Introduction
The patient safety includes how the healthcare Organizations can safeguard their patients from the adverse incidents like accidents, hospital borne infection, errors and injuries (Ghahramanian, Rezaei, Abdullahzadeh & Sheikhalipour, 2017). It is an important topic and the government and healthcare bodies take effective measures to maintain the safety of patients. The loopholes in patient safety cost more than half million deaths in hospitals annually due to preventable medical errors in US (CBC News, 2018). Many hospitals implement effective standards to maintain patient safety such as reducing the infection rate and facilitating transparent communication with the patients and put quality checks to mitigate the errors. However, few hospitals have no such mechanisms in place which results in experiences of fatal complications, reduced rate of recovery and preventable death incidents. The Grand River Hospital and St. Mary Hospitals are the fore-runners in their patient safety standards.
Grand River Hospital (GRH) has its own quality framework with a quality and patient safety committee, quality councils and teams to make the hospital responsible for the safety and quality. According to Canadian Institute of Health Information, GRH uses five benchmark indicators to assess its performance: Mortality after major surgery, nursing sensitive adverse events in surgical patients, Nursing sensitive adverse events in medical patients, Readmissions after surgery and Readmissions after medical treatment (CBC News, 2018).
St. Mary’s General Hospital (SMGH) uses lean management approach to bring consistent improvement in delivery of healthcare. The hospital has an objective of bringing 1000 improvements in a year and has a quality committee framework with algorithm of actions after the adverse events. It is known as the safest hospitals in Canada with a vision of ‘Respect, Innovation and compassion’ (GRH Strategic Plan, 2017). Even after all this, these hospitals still lack in quality standards and need to eliminate the persistent errors more effectively.
Data analysis against benchmarks and national standards
There are several areas of improvement in both of these hospitals to make them actually safe for the patients. The hospitals do not follow a true culture of safety at both the frontline and administrative positions.
For both the hospitals the evidences of poor attendance and underreporting at QCIPA (Quality of Care Information Protection Act) reviews show that there is a shortage of agreement of physicians about several efforts of quality improvement. Though the attendance of Physicians in these reviews is mandatory, most of them do not attend it. They assume that the attendance is not to be enforced and also they fear of the legal outcomes.
Both the hospitals have poor critical incident reporting records. The data collected through the reports is generally variable and inadequate. Even the consistent pressure from IOM for more than a decade, legal protections of QCIPA, legislative requirements and administrative encouragement could not change the behavior and attitude of physicians.
According to Bill 46, Excellence of care for All Act, both the hospitals have quality committees to directly report the critical incidents to the administrators. Both the hospitals have annual quality improvement plans. Yet there is improper and irregular reporting of critical incidents. It is because the physicians fear the legal repercussions and professional criticism. Though QCIPA protects the clinicians and the information for assessment and improvement in quality, there are cases of underreporting and absence from reviews. Every two years both the hospitals conduct a patient, employee and physician engagement survey and the results of the survey are transmitted to the senior leaders.
According to Qmentum Standards, at St. Mary General Hospital, the patient safety goal areas namely safety culture, communication, medication use, workforce safety plan, infection control and risk assessment have been met. However, the fall prevention is recorded unmet in 2 cases (Accreditation Canada, 2015). In both the hospitals the healthcare delivery services comply to the standards of Canadian Standards Association (CSA). Still the opportunities exist for making the environment better for the patients by reducing the interruptions and noise. The medication errors can be reduced by putting the silence zones around the pyxis dispensing machines (Accreditation Canada, 2015).
Observations about where quality improvements are needed
The quality improvements are needed to develop patient centered care by engaging the patients and their families in discussions and targeting the improvements on the basis of their feedback. The hospitals need to seek out evidence based best practice programs to adopt Quality based Procedures. The improvements in medication safety are needed by implementing new innovative technologies, and best practices (Accreditation Canada, 2015).
There are inadequacies of funds to operate the development processes which may be mitigated through introduction of new models of funding.
Most of the staff members have to work for longer hours at these Hospitals. According to Emergency Wait Times Performance Metrics, the patients at emergency departments have to wait longer to obtain care (GRH Strategic Plan, 2017). The information transfer in these hospitals is not timely and up to the mark. The hospitals need to implement additional technologies to facilitate effective transfer of information from the hospital to the other primary care departments. According to Physician Engagement Survey, the physicians play no leading role in bringing the change in patient safety and care. The physicians should lead the role to facilitate improvements in the operations and overall care at the hospitals (Feldman, 2018). There are no employee talent management systems to implement recruitment, education, performance review and compensation. Both the hospitals need an effective Human Resources Plan to consistently support the professional development and education opportunities for the staff.
The reporting of the critical incidents and medical errors should be timely, accurate and consistent without any fear of legal consequences (Office of Efficiency and Renewable Energy ,2019). The attendance of physicians at the review should also be consistent and regular. The communication between the patients and the staff is quality standard. The environment can be made better for the patients by reducing the interruptions and noise. The medication errors can be reduced by putting the silence zones around the pyxis dispensing machines (Ghahramanian et al., 2017). The fall prevention strategy at ambulatory services and diagnostic imaging services needs to be improved (Accreditation Canada, 2015). There is a need to address the strategy of information management system. There is a need to develop leadership for the advanced programs like cardiac care delivery programs (Accreditation Canada, 2015).
Goals for initiatives that address those deficiencies/opportunities in quality
- Development of advance system enablers to facilitate improvement in patient care
- Develop an integrated electronic medical record to assist the patient care, may be in partnership with the other hospitals.
- Physician Engagement Process within the hospitals to support the implantation of common information system.
- Reassessment of Priorities
- Support the people through communication excellence
- Disciplined commitment and diligence in planning and resource management
- Consistent Dialogue with the integrated network of hospitals
- Strengthen Physician Engagement in bringing the change
- Develop leadership for the advanced programs like cardiac care delivery programs
- Comprehensive Employee Talent Management Program
Outcomes that are anticipated in order to accomplish the initiatives
The hospital organized quality competitions to identify the contributions of staff members in safety improvement programs (Grand River Hospital, 2019). This improved the participation at the grass root level and also improved the physician leadership. There was considerable lack of communication skills, teamwork and lack of training in this regard. The curriculum also did not have patient safety. The model of Johns Hopkins School of Medicine was followed to demonstrate patient safety training sessions which developed student’s skills in safety and systems thinking. Dr. Sharma wanted to host a similar workshop for improving the skills of practicing clinicians.
Adjustments were made in Hospitals’ organizational structures for formalizing the positions at leadership and enhance the responsibility at the quality metrics. Mr. Sharma also introduced process redesign based on extensive analysis. This model was helpful in measuring the variations in care and analyzing the efficiency, quality and financial outcomes. The administrative structure was also developed to implement the guidelines on the basis of Intermountain Healthcare Delivery System.
The evaluation programs like Physician Engagement Survey, Progress on Human Resource Plan and patient Experience Feedback are highly effective in supporting the process of transformation (Office of Research and Innovation , 2019). Improving the access to care and transforming the processes is not a one day task. It requires a consistent improvement progress that is compulsory to follow up for many years. The joint research programs guided by the Hospitals are expected to improve the care for the patients in future and will also improve the skills, knowledge, and abilities of the staff. Through knowledge exchange and transparent communications, exceptional improvements in patient safety can be achieved (Okuyama,, Galvao, & Silva, 2018).
The hospitals need to optimize the safety and quality of patient care by facilitating the evidence based programs. They need to demonstrate best medication safety by following the best practices and improvements in creating the infrastructure and adopting new technologies.
The community of Grand River Hospital and the St. Mary General Hospital is continuously aging. Within the next 10-15 years the population will have double the old age people whose care requires 4-8 times greater resources than the young age people. By the next 5 years, the hospital admissions will increase by24% and thus the need for inpatient beds will also increase by 34% (Ontario Hospital Association, 2019). This growth won’t be compatible with the future funding by the government. The Grand River Hospital and the St Mary Hospital have 4th lowest rates of inpatient beds use. Thus the approach of these hospitals demands new innovations in future with enhanced integration, improved efficiencies, and standardized care. These hospitals need to be attractive in recruiting and sustaining the highly skilled clinicians to facilitate consistent care.
The hospitals need to bring evidence based policy to bring quality improvements. The coordination and transition of care need to be enhanced for the patients (GRH Strategic Plan, 2017). The achievers need to be recognized and appreciated for their progressive work culture and performance.
The GRH Planning Framework involves five main components of internal planning: Communications, Information Technology, Patient safety and quality, Human Resources and Enterprise Risk Management (Grand River Hospital, 2019). It strategic priorities are in congruence with these components.
Better hygiene methods like handwash and sanitation procedures have reduced the risk of adverse events which can be prevented. The factors which contribute to patient safety may range from communication and safety culture at the individual level to the active failures at the organization level such as mistakes in clinical procedures (Yang, Poly & Li, 2019). Knowledge and skills up gradation can help in mitigating these risks in the hospitals (Yang et al., 2019). The local working conditions, situational factors and team based factors also need to be considered in priority to make the working environment error free.
Appropriate time frames to re-evaluate data and provide a new analysis; Justify your response
Each of the predefined goals for the Hospitals’ Quality Improvement Plan would require an estimated timeline for re-evaluation and implementation.
- Goal: Development of advance system enablers to facilitate improvement in patient care
This goal involves the integration of both the hospitals with the other healthcare providers. It will enhance the transfer of information from the hospital to the primary care.
Timeline: 2019-2020. 1 Year.
- Develop an integrated electronic medical record to assist the patient care, in partnership with the other hospitals. Physician Engagement Process within the hospitals to support the implantation of common information system.
It will replace the existing McKesson Horizon Platform and will establish a common information systems solution. The initiative will improve the process of physician engagement.
Timeline: 2019-2020. 1 Year.
- Support the patients through improved communication excellence
It will improve the leadership development programs and HR infrastructure services to help the physicians, volunteers and staff in delivering better accountable patient care.
Timeline: 2019-2020. 1 Year.
- Disciplined commitment and diligence in planning and resource management
Staff and Physician engagement will be increased by upgrading the skills, knowledge and clinical skills of the staff (St. Mary Hospital Improvement Plan, 2011). It will improve the discipline and punctuality in physicians to attend the reviews on timely manner.
Timeline: 2019-2020; 1 Year.
- Develop leadership for the advanced programs like cardiac care delivery programs
Specialist Clinicians with advanced skills, educational qualification and experience will be retained in the hospitals to improve the patient care.
Timeline: 2019-2020; 1 Year.
- Comprehensive Employee Talent Management Program
The skills and education implementation of the clinicians will be reviewed monitored and evaluated by observing their records of errors, their work performance and the patient satisfaction level recorded in the patient feedback survey.
Timeline: 2019-2022; 3 Years.
The training of the clinicians and their performance evaluation will be a long term process that will involve several milestones of 6 months each to achieve to obtain better competency in practice.
Conclusion
Both the hospitals have excelled in the initiatives adopted to improve the patient safety and quality performance. They consistently follow re-evaluation practices and surveys to improve and monitor the met and unmet goals. The hospitals have adopted several strategies to consistently improve the patient safety and care from 2012 to 2019. During the years 2012 to 2015, these hospitals have done major transformations in facility renewal, capacity building and leading the edge technology. They have improved greater access to services, have modernized the tools for information management, have reduced the waiting times for the patients, improved their sound infrastructure and physical environment while supporting the education and learning for the staff and students. The hospitals have continuously focused on the improvements in patient care and services. However still there remain few areas which need further improvements. For example: Improving the communication and inter-professional relationship, improving the technical skills of the employees, bringing technical advancements in information exchange and improving the discipline and diligence in staff.
References
Accreditation Canada (2015). Accreditation Report. Retrieved from http://www.smgh.ca/wp-content/uploads/2012/01/Accreditation_Report-SMGH-2015.pdf
CBC News (2018). Grand River Hospital. Retrieved from https://www.cbc.ca/news2/health/features/ratemyhospital/profiles/grand-river-hospital/
Feldman, S.S.(2018). Health Information Technology in Healthcare Quality and Patient Safety: Literature Review. JMIR Med Inform. 6(2):e10264. DOI: 10.2196/10264
GRH Strategic Plan (2017). GRH Strategic Plan 2015-17. Retrieved from http://www.grhosp.on.ca/assets/documents/Strat-Plan-2015-2017.pdf
Grand River Hospital (2019).Quality and Patient Safety. Retrieved from http://www.grhosp.on.ca/about/quality-and-patient-safety
Ghahramanian A, Rezaei T, Abdullahzadeh F, Sheikhalipour Z, & Dianat I. (2017). Quality of healthcare services and its relationship with patient safety culture and nurse-physician professional communication. Health Promot Perspect. 7(3):168-174. doi: 10.15171/ hpp.2017.30
Okuyama, J., Galvao, T. F., & Silva, M. T. (2018). Healthcare Professional’s Perception of Patient Safety Measured by the Hospital Survey on Patient Safety Culture: A Systematic Review and Meta-Analysis. TheScientificWorldJournal, 9 (15). 1-12.doi:10.1155/2018/9156301
Ontario Hospital Association (2019). Physician Leadership Resource Manual. Retrieved from https://www.oha.com/Professional%20Issues1/Physician%20Leadership%20Resource%20Manual.pdf
Office of Research and Innovation (2019). The office of Research and innovation brings GRH clinicians and research partners together to explore ground breaking ways of helping GRH improve patient care. Retrieved from http://www.grhosp.on.ca/research
Office of Efficiency and Renewable Energy (2019). Program Evaluation: What, Why and When to evaluate. Retrieved from https://www.energy.gov/eere/analysis/program-evaluation-why-what-and-when-evaluate
St. Mary Hospital Improvement Plan (2011). St. Mary’s General Hospital Hospital Improvement Plan. Retrieved from http://www.smgh.ca/wp-content/uploads/2012/01/HIP-Final.pdf
