Alliance Asian Health - PowerPoint Presentation

Alliance Asian Health Dr.Prabhu Vianayagam CEO Ex- Managing Director JCI Asia Pacific

Alliance Asian Health To transform healthcare into High reliability organizations Our Vision

Our Solution.. Alliance Asian Health Pte Ltd. Is being launched to address the healthcare issue holistically Our multitude of consultant expertise spread across the entire Asia pacific region will work towards achieving this Specific expertise with medical device and pharmaceutical companies to address the need Government policy making expertise to formulate and implement on a national scale Patient education and involvement methodologies

Number of Physicians in the US = 700,000 Accidental deaths ‘caused by physicians/year=98,000 Accidental deaths/physicians per year=0.14 Number of gun owners in US=80,000,000 Number of accidental gun deaths/year= 1500 Accidental deaths/gun owner=.0000188 ? Conclusion-Doctors are approximately 7500 times more dangerous than gun owners Some Data

this is true… Odds of dying in a plane crash 1:29,000,000 Odds of dying in a car accident1:5000 Odds of medical error in the hospital 1:10 Odds of dying from medical error 1:300

We can continue to do what we have been doing and be here always….

Structure Processes Outcomes System as driver for success Journey of Continuous Improvement

If you want small changes, work on your behavior; if you want quantum leap changes, work on your paradigms

Where We Have Been… Last 50 years: Redesign of medical education Utilization Review Committees Professional Standards Review Organizations (PSROs) Public Reporting Pay for Performance, penalties TQM Accreditation, measures 9

Good News Bad News Beta blockers for heart attack patients Early elective deliveries Central line infections Islands of excellence But hospital care more challenging: Hardest most complex cases Complexity of care puts these patients more at risk for errors 10

Where we are … Routine safety processes fail routinely Hand hygiene Medication administration Patient identification Communication in transitions of care Uncommon, preventable adverse events Surgery on wrong patient or body part Fires in ORs, retained foreign objects Infant abductions, inpatient suicides 11

High Reliability Organizations (HROs) High reliability is the consistent performance at high levels of safety over long periods of time ( Chassin , Loeb 2011) Nuclear power, aviation, petroleum and chemical industries, aircraft carriers, wildfire fighting, space flight Where failure to perform can mean the death of some or all of the team 12

Traits of HROs Believe anything can and will go wrong (engineers) vs. nothing will go wrong (medical) Focus is on reliability It is a mindset and a culture The state of high reliability is never complete or perfect 13

More HRO Traits HROs seek to know what they do not know They aggressively avoid organizational hubris They design redundant systems They proactively share learning and information throughout the organization They break down the silos 14

HRO Traits continued It is NOT: A consensus culture An organization focused on success An organization focused on hierarchy High Reliability in health care: Very limited experience The path to success not clear But some organizations are striving 15

Crucial Elements of High Reliability Leadership Board, CEO, other leaders Safety Culture Robust Process Improvement Understand the methods, train staff 16

High Reliability Health Care RPI Safety Culture Improve Report Trust Leadership

What is culture? Language Food Behaviors Corporate culture Military culture 19

What is Safety Culture? (AHRQ) The safety culture of an organization is the product of individual and group values , attitudes, perceptions, competencies, and patterns of behavior that determine the commitment to, and the style and proficiency of, an organization's health and safety management. Organizations with a positive safety culture are characterized by communications founded on mutual trust , by shared perceptions of the importance of safety, and by confidence in the efficacy of preventive measures. 20

TJC Center for Transforming Health A safety culture within health care can be defined as the summary of knowledge, attitudes, behaviors and beliefs that staff share about the primary importance of the well-being and care of the patients they serve, supported by systems and structures that reinforce the focus on patient safety.  21

Something Simpler Doing things safely even when no one is looking. 22

Why Is Safety Culture So Important? Patients They should not have to worry Business Case, Enlightened Self Interest Errors are costly; payers are pushing back A safe culture is the feedback loop for constantly improving 23

Leaders and Safety Culture The high performing health care leader recognizes the importance of creating and sustaining a safe culture. 24

What is Meant by Blame Free? Need a clear blame free policy : Employees not blamed for honest mistakes or errors in judgment Critical to have near misses reported regularly – you need to create an environment where everyone feels safe making these reports You can’t fix a problem you do not know exists 25

What is a Just Culture? Understands difference between and among: Human error: interruptions, distractions, multitasking At-risk behavior: complacency Reckless behavior: incompetence, substance abuse Response is not related to severity of the error or whether there was harm to the patient 26

Human Error Versus Systems Error Too much focus on human element Root cause analysis, failure mode and effects analysis Determine human error or systems error Most errors result from bad systems Swiss cheese model 27

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Key features of a safety culture program Acknowledgment of high-risk nature of hospital’s activities and determination to achieve consistently safe operations Environment in which individuals are able to report errors or near misses without fear of reprimand or punishment; Collaboration across ranks and disciplines to seek solutions to patient safety problems; and Committed staff time, education, a safe method for reporting issues, etc., to address safety concerns. 29

Safety Culture Standards Compliance Have a patient safety plan Develop an annual report card Have a patient safety committee Educate all staff – near miss is an error Do we agree? Engage the board Engage the medical staff 30

Safety Culture Standards Compliance, cont’d Support employees when there is an event Hold all team members accountable for modeling desirable behaviors Develop organizational process to address intimidating and disruptive behaviors 31

Key Elements of a Safe Culture Leadership: Board, C-Suite, CFO engagement Measuring: safety culture survey Continuous improvement Requires reporting Learning 32

Leadership’s Role Monitor compliance with the safety culture standards Provide people and other resources Spend time on this; make it clear this is a priority Coach, inspire, communicate, motivate; a good CEO is acutely aware of the risks involved and is not irrationally optimistic that everything is ok Leaders give the signals on safety culture 33

Why is creating a safe and just culture so hard? It takes a long time It takes investment (but there is a return) It takes incredible discipline Up until recently, health care did not recognize its relevance Human nature: This can be a force for failure as well as for sustained improvement 34

35 The First Accreditation The American College of Surgeons described the need for standardization of hospitals through accreditation as the need to: “Encourage those which are doing the best work, and to stimulate those of inferior standard to do better.”

36 ACS: The Minimum Standards (1919) Organized medical staff Physicians and surgeons are licensed, competent, and ethical With the governing body, the medical staff adopts rules, regulations, and policies governing the organization’s professional work Accurate, complete, and accessible medical records Competently supervised diagnostic and therapeutic facilities are available

Strengths of the Accreditation Methodology as a QI tool Is implemented organization-wide Focuses on systems, not individuals Stimulates quality culture in the organization Focus on improving structures e.g. facilities and staffing and reducing variation through more systematic implementation of processes Greater sustainability as it requires periodic re-evaluation against standards Incentive to improve to meet standards as accreditation standards are revised 37

Summary of Studies on the Impact of Accreditation Hinchcliff , Greenfield, Braithwaite, and others “Narrative synthesis of health service accreditation literature” BMJ Qual Saf 2012,0. 1-13. Reviewed 122 empirical studies“The literature is limited in terms of the level of evidence and quality of studies, but highlights potential relationships among accreditation programmes , high quality organizational processes and safe clinical care.” 38

Summary of Studies on the Impact of Accreditation, cont’d Braithwaite et al: Qual Saf Health Care 2010; 19:14-21 Accreditation performance significantly positively correlated with organizational culture and leadership but unrelated to organizational climate and consumer involvement Greenfield, Braithwaite: Summary of studies of effectiveness of accreditation on clinical outcomes, Int J Qual Health Care 2008; 20:3, pp.172-183consistent findings showing accreditation positively impacted promoting change and professional development inconsistent findings related to professions’ attitudes toward accreditation, organizational impact, financial impact, quality measures, and program assessment 39

Summary of Studies on the Impact of Accreditation, cont’d Haute Autorite de Sante (HAS), 2011 “Literature review on the impact of hospital accreditation” A search produced 864 references of which 56 articles included in analysis. “Most of the studies suggest there is a positive relationship between accreditation / certification of hospitals and improvement in the organization / management and professional practice within hospitals…. its impact on health outcomes or improvement in these outcomes has not been demonstrated” 40

Weaknesses of Accreditation as a Methodology The standards are not uniform in content and language, even those ISQua accredited Some standards codify law and regulation and seem to take the place of licensing The evaluation process varies widely The decision process varies widely The re-evaluation varies in length and content Insufficient guidance on how to implement efficiently, reliably and sustainably 41

42 JCI Value and Impact Study in Jordan To quantify the value (expressed in monetary terms) and impact of implementing achieving JCI accreditation Retrospective case record review over a 3-year period Compare data related to 6 managerial and economic quality indicators in two groups of acute general hospitals in Jordan Accredited group consisted of 3 private hospitals that received JCI accreditation in 2007 or 2008 Non-accredited consisted of 2 similar private hospitals (not obtained nor sought accreditation during that time)

Results

44 Conclusions of JCI Jordan study Results show statistically-significant improvements in the JCI-accredited hospitals on 3 indicators: Return to ICU within 24 hours of discharge Staff turnover per year Completeness of medical records Total annual savings per accredited hospital = $87,600

45 JCI Value and Impact Study in Spain Objectives: Quantify the impact of Joint Commission International (JCI) hospital accreditation on quality and economic costs Location: Asturias and Andalusia regions, Spain Retrospective controlled design Compare JCI-accredited hospitals against control hospitals Quantitative indicators: Managerial quality (1), Clinical (4), Medical complications (6) Compare 2 periods and measure if there is statistically significant difference pre-accreditation (2-4 yr ), post-accreditation (3-4 yr ) Calculate savings

Results for Asturias 2008 JCI accreditation (compared to 4 control hospitals in same region and cluster) Positive indicators: 3 clinical Total savings: €2,827,000/ yr Cumulative over 4 years of accreditation: 11,308,000 46

Results for Andalusia One hospital, 1999 JCI accreditation (compared to 6 control hospitals, only 2 indicators available): Positive indicators: 2 clinical Total savings: €522,000/ yr 47

Closing Thoughts It is difficult to rigorously measure the effect of accreditation Data that we have does show that accreditation is a credible improvement methodology and can provide cost-savings beyond what is spent on accreditation However there is insufficient research on the key factors determining successful implementation of accreditation and what will make change sustainable Accreditation can be better thought as a tool for organizational transformation 48

Follow Us Dr. Prabhu Vinayagam Founder and CEO Alliance Asian Health No one can go back and make a brand-new start, my friend; but anyone can start from here and make a brand new end - Dan Zadra

Thank you Prabhu_v@Allianceasianhealth.com.sg www.allianceasianhealth.com.sg