322 Quiz 4/11
what does an internal assessment show?
(recognition and self awareness) Organizations must be able to assess the prevalence, context, and impact of behaviors to identify potential opportunities for improvement will help pinpoint the seriousness of the situation and provide clues to areas that need to be addressed
A quantified selfer is best described as one who: A. graphs data. B. tracks personal metrics. C. records lab values. D. uses a sleep diary.
B. tracks personal metrics
info exchange strategies
SBAR call out check back handoff
6 areas of what healthcare should be (Institute of Medicine)
safe, effective, efficient, equitable, patient centered, timely
10 simple rules for 21st century healthcare systems of what patients should expect from their healthcare
1. Beyond patient visits 2. individualization 3. control 4. information 5. science 6. safety 7. transparency 8. anticipation 9. value 10. cooperation
what is call-out?
A strategy used to communicate important or critical information It informs all team members simultaneously during emergency situations It helps team members anticipate next steps
Which factor has most influenced the epatient movement? A. The Internet B. The Human Genome Project C. The Association of Cancer Online Resources D. The quantified self
A. The internet
an epatient is best described as one who: A. from various sources and uses the information for decision making with health providers. B. manages health decisions, uses the Internet and uses biosensors. C. collaborates with the health provider, has a chronic illness, and writes blogs. D. makes all decisions, prepares for doctor visits, and gathers data points
A. seeks health information from various sources and uses the information for decision making with health providers.
Which of the following factors most influenced people to use the internet for their healthcare information: a. Out of pocket expenses for healthcare services b. Reluctance to take up the doctor's time asking questions c. Having to wait several weeks to see their doctor d. Distrust of the healthcare system
A: Out of pocket expenses for healthcare services
key components of any patient safety program
Addressing defects in communication that affect collaboration, information exchange, appreciation of roles and responsibilities, and direct accountability for patient care are key components of any patient safety program Clinical and administrative leaders must set the tone by establishing and adhering to behavioral standards that support agreed-upon code of conduct practices backed by a nonpunitive culture and zero-tolerance policy
what legislative and policy actions contributed to epatient movement what do the acts require
American Recovery and Reinvestment Act of 2009 (and the Meaningful Use requirement) Patient Protection and Affordable Care Act of 2009 & Health Care and Education Reconciliation Act of 2010 Both acts required all American citizens secure health care insurance either private insurance or government insurance
teamwork actions
Communicate with team members in a brief, clear, and timely format Seek information from all available sources Verify and share information Practice communication tools and strategies daily (SBAR, call-out, check-back, handoff)
effective strategies for enhancing collaboration and communication
Creating opportunities for different groups to just get together (interactions can be either formal or informal) Encouraging open dialogue collaborative rounds implementing preop and postop team briefings creating interdisciplinary committees or task forces that discuss problem areas frequently provides an upfront solution that reduces the likelihood of disruptive events When a disruptive event does occur, some organizations have implemented a time-out or red light policy that addresses the issue in real time to prevent any further serious consequences Developing and implementing a standard set of behavior policies and procedures is vital Policies need to be consistent and universally applied Should not be a separate policy for any one particular discipline or service For the medical staff, the policies should become part of the medical staff bylaws with signed agreements to abide by these policies at the time of appointment and recredentialing Included in the policies should be a standardized protocol outlining expected standards and the process for addressing disruptive behavior issues, recommendations, follow-up plans, and actions to be taken in the face of individual resistance or refusal to comply Prior to implementation, make sure all employees are familiar with the existence, purpose, and intent of the policies and procedures.
trends related to personal health records
Development of personal computing devices and the Internet Development of EHRs Governmental policies (Health Insurance Portability and Accountability Act [HIPAA], Health Information Technology for Economic and Clinical Health [HITECH]) Person's desire for functions
what domain most influenced epatient movement
Engage Patients and Families
how has interdisciplinary CRM training has brought significant improvements to communication flow in the perioperative setting.
Fostering an environment of trust and respect, accountability, situational awareness, open communication, assertiveness, shared decision making, feedback, and education
challenges for clinicians and healthcare systems with healthcare informatics and EHRs
Have to learn new ways to interact with patients Have to learn and invest in technology to meet current standards and expectations Have to increase knowledge and keep current with healthcare resources, information & treatment modalities
qualities of high performing teams
Hold shared mental models Have clear roles and responsibilities Have clear, valued, and shared vision Optimize resources Have strong team leadership Engage in a regular discipline of feedback Develop a strong sense of collective trust and confidence Create mechanisms to cooperate and coordinate Manage and optimize performance outcomes
I PASS the BATON
I-introduction P-patient A-assessment S-situation S-safety concerns the B-background A-actions T-timing O-ownership N-next (like SBAR but goes into more detail
meaningful use stage 1: 5 domains for implementation of electronic health records
Improve Quality, Safety, Efficiency Engage Patients & Families Improve Care Coordination Improve Public and Population Health Ensure Privacy and Security for Personal Health Information
barriers to team effectiveness
Inconsistency in Team Membership Lack of Time Lack of Information Sharing Hierarchy Defensiveness Conventional Thinking Complacency Varying Communication Styles Conflict Lack of Coordination and Followup With Co-Workers Distractions Fatigue Workload Misinterpretation of Cues Lack of Role Clarity
what does TeamSTEPPS say about importance of communciation
Ineffective communication is a root cause of nearly 66 percent of all sentinel events reported Ineffective communication has remained among the top three root causes of sentinel events As these data illustrate, failure to communicate effectively as a team significantly increases the risk of error
operational concepts of CRM include:
Inquiry seeking relevant operational information advocacy communicating proposed actions conflict resolution Decision making
what is a personal health record
It is a system which collects (aggregates) & stores information It is a tool that persons can use to manage their health
the most significant barriers to increased used of PHR
LACK OF AWARENESS ABOUT THEM AND LACK OF AWARENESS OF THE BENEFITS
challenges/barriers to clinical decision support implementation
Lack of incentives Implementation challenges Low adoption of a EHR system Multiple data sources with little information exchange Cookbook medicine": belief among some physicians that use of CDS systems reduces medicine as an art and highly individual care to one recipe fits all.
communication challenges
Language barrier Distractions Physical proximity Personalities Workload Varying communication styles Conflict Lack of information verification Shift change
clinical decision support application
Medication dosing support Order facilitators: system brings up orders as r/t diagnosis or services (pre & post op) Chronic disease management Point-of-care alerts and reminders Relevant information display: patient summaries Expert systems: makes automated recommendations for therapies based upon patient parameters (diagnosis based on s/s, antibiotics base on pt data Workflow support: tool that coordinates steps of pt. care (orders, care transitions, documentation)
communication style difference between nurses and doctors
Nurses are taught to be more descriptive of clinical situations, whereas physicians learn to be very concise
what does a handoff include?
Optimized Information Responsibility-Accountability Uncertainty Verbal Structure Checklists IT Support Acknowledgment
paper health record
Persistent data storage that is portable and shareable
electronic personal health record
Persistent data storage that is portable and shareable plus additional functions that include access to electronic health records (EHRs), secure messaging, and scheduling
integrated plan of care
Pooling of specialized services leads to integrated interventions The plan of care takes into account the multiple assessments and treatment regimens, and it packages these services to create an individualized care program that best addresses the needs of the patient
responses to reporting disruptive behaviors
Responses should be timely, appropriate, consistent, and provide necessary feedback and follow-up
Lack of communication among department staff can lead to failure to:
Sharing information with the team. Requesting information from others. Directing information to specific team members. Include patients and their families in communication involving their care.
Bates' Ten Commandments for effective CDS
Speed is everything Anticipate needs & deliver in real time Fit into the user's workflow Little things make big differences Recognize that physicians will resist change Changing directions is easier than stopping simple interventions work best Ask for additional info only when you need it Monitor impact, get feedback & response Manage & maintain your knowledge base systems
how do nurses and doctors bridge the difference between their communication styles
Standardized communication tools
three driving forces of participatory health
The needs of the patient come first. Every patient is the only patient. Nothing about me, without me
TeamSTEPPS says communication is
The process by which information is exchanged between individuals, departments, or organizations The lifeline of the Core Team Effective when it permeates every aspect of an organization
definition of clinical decision support
Tools and interventions that provide clinicians, staff, patients, or other individuals with knowledge and person-specific information, intelligently filtered or presented at appropriate times to enhance health and healthcare.
hand off
Transfer of info along with authority and responsibility during a transition in care to include an opportunity to ask questions, clarify, and confirm
Examples of missed communication opportunities include:
Unavailable or underutilized status board. Inconsistencies in the utilization of automated systems. Poor documentation—not timed, nonspecific, illegible, and incomplete. Failure to seek input from the patient.
advantages and disadvantages of current PHRs
Users know more about own health & manage it better. Improved HC coordination Have capacity for personal health data, medical appointments, integration of health care Disadvantage: access to technology and or user friendly programs
what is check back
Using closed-loop communication to ensure that information conveyed by the sender is understood by the receiver as intended sender initiates message receiver accepts message, provides feedback communication sender verifies message was received
characteristics of online healthcare consumers
Well: Online needs are episodic and occasionally driven by the need to seek out specific information related to prevention and wellness. research online resources/info prior to doctor appointments Newly Diagnosed: Is driven by a sense of urgency to understand, manage, and mitigate a recent change in health status. more likely to track their health using online biosensors: hear rate monitors, mood maps, sleep diariesdiari Chronically Ill: Aligns loyalty to sites with resources, services, and support for their specific condition. also more likely to track health & more likely to use online support groups Quantified Selfer : latest type; people vested in using tools and data to measure and monitor own health using personal metric: calorie intake, exercise
what is ehealth?
a broad concept used to describe Internet or web-based activities that relate to healthcare, yet no consensus about the definition exists among researchers, policymakers, clinicians, or patients.
participatory patient-centered healthcare
a patient centered model that encourages & expects active involvement in healthcare decisions & activities among patients, families, caregivers & health care professionals
hurdles to overcome to foster a team collaboration environment
additional time perceived loss of autonomy lack of confidence or trust in decisions of others clashing perceptions Territorialism lack of awareness of one provider of the education, knowledge, and skills held by colleagues from other disciplines and professions
what do aviation and wilderness firefighting have in common with interprofessional care in the health field
all involve settings: a huge variability in circumstances the need to adapt processes quickly a quickly changing knowledge base highly trained professionals who must use expert judgment in dynamic settings
what is 93% of communication affected by?
body language, attitude, and tone
what is an interdisciplinary approach?
combines a joint effort on behalf of the patient with a common goal from all disciplines involved in the care plan
literature reviewed shows that effective teams are characterized by:
common purpose and intent, trust, respect, and collaboration
An 89-year-old female presents to the hospital and has a history of chest pain. Many tests are being run to determine the cause of the chest pain. The patient and her family decide they no longer want aggressive measures taken and request that the patient's code status be changed to DNR. The night shift documents in the progress note that the patient requested not to be resuscitated. The night shift does not flag the patient's chart, relay the information during shift change, or notify the attending physician. The morning shift does not read the night shift's notes because of several immediate emergencies.
communication challenge example
what is the leading root cause of the sentinel events reported to the Joint Commission?
communication failures
standards of effective communication
complete clear brief timely
what is a clinical champion?
early adopter who actively promotes the importance of appropriate behavior, communication, and team collaboration can be an extremely valuable asset Champions can come from the executive ranks or through the voluntary interest and enthusiasm of other staff members Co-champions may be even more effective. Some Communication & Teamwork organizations have reported that having a nurse and physician (or other health care professional) go through a joint training program will help foster mutual cooperation and collaboration between the different disciplines
what do CRM programs typically include?
educating crews about the limitations of human performance Trainees develop an understanding of cognitive errors develop an understanding of how stressors (such as fatigue, emergencies, and work overload) contribute to the occurrence of errors
impact of physician and nurse disruptive behavior
effect on staff relationships staff satisfaction and turnover patient outcomes of care (adverse events & medical errors) compromises in patient safety poor quality care links to preventable patient mortality ***Many of these unwanted effects can be traced back to poor communication, collaboration and ineffective teamwork***
when it comes to reporting disruptive behaviors organizations need to:
encourage its employees to report disruptive behaviors address issues related to confidentiality, fear of retaliation, and the common feelings that there is a double standard and that nothing ever gets done Reporting mechanisms should be made easy and must be supported by the presence of a nonpunitive environment The ideal vehicle for reporting is to address the situation in real time, but concerns about position, appropriateness, receptiveness, fear, hostility, and retaliation are significant impediments.
what does the E mean in epatient
equipped enable empowered engaged
One member of the team calls out, "BP is falling, 80/48 down from 90/60." Another team member verifies and validates receipt of the information by saying, "Got it; BP is falling and at 80/48, down from 90/60." The original sender of the information completes the loop by saying, "Correct."
example of check back
A physical therapist sees a patient with carpal tunnel syndrome. The physical therapist discusses the case with the physician and recommends ice treatment to decrease inflammation. The physician agrees with the recommended treatment.
example of communication challenge
A patient in the Emergency Department needs a chest X-ray to rule out a pneumothorax (collapsed lung). The physician requests that the nurse call for a chest X-ray and assumes she understands his intent of a portable stat. Instead, the patient is transported to X-ray for a standard AP and Lateral chest X-ray
example of communication failure
benefits of current personal health records
experience of care: The flexibility offered by PHRs may improve individuals experience of care r/t e-scripts, treatment instructions, appointments Quality of care: PHRs still new thus evidence of quality limited. Early studies have data of positive outcomes r/t treatment compliance Other studies indicate increased satisfaction wit health care experience (less paperwork, less wait periods) Utilization and costs: Anticipated increase use of PHR for appointments, meds, will decrease time for both patients & providers
team members value __________ over __________
familiarity over formality
what does CRM consider?
fatigue and stress the nature of human error
methods to obtain assessment info
formal methods such as: incident reports, survey tools, focus groups, department meetings, task forces or committees, direct observation, suggestion boxes, and hot lines Informal methods such as: casual meetings and gossip can also provide valuable surface information and should be evaluated more deeply as to the source, relevance, and significance of the events to determine next steps
what is collaboration in healthcare defined as
health care professionals assuming complementary roles and cooperatively working together, sharing responsibility for problem-solving and making decisions to formulate and carry out plans for patient care
what has influenced people to seek out information and support for health care questions instead of going through healthcare providers
high cost of healthcare & out of pocket expenses
what have team training programs been shown to improve?
improve attitudes, increase knowledge, and improve behavioral skills
effective communication can lead to the following positive outcomes:
improved information flow more effective interventions improved safety enhanced employee morale increased patient and family satisfaction decreased lengths of stay
reasons for hesitancy to speak up
intimidation fear of getting into a confrontational or antagonistic discussion lack of confidentiality fear of retaliation the fact that nothing ever seems to change
what is the major concern about disruptive behavior
is how frequently they occur and the potential negative impact they can have on patient care
several ways patients are at risk when healthcare professionals are not communicating effectively
lack of critical information misinterpretation of information unclear orders over the telephone overlooked changes in status
CRM defines behaviors that are countermeasures to error such as:
leadership briefings Monitoring cross-checking decision making review and modification of plans
disadvantage of PHRs historically
lost, difficult to maintain
most crucial aspects of reporting system
maintaining confidentiality and reducing risks of retaliation give recognition and assurance that the complaints will be addressed and actions will be taken.
what is 7% of communication?
meaning and intent based on the actual words said
what ranks number five for top 10 causes of death in US
medical errors; which can occur from lack of communication
value that most health professionals have in common
meet needs of patients or clients
what is the first crucial step
organizational commitment and willingness to address the situation
characteristic most health professionals have in common
personal desire to learn
who should take courses on effective communication
physicians & physicians in training Nurses & nursing students all other staff who have patient contact or play a role in the delivery of patient care. For individuals who have consistently exhibited disruptive behavior, education may need to be supported by more focused sessions and specific counseling
what is crowdsourcing?
process of obtaining needed services, ideas, or content by soliciting contributions from a large group of people, and especially from an online community instead of suppliers - includes academic & clinical research to develop reliable patient reported outcomes
appropriate vehicles for reporting
reporting of the incident to a superior, filing an incident report, using a complaint or suggestion box, or reporting directly to a task force or interdisciplinary committee with assigned responsibilities for addressing these issues
what is crew resource management (CRM)
safety training focused on effective team management (aviation) Involves standardized communication and teamwork Emphasizes the role of human factors in high-stress, high-risk environments Encompasses team training as well as simulation, interactive group debriefings, and measurement & improvement of aircrew performance
the rallying point of organizational commitment
should be around behavioral standards and their relationship to patient safety
types of personal health records
stand-alone: Store records on personal computer or USB device. Not widely adopted untethered: Web based system. Can automatically gather data from multi sources. Does not link to providers (for appointments, prescriptions, etc) tethered: Linked to one healthcare system and allow pt to view their health data so also called patient portals. Provides users with messaging, med refills & appointment scheduling networked: Fully integrated PHR that links services and healthcare data that patients can access through a user name & password.Includes health information such as recommendations for illnesses, medication etc
Literature shows that because of the complexity of medical care, coupled with the inherent limitations of human performance, it is critically important that clinicians have:
standardized communication tools create an environment in which individuals can speak up and express concerns
implementing systems to facilitate team communication can:
substantially improve quality encourages effective teamwork among staff promotes continuity and clarity within the patient care team encourages collaboration fosters teamwork helps prevent errors
what is one of the most important factors in improving clinical effectiveness and job satisfaction
teamwork and communication
TeamSTEPPS
teamwork system developed jointly by the Department of Defense (DoD)and the Agency for Healthcare Research and Quality (AHRQ) to improve institutional collaboration and communication relating to patient safety (enhance evidence-based practice)
what is an effective strategy in enhancing teamwork and reducing risks
the adoption of standardized tools and behaviors
what is communication
the imparting or interchange of thoughts, opinions, or information by speech, writing, or signs
according to TJC what is the primary objective of a handoff?
to provide accurate information about a patient's/client's/resident's care, treatment and services, current condition, and any recent or anticipated changes. The information communicated during a handoff must be accurate to meet patient safety goals.
what are effective teams characterized by?
trust, respect, and collaboration
concerns regarding personal health records
usability: Users are disappointed in the: Amount of data available Type of data available Need to enter all the data themselves Limited options for sharing data with clinicians privacy: studies show that PHRs can securely exchange health information, users are still concerned with security digital divide: Individuals of lower socioeconomic status, ethnic minorities & elderly are less likely to adopt a PHR. interoperability: data and functions are constrained by the systems to which the PHR is linked (only as good as what has been purchased) law and policy: in cali, certain results can't be electronically released for any reason; currents laws prohibit healthcare providers from delivering care across state line
application of a CRM model to medicine
• Design of systems to absorb errors through redundancy, standardization, and checklists • Movement from placing blame to designing safe processes and procedures, i.e., applying a systems approach • Assurance of full immunity while implementing a nonpunitive approach • Debriefing of all events, including near misses, that have learning potential. Focus on the severity of the potential risk rather than on the severity of the event's final outcome is more conducive to establishing effective prevention programs. • Institutionalization of a permanent program for risk identification, analysis, and dissemination of the lessons learned throughout the professional community
components of successful teamwork
• Open communication • Nonpunitive environment • Clear direction • Clear and known roles and tasks for team members • Respectful atmosphere • Shared responsibility for team success • Appropriate balance of member participation for the task at hand • Acknowledgment and processing of conflict • Clear specifications regarding authority and accountability • Clear and known decision making procedures • Regular and routine communication and information sharing • Enabling environment, including access to needed resources • Mechanism to evaluate outcomes and adjust accordingly
common barriers to inter professional communication and collaboration
• Personal values and expectations • Personality differences • Hierarchy • Disruptive behavior • Culture and ethnicity • Generational differences • Gender • Historical interprofessional and intraprofessional rivalries • Differences in language and jargon • Differences in schedules and professional routines • Varying levels of preparation, qualifications, and status • Differences in requirements, regulations, and norms of professional education • Fears of diluted professional identity • Differences in accountability, payment, and rewards • Concerns regarding clinical responsibility • Complexity of care • Emphasis on rapid decision making
