HRO: What is it and Are You a Part of It?

Transcription

1 HRO: What is it and Are You a Part of It? Session Code: MN11 Date: Monday, October 23 Time: 12:45 p.m. - 2:15 p.m. Total CE Credits: 1.5 Presenter(s): Maggie Palmer, MSA, CPMSM, CPCS

2 HRO: What is it and Are You Part of It? Maggie Palmer, MSA, CPCS, CPMSM Vice President, North America IntelliCentrics Objectives Define what is an HRO and its relevance to healthcare Demonstrate how HRO principles relate to credentialing and privileging Outline the benefits of HRO practices in credentialing 1

3 What Is An HRO? Certain industries face the possibility of catastrophic, life or death, events everyday. High Reliability practices are proven to provide consistent, positive outcomes. High Reliability principles are used in high-risk, complex, dynamic environments -- like nuclear plants, aircraft carriers, wildfire firefighter operations, air traffic controllers -- where there is constant risk of catastrophic failure. A high reliability organization is an organization, that despite operating in a high stress, high-risk environment continually manages their environment mindfully, adopting a constant state of vigilance resulting in the fewest number of errors. 2

4 POLL QUESTION On a scale of 1 to 5, how much do you know about High Reliability? How Do HROs Operate? HROs work and train for zero accidents HROs share many properties with other highperforming organizations including highly trained-personnel, continuous training, effective reward systems, frequent process audits and continuous improvement efforts An HRO is an environment of collective mindfulness in which all workers look for, and report, small problems or unsafe conditions before they pose a substantial risk to the org and when they are easy to fix. ~(Weick and Sutcliffe 2007) 3

5 Occupations that embrace the value of high-reliability organizations No Room for Error! Zero Is where It s At! What are HRO Principles? 1. Preoccupation with failure» Never satisfied that they have not had an accident for many months or many years» Are always alert to the smallest signal that a new there have been no incidents always alert to the smallest signal that a new threat to safety may be developing 4

6 2. Reluctance to simplify» There is no one-size-fits-all best practice solution» Resist the temptation to simplify their observations, threats can present themselves in many different forms» Recognize the risks of painting with broad strokes and failing to dig deeply enough to find the real source of a particular problem 3. Sensitivity to operations» Recognize that the earliest indicators of threats to organizational performance typically appear in small changes in operations» Each employee pays close attention to operations and maintains awareness as to what is or isn't working 4. Commitment to resilience» Recognize that despite all precautions, errors will occur but errors should not be allowed to disable operation 5

7 5. Deference to expertise» Identify individual who would best know how to resolve threat, even if they are not the highest ranking Are HRO Principles Working? Airline industry death rate» = 13.9 deaths per million flights» = 1.43 deaths per million flights A 90% Decrease HRO and Healthcare 6

8 Zero Deaths U.S. Airlines 2016 was the seventh straight year of NO FATALITIES as a result of a crash on a United States-certificated scheduled airline operating anywhere in the world. POLL QUESTION According to most reports, how many avoidable deaths occur in U.S. hospitals each year? a) 25,000 b) 50,000 c) 100,000 d) 200,000 That is the equivalent to a fully loaded Boeing 737 crashing every 7 hours. Despite serious and widespread efforts to improve the quality of health care, many patients still suffer preventable harm every day Hospitals find improvement difficult to sustain, and they suffer project fatigue because so many problems need attention 7

9 Adapting and applying the lessons of High Reliability science to health care offers the promise of enabling hospitals to reach levels of quality and safety that are comparable to those of the best high-reliability organizations. ~High-Reliability Health Care: Getting There From Here, by Mark R. Chassin and Jerod M. Loeb The Center for Transforming Healthcare High Reliability introduced into healthcare by TJC s Center for Transforming Healthcare Created in 2008, the center has aligned with healthcare facilities to help facilities develop:» Leadership commitment to zero harm» Sustainable safety culture» Robust process improvements The Center for Transforming Healthcare Mission Statement: To transform health care into a high-reliability industry by developing highly effective, durable solutions to health care s most critical safety and quality problems in collaboration with health care organizations, by disseminating the solutions widely, and by facilitating their adoption. 8

10 High Reliability Credentialing (HRC) Concepts sounding familiar? As we looked into this very important initiative, we realized: 1. The characteristics of High Reliability Organizations could also apply to credentialing and privileging 2. HRO s collective mindfulness should also include the processes that examine the practitioners who provide patient care 9

11 The quality of the hospital s staff will, in large part, determine the quality of the care, treatment, and services it provides. From: World Health Organization (WHO): World Health Report 2000 Health Systems: Improving Performance. Geneva: WHO, Applying HRO principles to the credentialing and privileging process is: High Reliability Credentialing Why HRC? 1. Who credentials who? Gray areas and overlapping processes 2. Credentialing risks are greater than ever, and more public than ever! 3. New credentialing technology, more on the horizon 10

12 In the current shifting credentialing landscape, we don t want to lose site of the real reason we care so much about what we do Keeping patients safe (zero harm) 5 Basic Principles of HRC HRC Principle #1: Embrace Change 11

13 Let your facility leaders know you are adopting HRC principles and your staff are onboard with the latest concepts in patient safety Document how the Medical Staff Department contributes to this core value Get your entire staff on board Create a supplemental program that is specific to the department (include refreshers) Award CE s for the program Reward success The success of the initiative relies on every employee Recognize and reward your employees that embrace the program and achieve excellent results 12

14 Be resilient. Resilient HRO teams lean on their training, experience and imagination as a reliable means to recover from failure Promote skill development on a routine basis with a 90-day action plan Learn from new employees HRC Principle #2: Commit to Perfection 13

15 Don t be afraid to admit errors, find the cause and fix it If one person made an error, others can too Assume a zero defect environment ZERO Follow checklists - the checklist system can help fine tune the credentialing and privileging process by eliminating human error and ensuring thorough verification of credentials Adapt your credentialing framework to bullet proof your processes 14

16 Use your team s expertise, encourage problem sharing and solutions Expert may not be the one in charge, listen to your front line Encourage open and frank discussions Use basic Six Sigma principles to examine why process has failed Analyze breakdowns in credentialing Discover underlying causes Devise targeted solutions Share with others 15

17 Be sensitive to operations Get more transparent Share success and improvement Most important of all Listen to your gut instinct! HRC Principle #3: Anticipate Disaster 16

18 Every employee at every level in a high reliability organization is encouraged to constantly think of ways their work processes might break down Employees are encouraged to share their concerns for potential failures, which can help create best practices across departments It is an environment of collective mindfulness in which all workers look for, and report, small problems or unsafe conditions before they pose a substantial risk to the organization and when they are easy to fix. Document for the future Imagine every provider you credential will be involved in a high-profile legal negligent case Do you have the documentation to support all decisions made regarding privileging? 17

19 Could you demonstrate a total picture of the individual as well as the choices/decisions that were made during the credentialing process? Have approved policies in place for those tough situations» Pressured to take short cuts» Bad doctor is well-liked Refer to those policies when faced with pressure to deviate Pre-establish boundaries At what point to you push back when a practitioner has a 54-page NPDB report? Do you run state sanctions only on your state or do you include all previous states? Criminal Background Check on maiden names? 18

20 New regulation? Think ahead how will it affect your processes? Does it affect anything else? Collective mindfulness be alert to issues, roadblocks Continuously reinvent your department HRC Principle #4: Be Always On No matter how many years experience, no one person can know everything use your team!» Sign up for regulatory and industry e-news to stay up-to-date with regulatory changes» Have your team sign up for free webinars 19

21 Are you prepared for disaster credentialing? Do you have a breach plan? Would your credentialing documentation hold up in court? Adopt continuous credentialing practices Participate in recurrent training as often as possible Keep all policies up to day with process changes/improvements HRC Principle #5: Don t Let Technology Over-Simplify 20

22 Technology allows us to build in speed and accuracy However, technology does not have a gut instinct Use technology to increase transparency HRO leaders should constantly seek information that challenges their current beliefs as to why problems exist Develop your own internal quality data that reflects your organizations most important goals Track medical staff office metrics such as: Number of applications processed per year Initial Reappointment # of Denials # of additional privileges requests Temporary Privileges # FPPE for performance or competency evaluation Turn around time for each category, as applicable # New privileges (new technology) added (by specialty/department) # of Bylaws recommendation/approve (same with R&R, policy, procedure) Current staffing levels/national benchmarks 21

23 POLL QUESTION After learning about HRC, how close are your current practices to these HRC principles? a. Very close, nothing new here b. I can see I have a few changes to make c. I have a LOT of work to do! Benefits of HRC If your facility is accredited by The Joint Commission, they are likely already working to implement HRO processes Your HRC processes will support the larger HRO efforts of your facility 22

24 As one of the first points of contact, the Medical Staff Office sets the tone for incoming practitioners Safety cultures are harder to maintain than to create It takes a full commitment from ALL departments Building consistent reliability into programs such as privileging and verification helps to sustain the safety culture Build a sharp team Be the gold standard 23

25 Improves organizational effectiveness we think outside our office walls and participate in organizational task forces, etc. Improves organizational efficiency what do we lend to the organization as a whole? How are we viewed by leadership? Improves customer satisfaction Who are our customers? Are they all satisfied if not why not? 24

26 Improves compliance robust regulatory compliance, improved outcomes Improves organizational culture What an opportunity to change the perception of credentialing! Improves documentation We should be the Single Source of Truth 25

27 POLL QUESTION Do you feel you are recognized for the work you do? 1) Yes, and I ve worked hard at it! 2) No, and it s frustrating 3) Not yet, but this presentation gave me some good ideas Above all else, employees at high reliability organizations remember their purpose. They do worthwhile work and feel as though they can make a difference within their organizations. References /building-high-reliability-organizations-(hros)-in 26