- A standard of excellence, achievement, etc., against which similar things must be measured or judged.
- Any standard or reference by which others can be measured or judged.
When I was young, my friends used to say I was too competitive for my own good–though they described my competitive tendencies with a little more color. They even accused me of “bending the rules” at times just to gain a competitive advantage. Whether it was the testosterone of my teens, or just something inbred in my character, I hated losing. As I grew older and entered healthcare, the competitive fire mellowed and my vocabulary changed to phrases like “win-win” situations, collaboration, shared learning…and benchmarking.
Benchmarking is a very important tool used in most industries including healthcare. I have always been a big believer in benchmarking one’s outcomes against others. From an improvement standpoint, how else can we assess where we stand against a norm, and then use those benchmarks to focus on quality and safety improvements? Made total sense to me. Besides, from a safety and quality standpoint, hospitals are constantly being benchmarked against one another by numerous organizations that publish grades, scorecards, self-developed rankings, and more.
A few things have now made me re-think some of my beliefs related to benchmarking, and the possible unintended consequences that may be occurring in the quality and safety domain. One challenge to my thinking occurred when Paul Levy (Not Running A Hospital) recently spoke to over 100 quality, safety and risk management leaders from across our health system. Paul spoke on transparency, and the ground-breaking work done at BI Deaconess while he was CEO there many years ago. During his talk, he also shared his thoughts on benchmarking and stated:
“There is no virtue in benchmarking to a substandard norm. Eliminate. Don’t benchmark!”
Wow – Don’t Benchmark?? His statement reminded me of a quote I have often heard throughout the years…”In the land of the blind, the one-eyed man is king”.
As I connect with safety colleagues and friends across the country, it seems we have all set the quality and safety benchmarking goal of being in the top 10% of hospitals across the country. Math was never my best subject, but even I can figure out we can’t all possibly be in the top 10%. It also means those that benchmark to the top 10% still have a long way to go to eliminate harm, as Paul points out.
Striving to achieve quality and safety greatness is vital for all us; using outcome measures to track our progress is a necessary component in achieving that highest level of care. However, my growing concern is that benchmarking might be used only to gain the “competitive advantage” for increasingly uncertain healthcare dollars. If this mindset takes hold, then why share safety and quality best practices with others for fear you might lose your ranking to a competitor? I don’t believe safety and quality people think this way…but am concerned many CFO’s have to. Competing on safety is something other high-risk industries, like aviation, have never done. Airlines may compete on things like on-time arrivals, lost baggage, or customer service, but they always share safety learnings and best-practices.
Paul is right. As far as safety goes, if we strive to eliminate (versus benchmark against a substandard norm), we only compete against ourselves. We know what the ultimate measure of success is – zero harm. More thoughts on competitive concern to come…
This past weekend, I had the wonderful opportunity to give the welcoming remarks at the Annual Recent Advances in Obstetrical Care conference in Baltimore, MD. Being an anesthesiologist, I have worked closely through the years with many obstetrical caregivers in the labor and delivery suite, and I am always honored when asked to share a few thoughts on healthcare today. A few attendees who knew of our blog asked if I would post my opening remarks on Educate the Young. Following is an excerpt sharing my comments on the increasing demands for transparency and the true value of patient partnerships:
What types of transparency are now being asked of us by our patients?
They want Transparency in outcomes. I have heard Peter Pronovost say, “consumers can get more information about the toothpaste they buy than about the care they will receive”. Patients want information on healthcare similar to the information they can obtain and review before buying a new car, choosing a hotel for a vacation, or selecting a restaurant for dinner. They want to be able to make more educated choices about their care options.
They want Transparency in shared decision-making. Informed consent doesn’t cut it anymore. More and more patients want their caregivers to fully understand their values, preferences, needs and goals before any discussions on care options, risks, benefits and alternatives begin. They want information on the hospital and their physician’s experience related to the procedure they will undergo–more succinctly–how many similar procedures have we performed, and how well have we done? They want to know our infection and complication rates. And more and more patients also want to understand the costs related to different treatment options.
And they want Transparency related to medical errors when that error has led to personal harm or loss. They are understandably frustrated and angry when traditional “deny and defend” approaches to unintentional patient harm are used because of medical malpractice fears, or when they are “passed off” to administrators and lawyers when trying to get basic questions answered about their care and possible follow-up treatment needs.
It is my opinion these new patient demands for transparency have been long overdue, are badly needed, and will help move us to a more cost-effective, higher quality, lower risk patient care model. It will be a new and better healthcare system, but history has taught us change will not come easily or quickly.
As you begin your educational meeting today, I want to leave you with one “take-home” suggestion – truly engage and partner with your patients. Many of us who work in quality and safety have learned so much from our patients and family members through the years. For me, one example of this valuable partnership is what I have learned through Carole Hemmelgarn, an amazing woman and patient advocate who taught me the following important communication skill.
When you enter a patient’s room, instead of standing at the foot or side of the bed (as I had done for so many years) pull up a chair, sit down and have a true conversation with them. Research has shown that patients perceive caregivers who did this to have spent twice as much time in the room with them, versus a comparison group of physicians, who actually spent the same amount of time with the patient, but stood at the foot of the bed while talking to them.
Courtesy of our friend, Paul Levy at Not Running A Hospital, who shared a post from ePatient Dave’s healthcare blog, made by Cleveland Clinic and inspired by the words of Henry David Thoreau. What would healthcare, and the world, be like if everyone remembered to see through someone else’s eyes?
The following documentary film trailer for the work in progress entitled, Breaking the Wall of Silence, further reinforces and outlines the need for healthcare consumers to have better access to transparent information as it relates to every aspect of the care being purchased. From access to medical records, to the track record of the physicians performing procedures, to open, honest communication when things don’t go as planned — healthcare thought leaders share their experiences in a system that has taken on a life force of its own, at times at the expense of patients and families. Filmmakers, Carolyn McCulley and Brad Allgood from Citygate Films, also follow Dave Mayer MD, as he leads the Quality & Safety journey at the MedStar Health system in Washington DC/Maryland to create a care environment that embraces the new and evolving demands of healthcare.
Click here to support the film via the Kickstarter Campaign for Breaking the Wall of Silence.
Last week, Dave Mayer MD, the host of Educate the Young, and Tim McDonald MD/JD, were honored for the quality and safety contributions they have made throughout their careers. The pair received the American College of Medical Quality (ACMQ) Founders Award–an award shared by an esteemed group of luminaries in patient safety and quality, such as Carolyn Clancy, Brent James and Don Berwick.
Because of their dedication to students, residents and care providers and their constant premise of “Educating the Young”, many have joined the patient safety movement along the way using their teachings as touchstones for change. Here are excerpts from the shared acceptance speech they gave last week:
All of us working in the quality and safety domain move at such an urgent pace, trying to implement new ideas or best practices that can reduce harm or increase the quality of care for our patients. Because of this, there is little time to reflect on the past and much work still to be done.
Everything we’ve accomplished was made possible by many other thoughtful, clever, original, and wonderful people who invested their passion, soul and expertise in this work.
Whatever we may have accomplished came as a result of our focus always staying true to three things…
First, the importance of the Patient Voice. We have learned more about safety and quality from patients and family members than we have from many of our colleagues. Ten years ago through Rosemary Gibson’s mentorship, we brought patient and family advocates to our Telluride Patient Safety Roundtable long before the term “patient partnership” was a common phrase in quality and safety. They have been a huge part of our work through the years – helping design and implement the Seven Pillars program, being members on our safety and quality committees, creating and teaching in our quality and safety educational programs from our medical school up through our Master’s Program – their support and partnership with us has been so critical to our mission and a classic demonstration of a partnership for patients as CMS envisioned
Second, the importance of Honesty. We did it wrong for too many years. Deny and Defend models when harm occurs don’t work – it is a morally and ethically wrong approach – and it stifles learning and improvement. As Rick Boothman the CRO from Michigan says” “we don’t need a court system to tell us when we have done wrong – we know when we have done wrong.” This isn’t rocket science. We need to be honest and transparent at all times – when we do things well and when we don’t do things so well.. Through the seven pillars we have learned that the honest approach is just not the right thing to do but the smart thing to do for physicians and patients alike.
Third, the importance of a Learning Organization. We are and will always be educators – why this award means so much to us. “Educate the Young” has been an important mission for both of us through the years. The investment ACMQ has made to medical education demonstrates their commitment to “Educating the Young”. The College’s Quality Scholars program that brings students and residents to this meeting is a great example of ACMQ’s commitment to producing the next generation of physician leaders who hopefully always begin each day with their quality and safety compass pointing north. We congratulate and applaud the scholars who are here today for your interest, commitment and leadership to high quality patient care.
ACMQ Leadership also asked that Dave and Tim share some of the highlights of their work over the years. I will share these highlights in a subsequent post so that others can benefit and build on this work, moving the needle even further in the direction of transparent, safe, patient-centered care for all of us, and our families.
March 3rd-9th, 2013 is Patient Safety Awareness Week!
This year, the National Patient Safety Foundation (NPSF) will focus on medication safety and healthcare culture and safety with their Patient Safety 7/365 Campaign: 7 days of recognition, 365 days of commitment to safe care. Below is short video that explains the program, and ETY wants to hear what your organization is doing for Patient Safety week.
Please share the programs you will be providing at your institutions for Patient Safety Awareness Week so that we can create an exchange of good ideas here on ETY!
In October of last year, MedStar Health became the first health system to join the Million HeartsTM campaign, an effort launched by the U.S. Department of Health & Human Services to prevent 1 million heart attacks and strokes by 2017 (see T Friedman & D Berwick, N Engl J Med 2011; 365:e27). As a result, every MedStar patient who sees a cardiologist or primary care provider will be asked to take the “Million Hearts Pledge” and adopt the “ABCs” of cardiovascular health (see MedStar Press Release, 10/8/12). The ABCs below, are also a way to capture Stage 1 & 2 Meaningful Use data in a truly meaningful way — using healthcare prevention as both a springboard and outcomes-based strategy. ABCs include:
- A – Aspirin for people at risk
- B – Blood pressure control
- C – Cholesterol management
- S – Smoking cessation
Million HeartsTM provides a number of resources for your teams to pick up the program and run with it at your institutions as well. Videos, journal articles, took kits and access to partners who can share best practices all can be found here, and following is one example of a video being used to educate individuals on risk factors of stroke. Dr. Amy Hsia, Medical Director of the MedStar Washington Hospital Stroke Center, reminds viewers that stroke is preventable:
As Nicholas Christakis and James Fowler have shared, most people wait until after someone in their own social network experiences a cardiovascular event to adopt prevention strategies (see ETY post, The Power of Social Networks to Change Health Behavior). Here’s a chance to be a leader within your own social network and potentially impact the health of your friends and family. Share the resources provided by Million HeartsTM with friends and family. Share what works here at ETY as well.
Mom had a total knee replacement surgery on Friday, and I’m happy to report she is doing great. She trained for surgery, doing as much pre-surgical physical therapy in the pool and on the bike as her body could tolerate. She is an engaged and determined patient, and she has an engaged family and patient advocate by her side, asking questions she may not know she needs to ask, not being intimately involved in healthcare herself. I’m confident the surgeon was technically skilled, the pain service was attentive and on a schedule for pain management, nurses came in roughly every 4 hours for vitals in the first 48 hours and were kind, always asking her to rate her pain level, and while nutrition services started off like the worst take out order imaginable, they pulled it together over the next couple days. Mom rolled with all of it — no complaints, as she usually does with everything in life.
As someone intimately involved in the delivery of healthcare, I now understand just how many moving parts are involved in a successful hospital stay, and I am also more critical of the care being delivered. I also know it is the greatest gift to care for patients in their time of need, and that as we do this, we are also delivering a costly service that the patient is paying for–one way or another. As such, we need to step up and design and deliver care that addresses the patient’s needs, values, preferences and goals from the outset. While the flow of Mom’s care seemed to even out nicely over the course of her stay, and on a weekend no less, I still saw a number of ways that care could have been more patient-centered. Here are a few:
- The white board in the room had a place for Patient Goals but those were never addressed until I wrote her wishes to be woken up for pain medication on the board.
- Each member of the care team came in separately–the patient or family was not included in a meaningful way in any of the rounds or handoffs.
- The surgeon only did surgeries on Fridays–a nightmare for anyone savvy to the potential hazards of night and weekend care in hospitals.
- Mom was being given instructions while on narcotic pain medication, fresh out of surgery and over the course of the next two days.
- We had to ask the questions, and were not invited into the conversation in a meaningful way as part of the care team.
So the first procedure-related hurdles appear to have been cleared. She’s alive and well, and heading home today. As I remain mindful of the potential for an infection lurking beneath her bandage, or a fall once she’s home, she remains positive and upbeat, ready to do the other knee next year. She has had a positive experience of care, and reports feeling very informed about her procedure and what is to follow, and I’m grateful for the care she received. I can’t help but wonder, however, about the other patients I saw with similar bandages, who may not have been referred to their surgeon by one of his own work colleagues, or did not have a cadre of family and extra ears present to listen in as the pain medication kept them comfortable–I hope their experience was equally as positive. It also reminded me just how resilient we are all are–that despite care not quite as patient-centered as I might have liked, Mom is happy and so far, healing nicely.
As a holiday gift to our readers, we would like to share a talk given by Rosemary Gibson, noted author and patient advocate, who was just named in a recent Forbes article as one of 13 to Watch in 2013: The Unsung Heroes of Healthcare. Rosemary was kind enough to share her expertise with the Patient Safety and Quality leadership at MedStar Health this past October. In an earlier post, Dave Mayer provided highlights from her keynote address, found here. The following video is a copy of her talk, as she outlines the value of ensuring patients are included in all aspects of their care.
Please share Rosemary’s wisdom with your own institutions, as we take a break from blogging this week to reflect and recharge for 2013!