medicine s position with respect to a culture of safety and quality. Improve
More information5. PATIENT SAFETY IN THE MILITARY HEALTH SYSTEM
Military Health System Review Final Report August 29, 2014 5. PATIENT SAFETY IN THE MILITARY HEALTH SYSTEM Introduction The Military Health System (MHS) Review Group analyzed current policies, governance
More informationNoCVA SSI/VTE Safe Surgery Collaborative
NoCVA SSI/VTE Safe Surgery Collaborative Orientation Webinar #3 Measures and Data Collection July 19, 2012 Presented by: Jan Mangun, MT(ASCP), MSA, CPHRM Executive Director, Quality and Patient Safety
More informationPG snapshot Nursing Special Report. The Role of Workplace Safety and Surveillance Capacity in Driving Nurse and Patient Outcomes
PG snapshot news, views & ideas from the leader in healthcare experience & satisfaction measurement The Press Ganey snapshot is a monthly electronic bulletin freely available to all those involved or interested
More informationFHA HIIN Safety Culture Measurement Informational Webinar May 7, 2018
FHA HIIN Safety Culture Measurement Informational Webinar May 7, 2018 Mission to Care HIIN Collaborative Focus 20% reduction in all cause harm 12% reduction in readmissions By September 2018 (possible
More informationImproved Patient Care and Safety
Improved Patient Care and Safety David Fitzgerald, CCP, LP Division of Cardiovascular Perfusion College of Health Professions Medical University of South Carolina ARS Question #1 In my department/unit,
More informationHOSPITAL SURVEY ON PATIENT SAFETY CULTURE
HOSPITAL SURVEY ON PATIENT SAFETY CULTURE USER S GUIDE PATIENT SAFETY AHRQ Hospital Survey on Patient Safety Culture: User s Guide Prepared for: Agency for Healthcare Research and Quality U.S. Department
More informationImproving Nursing Home Patient Safety in Maine: A Review of the AHRQ Patient Safety Culture survey Implementation Process
University of Southern Maine USM Digital Commons Muskie School Capstones Student Scholarship 5-1-2012 Improving Nursing Home Patient Safety in Maine: A Review of the AHRQ Patient Safety Culture survey
More informationHealth Care Systems - A National Perspective Erica Preston-Roedder, MSPH PhD
Health Care Systems - A National Perspective Erica Preston-Roedder, MSPH PhD Outline Quality Overview Overview and discussion of CMS programs Increasing transparency Move from P4R to P4P Expanding beyond
More informationScoring Methodology FALL 2016
Scoring Methodology FALL 2016 CONTENTS What is the Hospital Safety Grade?... 4 Eligible Hospitals... 4 Measures... 5 Measure Descriptions... 7 Process/Structural Measures... 7 Computerized Physician Order
More informationThese Things (Don t Have to) Happen Patient Safety Tami Minnier Chief Quality Officer Friday, April 5, 2013
These Things (Don t Have to) Happen Patient Safety 2013 Tami Minnier Chief Quality Officer Friday, April 5, 2013 Agenda Review the current state of healthcare Define and understand the concept of reliability
More informationAccreditation, Quality, Risk & Patient Safety
Accreditation, Quality, Risk & Patient Safety Accreditation The Joint Commission (TJC) Centers for Medicare & Medicaid Services (CMS) Wyoming Department of Health (DOH) Joint Commission: - Joint Commission
More informationText-based Document. The Culture of Incident Reporting Among Filipino Nurses. de Guzman, Barbara Michelle. Downloaded 28-Apr :54:41
The Henderson Repository is a free resource of the Honor Society of Nursing, Sigma Theta Tau International. It is dedicated to the dissemination of nursing research, researchrelated, and evidence-based
More informationHospital Survey on Patient Safety Culture: 2007 Comparative Database Report
Hospital Survey on Patient Safety Culture: 2007 Comparative Database eport Prepared for: Agency for Healthcare esearch and Quality (AHQ) U.S. Department of Health and Human Services (HHS) 540 Gaither oad
More informationQuality Improvement and Patient Safety (QPS) Ratchada Prakongsai Senior Manager
Quality Improvement and Patient Safety (QPS) Ratchada Prakongsai Senior Manager Overview 2 Comprehensive approach to quality improvement and patient safety that impacts all aspects of the facility s operation.
More informationDevelopment and assessment of a Patient Safety Culture Dr Alice Oborne
Development and assessment of a Patient Safety Culture Dr Alice Oborne Consultant pharmacist safe medication use March 2014 Outline 1.Definitions 2.Concept of a safe culture 3.Assessment of patient safety
More informationScoring Methodology SPRING 2018
Scoring Methodology SPRING 2018 CONTENTS What is the Hospital Safety Grade?... 4 Eligible Hospitals... 4 Measures... 6 Measure Descriptions... 9 Process/Structural Measures... 9 Computerized Physician
More informationMedicare Value Based Purchasing Overview
Medicare Value Based Purchasing Overview South Carolina Hospital Association DataGen Susan McDonough Bill Shyne October 29, 2015 Today s Objectives Overview of Medicare Value Based Purchasing Program Review
More informationAdverse Events in Hospitals: How Many and Why Not Reported. Fran Griffin Senior Manager Clinical Programs, BD
Adverse Events in Hospitals: How Many and Why Not Reported Fran Griffin Senior Manager Clinical Programs, BD Disclosure Currently full time employed at BD and faculty at The Institute for Healthcare Improvement
More informationThe OAT Analysis Toolkit
August 2012 The OAT Analysis Toolkit A Quality and Patient Safety Roadmap UPMC St. Margaret Hospital Table of Contents Introduction... 3 OAT Analysis Roadmap... 5 Executive Summary... 7 Top 22 Questions...
More informationWalk through a QAPI Project
Walk through a QAPI Project Quality Assessment to Performance Improvement Sandra Jones, CASC, CHPRM, LHRM, CHCQM, FHFMA Sjones@aboutascs.com 1 Types of Quality Measures Outcomes Measures results of care
More informationCREATING SAFETY IN AN EMERGENCY DEPARTMENT
T H E U N I V E R S I T Y O F B R I T I S H C O L U M B I A! CREATING SAFETY IN AN EMERGENCY DEPARTMENT Garth Hunte, MD PhD Clinical Associate Professor Department of Emergency Medicine Research Scientist,
More informationIMPORTANCE OF IMPROVING INTERPERSONAL COMMUNICATION SKILLS OF MEDICAL PERSONNEL IN MINIMIZING MEDICAL LIABILITY CLAIMS PIOTR DANILUK, MD
Polskie Towarzystwo Medycyny Ubezpieczeniowej IMPORTANCE OF IMPROVING INTERPERSONAL COMMUNICATION SKILLS OF MEDICAL PERSONNEL IN MINIMIZING MEDICAL LIABILITY CLAIMS PIOTR DANILUK, MD Warsaw, 23.09.2016
More informationPatient Safety Academy /8/16 PROVIDING INFORMAL FEEDBACK: AN INTERACTIVE WORKSHOP. Objectives
PROVIDING INFORMAL FEEDBACK: AN INTERACTIVE WORKSHOP Frank Korn R.N., MBA, CPPS Risk Coordinator 9/8/2016 Patient Safety Academy 1 Objectives At the end of the presentation you should be able to explain
More informationHealthcare- Associated Infections in North Carolina
2018 Healthcare- Associated Infections in North Carolina Reference Document Revised June 2018 NC Surveillance for Healthcare-Associated and Resistant Pathogens Patient Safety Program NC Department of Health
More informationSCORING METHODOLOGY APRIL 2014
SCORING METHODOLOGY APRIL 2014 HOSPITAL SAFETY SCORE Contents What is the Hospital Safety Score?... 4 Who is The Leapfrog Group?... 4 Eligible and Excluded Hospitals... 4 Scoring Methodology... 5 Measures...
More informationScoring Methodology FALL 2017
Scoring Methodology FALL 2017 CONTENTS What is the Hospital Safety Grade?... 4 Eligible Hospitals... 4 Measures... 5 Measure Descriptions... 9 Process/Structural Measures... 9 Computerized Physician Order
More informationA23/B23: Patient Harm in US Hospitals: How Much? Objectives
A23/B23: Patient Harm in US Hospitals: How Much? 23rd Annual National Forum on Quality Improvement in Health Care December 6, 2011 Objectives Summarize the findings of three recent studies measuring adverse
More informationMOCQI APPROVAL PROCESS AND REQUIREMENTS FOR QUALITY IMPROVEMENT PROJECTS
MOCQI APPROVAL PROCESS AND REQUIREMENTS FOR QUALITY IMPROVEMENT PROJECTS Maintenance of Certification (MOC) Part IV: As an American Board of Medical Specialties (ABMS) MOC Part IV Portfolio Program Sponsor,
More informationMidwest Alliance for Patient Safety Patient Safety Organization Getting Started with a PSO. An Illinois Hospital Association Company
Midwest Alliance for Patient Safety Patient Safety Organization Getting Started with a PSO An Illinois Hospital Association Company Today s Roadmap Objectives: 1. Explain the PSQIA and PSO Basics 2. Learn
More informationHealthcare- associated Infections in North Carolina: A Statewide Discussion
Healthcare- associated Infections in North Carolina: A Statewide Discussion 1 State Stakeholders 2 Agenda Background Data limitations Data review Prevention activities Q&A 3 Goal To discuss HAI prevention
More informationOHA HEN 2.0 Partnership for Patients Letter of Commitment
OHA HEN 2.0 Partnership for Patients Letter of Commitment To: Re: Request to Participate in the Ohio Hospital Association Hospital Engagement Contract Date: September 24, 2015 We have reviewed the information
More informationGHS Quality and Safety Report
GHS Quality and Safety Report January 2012 Core Measures Background The Center for Medicare and Medicaid Services (CMS) and The Joint Commission (TJC) have developed process of care measures for Acute
More informationFuture of Quality Reporting and the CMS Quality Incentive Programs
Future of Quality Reporting and the CMS Quality Incentive Programs Current Quality Environment Continued expansion of quality evaluation Increasing Reporting Requirements Increased Public Surveillance/Scrutiny
More informationPatient Safety Culture: Sample of a University Hospital in Turkey
Original Article INTRODUCTION Medical errors or patient safety is an important issue in healthcare quality. A report from Institute 1. Ozgur Ugurluoglu, PhD, Hacettepe University, Department of Health
More informationPatient Safety: 10 Years Later Why is Improvement So Hard? Patient Safety: Strong Beginnings
Patient Safety: 10 Years Later Why is Improvement So Hard? G. Ross Baker, Ph.D. Institute of Health Policy, Management & Evaluation University of Toronto 3 November 2014 Patient Safety: Strong Beginnings
More informationHospital-Acquired Condition Reduction Program. Hospital-Specific Report User Guide Fiscal Year 2017
Hospital-Acquired Condition Reduction Program Hospital-Specific Report User Guide Fiscal Year 2017 Contents Overview... 4 September 2016 Error Notice... 4 Background and Resources... 6 Updates for FY 2017...
More informationHealthcare- Associated Infections in North Carolina
2012 Healthcare- Associated Infections in North Carolina Reference Document Revised May 2016 N.C. Surveillance for Healthcare-Associated and Resistant Pathogens Patient Safety Program N.C. Department of
More informationThe Safety Management Activity of Nurses which Nursing Students Perceived during Clinical Practice
Indian Journal of Science and Technology, Vol 8(25), DOI: 10.17485/ijst/2015/v8i25/80159, October 2015 ISSN (Print) : 0974-6846 ISSN (Online) : 0974-5645 The Safety Management of Nurses which Nursing Students
More informationUsing SBAR to Communicate Falls Risk and Management in Inter-professional Rehabilitation Teams
teamwork and communication Using SBAR to Communicate Falls Risk and Management in Inter-professional Rehabilitation Teams Angie Andreoli, Carol Fancott, Karima Velji, G. Ross Baker, Sherra Solway, Elaine
More informationRISK MANAGEMENT EXPERT SUPPORT TO MANAGE RISK AND IMPROVE PATIENT SAFETY
RISK MANAGEMENT EXPERT SUPPORT TO MANAGE RISK AND IMPROVE PATIENT SAFETY medicalprotection.org +44 (0)113 241 0359 or +44 (0)113 241 0624 RISK MANAGEMENT EXPERT SUPPORT TO MANAGE RISK AND IMPROVE PATIENT
More informationFacility State National
Percentage Summary Report Page 1 of 5 Data As Of: 07/27/2016 Total Performance Facility State National 35.250000000000 37.325750561167 35.561361414483 Unweighted Domain Weighting Weighted Domain Clinical
More informationQuality Assessment and Performance Improvement in the Ophthalmic ASC
Quality Assessment and Performance Improvement in the Ophthalmic ASC ELETHIA DEAN RN,BSN, MBA, PHD Regulatory Requirements QAPI Program required by: Medicare Most states ASC licensing regulations Accrediting
More informationTOWN HALL CALL 2017 LEAPFROG HOSPITAL SURVEY. May 10, 2017
2017 LEAPFROG HOSPITAL SURVEY TOWN HALL CALL May 10, 2017 Matt Austin, PhD, Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine 2 Leapfrog Hospital Survey Overview Annual Survey
More informationQuality Management and Accreditation
Quality Management and Accreditation Lina Mekawi, RPh, MS Epidemiology, CPHQ, Senior Quality Analyst, Quality, Accreditation and Risk Management Department, AUBMC November 2017 Disclosure Slide I, Lina
More informationStaffing and Scheduling
Staffing and Scheduling 1 One of the most critical issues confronting nurse executives today is nurse staffing. The major goal of staffing and scheduling systems is to identify the need for and provide
More informationHospital Value-Based Purchasing Program
Hospital Value-Based Purchasing (VBP) Program Fiscal Year (FY) 2017 Percentage Payment Summary Report (PPSR) Overview Presentation Transcript Moderator/Speaker: Bethany Wheeler-Bunch, MSHA Project Lead,
More informationQuality Improvement Plan (QIP) Narrative for Health Care Organizations in Ontario
Quality Improvement Plan (QIP) Narrative for Health Care Organizations in Ontario 3/31/2016 This document is intended to provide health care organizations in Ontario with guidance as to how they can develop
More informationRevolutionizing Patient Safety through Organizational Certification Anne Arundel Medical Center
Revolutionizing Patient Safety through Organizational Certification Anne Arundel Medical Center 1 Anne Arundel Medical Center 1 Learning Objectives Established the Patient Safety Officer (PSO) as the focal
More informationOverview of the Hospital Safety Score September 24, Missy Danforth, Senior Director of Hospital Ratings, The Leapfrog Group
Overview of the Hospital Safety Score September 24, 2013 Missy Danforth, Senior Director of Hospital Ratings, The Leapfrog Group Presentation Overview Who is getting a Hospital Safety Score? Changes to
More informationVA Radiotherapy Incident Reporting and Analysis System (RIRAS)
VA Radiotherapy Incident Reporting and Analysis System (RIRAS) Jatinder R Palta PhD Rishabh Kapoor MS Michael Hagan, MD National Radiation Oncology Program(10P11H) Veterans Health Administration Disclosure
More informationECRI Patient Safety Organization HFACS and Healthcare
October 15, 2015 ECRI Patient Safety Organization HFACS and Healthcare Thomas W. Diller, MD, MMM VP System Chief Medical Officer CHRISTUS Health Learning Objectives Understand the human factors errors
More informationA survey on patient safety culture in primary healthcare services in Turkey
International Journal for Quality in Health Care 2009; Volume 21, Number 5: pp. 348 355 Advance Access Publication: 22 August 2009 A survey on patient safety culture in primary healthcare services in Turkey
More informationUnderstanding Hospital Value-Based Purchasing
VBP Understanding Hospital Value-Based Purchasing Updated 12/2017 Starting in October 2012, Medicare began rewarding hospitals that provide high-quality care for their patients through the new Hospital
More informationPatient Safety Incident Report Form
Page 1 This form is not meant to be a substitute to the health region s incident reporting. The purpose of this form is to assist with the identification and management of adverse events and near misses;
More informationPatient Safety Culture and Application of Medication Safety Rules as Perceived by Nurses
American Journal of Nursing Science 2016; 5(2): 52-58 http://www.sciencepublishinggroup.com/j/ajns doi: 10.11648/j.ajns.20160502.13 ISSN: 2328-5745 (Print); ISSN: 2328-5753 (Online) Patient Safety Culture
More information2016 ANNUAL REPORT CENTERFORPATIENTSAFETY.ORG
2016 ANNUAL REPORT CENTERFORPATIENTSAFETY.ORG 2 TABLE OF CONTENTS Message from the Executive Director Message from the Board of Director s Chair Message from the Medical Director 2015-2016 By the Numbers
More informationHigh Reliability Organizations The Key to Improving Quality and Safety
High Reliability Organizations The Key to Improving Quality and Safety William B Munier, MD, MBA Acting Director Center for Quality Improvement and Patient Safety Agency for Healthcare Research and Quality
More informationADMINISTRATIVE POLICY & PROCEDURE PATIENT SAFETY PLAN
PAGE #: 1 of 6 CROSS REFERENCES: Administrative Policy PI-01: Administrative Policy PI-03: Administrative Policy RI-20: Administrative Policy EC-25: Sentinel Event Risk Management Plan Guidelines for Disclosure
More informationUnit Based Culture of Safety and Learning. Owensboro Health March, 2017
Unit Based Culture of Safety and Learning Owensboro Health March, 2017 Owensboro Health 477 Bed Regional Hospital 32 Bed ICU 30 Transitional Care Beds Level III Trauma Center Level III NICU Largest employer
More informationUniversity of Illinois Hospital and Clinics Dashboard May 2018
May 17, 2018 University of Illinois Hospital and Clinics Dashboard May 2018 Combined Discharges and Observation Cases for the nine months ending March 2018 are 1.6% below budget and 4.9% lower than last
More informationUNIVERSITY OF ILLINOIS HOSPITAL & HEALTH SCIENCES SYSTEM HOSPITAL DASHBOARD
UNIVERSITY OF ILLINOIS HOSPITAL & HEALTH SCIENCES SYSTEM HOSPITAL DASHBOARD January 19, 2017 UI Health Metrics FY17 Q1 Actual FY17 Q1 Target FY Q1 Actual Ist Quarter % change FY17 vs FY Discharges 4,836
More informationK-HEN Acute Care/Critical Access Hospitals Measures Alignment with PfP 40/20 Goals AEA Minimum Participation Full Participation 1, 2
Outcome Measure for Any One of the Following: Outcome Measures Meeting Either A or B: Adverse Drug Events (ADE) All measures are surveillance data Hospital Collected Anticoagulant (ADE-12) Opioid (ADE-111)
More informationMedical Office Survey on Patient Safety Culture Initiatives
Medical Office Survey on Patient Safety Culture Initiatives MARIAH RAMIREZ MENTOR: KATHY DONOHUE BSN,MBA,CHCQM,CPPS DIRECTOR AMBULATORY QUALITY CEQI Agenda I. The Reality of Medical Errors II. Definition:
More informationMedicare P4P -- Medicare Quality Reporting, Incentive and Penalty Programs
Medicare P4P -- Medicare Quality Reporting, Incentive and Penalty Programs Presenter: Daniel J. Hettich King & Spalding; Washington, DC dhettich@kslaw.com 1 I. Introduction Evolution of Medicare as a Purchaser
More informationFostering a Culture of Safety
Fostering a Culture of Safety June 11, 2017 Alabama Society of Health System Pharmacists Presenter: Trey Gwin, RPh, MBA, Medication Safety Coordinator, Infirmary Health Financial Disclosure The speaker
More informationQuality Based Impacts to Medicare Inpatient Payments
Quality Based Impacts to Medicare Inpatient Payments Overview New Developments in Quality Based Reimbursement Recap of programs Hospital acquired conditions Readmission reduction program Value based purchasing
More informationA GLOWING RESEMBLANCE A COMPARE AND CONTRAST OF MEDICAL AND NUCLEAR PERFORMANCE IMPROVEMENT INITIATIVES
A GLOWING RESEMBLANCE A COMPARE AND CONTRAST OF MEDICAL AND NUCLEAR PERFORMANCE IMPROVEMENT INITIATIVES 23 rd Annual HPRCT Conference June 12-15, 2017 Thomas Diller, MD, MMM; Executive Director University
More informationThe medical office survey on patient safety culture MOSPSC!
The medical office survey on patient safety culture MOSPSC! Opinions and views! of EQuiP network General Practitioners! Dr Isabelle DUPIE! Dr André NGUYEN VAN NHIEU! EQuiP Conference Dublin 4 th March
More informationAdditional Considerations for SQRMS 2018 Measure Recommendations
Additional Considerations for SQRMS 2018 Measure Recommendations HCAHPS The Hospital Consumer Assessments of Healthcare Providers and Systems (HCAHPS) is a requirement of MBQIP for CAHs and therefore a
More informationEXECUTIVE SUMMARY. The Military Health System. Military Health System Review Final Report August 29, 2014
EXECUTIVE SUMMARY On May 28, 2014, the Secretary of Defense ordered a comprehensive review of the Military Health System (MHS). The review was directed to assess whether: 1) access to medical care in the
More informationThe Multidisciplinary aspects of JCI accreditation
The Multidisciplinary aspects of JCI accreditation Saleem Kiblawi MD, FCCP, Physician consultant, Joint Commission International Oakbrook, Illinois USA Lebanese American University April 15, 2016 Beirut,
More informationTeamSTEPPS Introductory Webinar. July 19, 2018
TeamSTEPPS Introductory July 19, 2018 Agenda Welcome & HIIN Update TeamSTEPPS Master Trainer Course Presentation --Duke University Health System Master Trainers Next Steps Questions / Discussion Pre-Meeting
More informationTable of Contents. TeamSTEPPS Framework and Competencies Key Principles. Team Structure Multi-Team System For Patient Care
Table of Contents TeamSTEPPS Framework and Competencies Key Principles Team Structure Multi-Team System For Patient Care Leadership Effective Team Leaders Team Events Brief Checklist Debrief Checklist
More informationGHS Quality and Safety Report
GHS Quality and Safety Report April 2012 Core Measures Background The Center for Medicare and Medicaid Services (CMS) and The Joint Commission (TJC) have developed process of care measures for Acute Myocardial
More informationJCI 6 th ed. Hospital Standards Review: Patient-Centered Standards
JCI 6 th ed. Hospital Standards Review: Patient-Centered Standards Standards Overview This presentation provides a general sense of what types of issues and themes are covered in our Patient- Centered
More informationUI Health Hospital Dashboard September 7, 2017
UI Health Hospital Dashboard September 20 September 7, 20 UI Health Metrics FY Q4 Actual FY Q4 Target FY Q4 Actual 4th Quarter % change FY vs FY Discharges 4,558 4,680 4,720 Combined Observation Cases
More informationUNIVERSITY OF ILLINOIS HOSPITAL & HEALTH SCIENCES SYSTEM HOSPITAL DASHBOARD
September 8, 20 UNIVERSITY OF ILLINOIS HOSPITAL & HEALTH SCIENCES SYSTEM HOSPITAL DASHBOARD UI Health Metrics FY Q4 Actual FY Q4 Target FY Q4 Actual 4th Quarter % change FY vs FY Average Daily Census (ADC)
More informationRisk Management in the ASC
1 Risk Management in the ASC Sandra Jones CASC, LHRM, CHCQM, FHFMA sjones@aboutascs.com IMPROVING HEALTH CARE QUALITY THROUGH ACCREDITATION 2014 Accreditation Association for Conflict of Interest Disclosure
More informationUtilizing the Fish-Bone Model to Identify Systems Errors During Pediatric Morbidity and Mortality Conference
Utilizing the Fish-Bone Model to Identify Systems Errors During Pediatric Morbidity and Mortality Conference INGA AIKMAN, MD, MPH PEDIATRIC CHIEF RESIDENT EAST CAROLINA UNIVERSITY Second Annual REACH Medical
More informationMedicare Value Based Purchasing Overview
Medicare Value Based Purchasing Overview Washington State Hospital Association Apprise Health Insights / Oregon Association of Hospitals and Health Systems DataGen Susan McDonough Lauren Davis Bill Shyne
More informationWhy Shepherd? Shepherd Center Patients. Here s How We Measure Up: Shepherd Patient Population
Center Patients Total Patients ABI Patients SCI Patients Other Patients Center specializes in medical treatment, research and rehabilitation for people with spinal cord and brain injury. In CY, had 911
More information