
Today, a key priority for healthcare facilities, in the era of pay-for-performance, is addressing patient safety issues such as preventable medical errors and adverse outcomes of routine care. When evaluating software to address policy and procedures management, one of the most important considerations that healthcare providers ask us is, “How does policy management software address patient safety and improvement in quality?” This is an extremely understandable concern and one that we see as becoming increasingly important at the forefront of policy management automation projects. Usually hospitals or health systems are driven to invest in policy management systems because of a poor or pending accreditation survey. However it is the impact on patient safety, continuous quality improvement, and patient satisfaction that truly matters when thinking about upgrading your policy and procedures management systems.
Preventable Medical Errors & Adverse Events
In 2000, the Institute of Medicine (IOM) published a landmark study on the state of patient safety in the US healthcare system and put the spotlight on systems of care that needed to be addressed. The report found that between 44,000 and 98,000 patients die of preventable medical errors each year at hospitals in the United States, and many more suffer from adverse outcomes that could have been prevented with better systems of care (IOM, 2000). In addition research indicated that another 100,000 preventable patient deaths occur annually as a result of avoidable hospital acquired infections (HAIs). Overall, deaths from preventable medical errors and HAIs are considered to be the fourth leading cause of death by the CDC (higher than deaths from breast cancer, motor vehicle accidents, and AIDS/HIV combined). Despite major strides that have been made in science and technology over the past two decades, patient safety and variation in the quality of care delivered remains a major issue for policy makers, payers, and healthcare facilities to address. Dr. Sanjaya Kumar, Chief Medical Officer at PolicyMedical, highlighted the impact on patients that preventable medical errors can have in his first book, Fatal Care, and in his second book, Demand Better, pointed out what healthcare systems could do to establish better practices and environments of care. A key to a good system of care is having staff that are knowledgeable and that have access to key information on the standard operating protocols of the healthcare system. This needs to readily available when needed, such as those that are contained within current policies and procedures.
It is clear that healthcare providers are committed to the health and safety of their patients, and delivering the highest quality of care possible. Sadly though human error, failure of mitigating safeguards, and other system related issues regularly cause preventable adverse events to occur. This can lead to untoward harm to patients. Over 70% of these events have been found to be avoidable through implementation of better processes and systems that have better safeguards in place. One of the most important system related components found to be critical in mitigating patient safety events, decreasing risk, avoiding HAIs and improving quality is ready access to key information and knowledge bases for staff. This allows them to make better-informed decisions when encountering situations or practicing in a more reliable and precise fashion. As organizations become more complex, having centralized document management with ready access and distribution capabilities for staff to use is hugely important. This goes for governance, risk management, and compliance (GRC) become a priority for healthcare providers to establish. Various organizations, from the World Health Organization (WHO) to regional and local governments have devised patient safety strategies. Many of these strategies are focused not only on direct patient care, but also on a shift to an organizational culture of safety overall. One of the first and most important steps, in an organizational shift to become safer, is to implement healthcare policy and procedures management software. Not only to implement, but to utilize it and administer it to its full potential.
The Relationship Between Organizational Culture And Patient Safety
In Canada, taking a cue from the US, a number of initiatives are underway to better understand what Canadian healthcare providers can do to establish better systems of care. One of the organizations we spoke with was the Public Services Health and Safety Association. Brent Webb, who is the Regional Consultant in the North-eastern Region for the Association, is an expert on the relationship between organizational culture and patient safety. His department works within the prevention system, helping hospitals and healthcare facilities with their policies, procedures, and training to be able to prevent injuries before they happen. They look specifically at the organization’s health and safety culture, to determine why certain behaviours occur and how they can be strategically addressed.
Webb and his team recently carried out a climate assessment project on behalf of the Ontario Ministry of Health and Long-Term Care. The goal of the project was to measure tangible aspects of a health and safety culture. Specifically, it looked at the perceptions, values and beliefs of the individuals within healthcare organizations, and how these things affect patient safety. The project took place at four types of healthcare facilities: a community care organization, an acute care clinic, a public health unit, and a long-term care home. The project included health and safety assessments, interviews, focus groups, and an analysis of the direct and indirect behaviours of the organization. Information gleaned from the climate assessment project was used to inform patient safety initiatives within each organization.
After analyzing these healthcare organizations, Webb noticed a definite trend – a greater focus on health and safety of employees and patients. If employees believe that an organization cares about them as individuals, both physically and psychosocially, this can serve as a catalyst to change the greater organizational culture. Webb believes that this can have significant effects on patient safety and quality of care.
Developing A Cultural Of Health And Safety
Developing a culture of health and safety in an organization does not happen overnight, and usually does not happen organically. In most cases, the culture of an organization is rooted in policies an
d procedures. Webb explains, “Health and safety has legal requirements to it. We need that foundational aspect. As human beings, we need direction.” It is critical for an organization to have formal documents to provide a governance structure and guide the development of a culture of health and safety. Webb continues, “Now, more importantly than that is how those documents become liveable. How they become something that changes or affects the behaviour of people within your organization.”
In today’s increasingly complex healthcare operating environment, where different healthcare providers are having to align and operate as a unit to ensure better outcomes from care delivered, it is imperative that we maintain our focus on implementing, adopting, and establishing solutions that can aid in the ready access to, and distribution of, key policies and procedures that staff need to stay on top. The WHO has called patient safety an endemic concern, and our efforts to address it should be broad and systemic (World Health Organization). It is clear that initiatives to improve patient safety must be grounded in policies and procedures that influence a culture of safety at the organizational level.
Improving Healthcare By Using Policy Management Software
Over the past 15 years we have worked to support these efforts and it is why we pioneered the use of policy management software within the healthcare environment. We have found that over the years that those organizations that use our software, or other vendors’ software, become significantly more confident in the management of their policies and procedures. A lot of this confidence comes from being more in control of policies, being more responsive to changes, and managing staff uptake of policies and procedures. This in turn helps reduce the amount of preventable medical errors and quality of care delivered, which is the absolute critical objective of everyone within the healthcare community.
That is why we would be more than happy to discuss your organizations needs for the management of policy and procedures whether you use our software or not. At the end of the day any experience sharing (having gone through thousands of policy management projects) and direction we can give you that helps improve healthcare provision makes it a worthwhile conversation to have. Please contact a member of our team for more information. Alternatively if you would like to see our software firsthand then please request a free demonstration.