From reporting incidents to ERM
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1 From reporting incidents to ERM Philippe A. COUCKE ERM = Enterprise Risk Management
2 Why ERM in HCS? The hard reality: it s all about numbers! Useless procedures and defensive medicine. Misdiagnosis. Systemic risk. Incidents/accidents
3 Annals of Health Care May 11, 2015 Issue Overkill An avalanche of unnecessary medical care is harming patients physically and financially. What can we do about it? By Atul Gawande What explained this? Our piecework payment system rewarding doctors for the quantity of care provided, regardless of the results was a key factor. The system gives ample reward for overtreatment and no reward for eliminating it.
4 How the U.S. Health-Care System Wastes $750 Billion Annually Waste in US HCS? (2014) 69,3 % More than 18 months in the making, the report identified six major areas of waste: unnecessary services ($210 billion annually); inefficient delivery of care ($130 billion); excess administrative costs ($190 billion); inflated prices ($105 billion); prevention failures ($55 billion), and fraud ($75 billion). Adjusting for some overlap among the categories, the panel settled on an estimate of $750 billion.
5 New Coalition to Tackle Diagnostic Errors in Medicine August 26, 2015 Second Opinions Often Lead to Recommended Changes May 29, 2015 Second Look Alters 20% of Breast Biopsy Conclusions Fran Lowry May 07, 2015 Misdiagnoses All Too Common: 1 in 20 US Adult Patients April 22, 2014 Autopsy Study Shows Misdiagnoses Are Common in ICU Laurie Barclay, MD August 30, 2012 More Than Half of Pediatricians Report Making Frequent Diagnostic Errors Pauline Anderson June 23, 2010 The Society to Improve Diagnosis in Medicine (SIDM), a physician-led nonprofit organization, established and will lead the coalition. To ensure that diagnosis is ACCURATE TIMELY EFFICIENT
6 As a starter. IOM report (1999) deaths/year. Department of Health and Human Services (2010) iatrogenic deaths/year.* Journal of Patient Safety (2013) > deaths/year. Deaths/year John James * Only for «Medicare» patients
7 1000 deaths* per day in HCS in US *as a result of system error passengers 180 passengers 408 passengers
8 You cannot manage what you do not measure Measurable quality = improvable quality What you can t measure, you do not know. What you do not know, you can t improve. Without observation and measurement, there is no improvement! If you cannot improve, you lose money! William E Deming
9 TCELab's research on 4,610 Hospitals using U.S. Gov't HCAHPS survey data. What really matters to patients? It's not what you think.
10 For GQM we need a model! For GQM we need a method! The industrial models are HRO s! A method is the EFQM approach GQM = Global Quality Management MaGIQ = Managament Global et Intégré de la Qualité
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12 Leadership (1) Define as a leader mission, vision and values: Leaders drive values, values drive behaviors and behaviors define culture (Ann Rhoades). >50% of weekly COPIL totally dedicated to Q&S management. SO (safety officer) is ex officio full member of COPIL One of the ROP (ACI) = Required Organizational Practices of accreditation programs. Transparent and effective communication policy: Campaign mission/vision/values : priority Q&S management! Powerpoint at strategic point with Q&S (positive) messages. Three annual meetings mostly dedicated to Q&S. Communication policy has been audited (external).
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14 Strategy (2a) IR and CREx (FMEA & PDCA). Patient as a safety partner! Patient participation in COPIL
15 Incident reporting No shame, no blame policy «Just culture». Cultural shift in Health Care Sector! Define what is expected! Standards Procedures Guidelines SOP s IR
16 Analysis : The CREx methodology (ORION ) Definition: Comité de Retour d Expérience) Register near incidents, incidents and accidents. Prioritization Analysis (RCA and FMEA) Corrective actions Measurement of effect and consolidation What is the compliance to procedures and standards? Checklist! Register, analysis and adapt (if necessary). Frequency Detectability Severity
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19 Strategy (2b) Balanced Score Card (BSC) Objectives KPI: FABRIC SMART-R
20 FABRIC and SMART-R analysis of performance indicators (PI) F = Focused A = Appropriate B = Balanced R = Robust I = Integrated C = Cost effective S = Specific M = Measurable A = Achievable R = Relevant, reliable, reportable T = Timely, time based. R = Recognized as valid by institution.
21 FABRIC analysis of PI Légende abouti en cours à améliorer répond à 80% des attentes
22 Human Resources: HR management (3) Turn-over. Satisfaction. Burn-out (MD s, nurses, physicists). Culture poll (HEC): maturity level. Organizational learning: Technical skills. Non-technical skills (VERT-project). University Certificate
23 Organizational learning Profile defined by nursing department => Profile required in radiotherapy Démarche de développement des compétences
24 VERT project will be started in 2015 / CRM training
25 Process: Processes (4) Mapping LEAN management CK Definition of bottle necks: Flow Optimization. «No Fly» policy
26 CREx data Overall reported UE s: to : N= 558 Treatment File Process: to N i = 135 (24%) Steps in process: Step 1 M 20 Step 2 C 17 Step 3 T 9 Step 4 A 6 Step 5 D 0 Step 6 M 46 Step 7 D 9 Step 8 M 12 Step 9 D 10 Step 10 P 3 Step 11 A 0 Step 12 N 3 46 M = Medical, C = Coordination, T= Technician, A = Administration, D= Dosimetry P = Physicist, N = Nurse
27 No-Fly Policy
28 Partner satisfaction: Patient s satisfaction: Partners (5) Questionnaire (N = 2000, RR= 43%). H to H (N = 150). PROM s GP satisfaction: Focus group: What do you expect? Open communication through videoconference.
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30 Closing the loop: results People / Society / Customer / Key Performance Indicators (KPI) BSC Adapting EMR: Make the right thing the easy thing to do. Coding toxicity. Coding outcome. PROM Coding QoL Coding cost CK Outcome analysis Markov Model
31 Results SMART indicators Patient-oriented indicators: Patient-load: yearly growth rate 1,5%. Geographical distribution as an index of regional penetrance. Patient satisfaction score (target 85% HDS* / result: 96%). Patient characteristics and outcome. Resource-oriented indicators: Operational resources. Financial targets. Process-oriented indicators: Efficiency of organizational processes. Cycle time and percentage efficacy (value stream model). HDS = High Degree of Satisfaction
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33 EFQM score in RTH-Liège 15/10/2015 Feedback by MWQ Score:
34 DMP Exporting the safety culture Radiology Medical Oncology Vendors Radiotherapy Surgery Federal & Regional authorities Nuclear Medicine Internal Medicine Patients & associations
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Text-based Document. The Culture of Incident Reporting Among Filipino Nurses. de Guzman, Barbara Michelle. Downloaded 28-Apr :54:41
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