Pag­ing Dr. Su­per­star

Docs urged to adopt habits that lead to op­ti­mal care

Modern Healthcare - - The Week In Healthcare - Jessica Zig­mond

Aphysi­cian with su­pe­rior clin­i­cal skills who at­tracts busi­ness but dis­plays a bad tem­per is no su­per­star. So said Diane Pi­nakiewicz, pres­i­dent of the Na­tional Pa­tient Safety Foun­da­tion, last week dur­ing the group’s 13th an­nual Pa­tient Safety Congress in Wash­ing­ton.

“A su­per­star is some­one who has ex­cel­lent clin­i­cal skills and maybe brings a lot of busi­ness into your or­ga­ni­za­tion but also be­haves in a way that ab­so­lutely is sup­port­ive of an ef­fec­tively func­tion­ing team,” Pi­nakiewicz said.

Ef­fec­tive team­work is crit­i­cal in cre­at­ing a cul­ture of pa­tient safety, she said, adding that al­though the health­care in­dus­try has talked about accountability—the theme of this year’s meet­ing—in terms of clin­i­cal out­comes, it has not talked about accountability of be­hav­ior.

Pi­nakiewicz also said “dis­rup­tive be­hav­ior” is a big term to­day in the pa­tient-safety arena and de­scribed that be­hav­ior as any ac­tion that com­pro­mises a team’s abil­ity to pro­vide a pa­tient with op­ti­mal care. Fail­ing to wash hands or eye-rolling among team mem­bers dur­ing a “time out” in the op­er­at­ing room would qual­ify as dis­rup­tive, she said.

The meet­ing, which drew 1,100 to 1,200 par­tic­i­pants, also sought to broaden pa­tient-safety ef­forts be­yond the tra­di­tional in­pa­tient set­ting.

“We al­ways knew from the be­gin­ning of this work when it be­gan in earnest that we were re­ally only look­ing at the tip of the ice­berg when we looked at the in­pa­tient side,” Pi­nakiewicz said. “And we fo­cused there be­cause that’s where the stud­ies were first done and be­cause that’s where the com­plex­ity is high­est so that’s where the big fixes needed to take place first.”

In one break­out session on out­pa­tient safety, Ruthie Goldberg, group leader for Kaiser Per­ma­nente’s South­ern Cal­i­for­nia Clin­i­cal Op­er­a­tions, and Dr. Michael Kanter, med­i­cal di­rec­tor, qual­ity and clin­i­cal anal­y­sis at South­ern Cal­i­for­nia Per­ma­nente Med­i­cal Group, high­lighted re­sults from Kaiser Per­ma­nente South­ern Cal­i­for­nia’s Out­pa­tient Safety Pro­gram. The pro­gram fea­tures “safety nets”—re­gional pro­grams that iden­tify pa­tients who have out­pa­tient safety risks by us­ing small, cen­tral­ized teams that have lim­ited clin­i­cal scope ca­pac­ity and cler­i­cal sup­port. The ar­eas of pri­mary fo­cus are diagnosis de­tec­tion, med­i­ca­tion mon­i­tor­ing, po­ten­tially harm­ful in­ter­ac­tions and nec­es­sary fol­low-up care.

“The first place that’s eas­i­est to start is with track­ing ab­nor­mal re­sults,” Goldberg said af­ter the pre­sen­ta­tion. “Ev­ery sin­gle am­bu­la­tory in­sti­tu­tion has pro­cesses for test­ing peo­ple and screen­ing peo­ple for things and they all have pro­cesses—many of which are pa­per—to see what the re­sult is,” she added. “And the first place to look is: How do we make sure that if a re­sult is ab­nor­mal, we make sure that we fol­low up with it?” Even if a pa­tient does not ini­tially fol­low clin­i­cians’ di­rec­tions, Goldberg said, “I think that’s re­ally the first place to start.”

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