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Delivering World Class Healthcare

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2012 healthcare leaders must streamline processes, avoid uncompensated hospital acquired conditions, optimize the patient/family experience, compete for top tier patient satisfaction and quality, and provide the best value healthcare in the midst of unprecedented uncertainty in reimbursement along with policy turmoil. Although doing our best to fulfill our covenant with the public, we often overlook the actual healing interface between patients and their care providers. Fundamental tasks and processes at the point of care are crucial to avoiding patient safety errors, tragic complications, lengthened stays, disappointed and noncompliant consumers, and dissatisfied, disengaged employees.

Recent research related to omitted care processes is particularly disturbing because of the reported prevalence, and the potential impact on patient safety, mortality and morbidity. Nine types of missed care are most frequently reported including ambulation, turning, delayed or missed feedings, patient teaching, discharge planning, emotional support, hygiene, intake and output documentation, and surveillance or assessment (Bittner, Gravlin, Hansten, Kalisch 2011). The impact of gaps in task completion can be severe, especially in vulnerable populations, leading to hospital acquired conditions as pressure ulcers, deep vein thrombosis, pneumonia, failure to rescue, falls with injury, and uncompensated readmissions. Patients receiving deficient care would not be apt to score highly on their satisfaction surveys, thus driving the hospital’s percentiles below their competitors. A sample of 4086 staff revealed that missed ambulation topped the frequency charts at over 70%, mouth care at >60%, team conferences at >60%, turning at ~60%, focused reassessments at 30%, with patient assessments performed each shift being missed at ~10% (the mean of “missed frequently, always, or occasionally” at 10 hospitals; Kalisch et al., 2011). The reasons behind these serious treatment gaps include insufficient (or perhaps inadequately deployed) labor resources, materials, or communication.


Hansten, RN, PhD, FACHE, Ruth. I.

 

Hanten Healthcare PLLC

Performance Improvement

February 7, 2012

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