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Mean hospital costs were lower for intervention patients than for controls at days Coleman et al. The model is implemented by a single advanced practice nurse using evidence-based protocols and with a focus on long-term outcomes. The model was initially tested in a randomized controlled trial of older adults at the University of Pennsylvania Hospital Naylor et al.

It resulted in fewer hospital readmissions, fewer total days rehospitalized, lower readmission charges, and lower charges for healthcare services after discharge. The final model emerged from a collaboration among the American College of Physicians, the Society of Hospital Medicine, the American Geriatric Society, the American College of Emergency Physicians, and the Society for Academic Emergency Medicine to develop consensus standards to address quality gaps in care transitions.

Although efforts to improve care transitions had been ongoing for some time, those efforts were fragmented and uncoordinated. About 3 years ago, a small group of clinicians, healthcare administrators, and government agency staff, coordinated by the Massachusetts Health Data Consortium and Massachusetts Senior Care Foundation, came together to discuss gaps in such efforts and how to disseminate individual work more broadly.

That group grew to more than stakeholders and is now known as the Care Transitions Forum, representing a community of interest that meets quarterly to share best practices and provide mentorship to institutions and organizations across the state. Concurrently, senior policy staff from the Massachusetts Executive Office of Health and Human Services had been developing statewide initiatives around patient-centered medical homes and accountable care organizations. They determined that none of these reforms would attain maximum effectiveness unless coordination across care settings was improved.

The development work was a learning process involving public and private stakeholders from across the Commonwealth. A working group composed of senior administration officials working together with the policy community began by reviewing the. To effect system change, the group explored innovations along multiple dimensions—medical practice, public health, and healthcare financing—and eventually composed a vision for the future Box A strategic plan was drafted over the subsequent months.

The strategic plan 2 contains five main sections. The next section reviews what is known about effective transitions based on national models and randomized trials. The next two sections summarize current projects in Massachusetts that form the infrastructure for future work, and place them in the state and federal policy context. The final section presents the vision for improving care transitions, including principles, recommendations, action steps, and measures for consideration. One goal is to weave the many currently fragmented care transition projects in Massachusetts into a fabric that covers the state.

We believe Massachusetts can be a model healthcare learning state and can lead the nation in improving care transitions and reducing avoidable hospitalizations. We had a number of objectives in writing the strategic plan. To this end, we. Still, the first few drafts appeared to lack a strong enough patient focus, so an unfolding case study was added to the document. Another objective was to build consensus among the many stakeholders as to the most important care transition principles; to this end, it was necessary to get people to agree to work together outside of their individual institutions for the good of state health policy.

For example, many institutions have their own patient transfer form or process. Numerous forms, very similar but each somewhat unique, exist. To improve consistency and institute a standardized, evidence-based process, each institution must agree to give up some customization so that a unified form and process can be adopted statewide. Bringing stakeholders in early, obtaining their input, and listening to their concerns have been essential parts of our process. We are currently moving forward with final development and deployment of our statewide resident transfer form, which we anticipate will be posted on the Massachusetts Department of Public Health website in the next few months.

A third objective was to include guidance addressing accountability between sending and receiving institutions. When a patient leaves one setting of care, someone must be prepared to receive that patient in the next setting of care. Longitudinal responsibility rests with the sending provider until the receiving provider has acknowledged and accepted the patient. While we anticipated that hospitals and physicians would be resistant to this concept, they accepted the significance of this component of care transitions and the need to address this difficult problem.

Ongoing discussions in 22 communities are currently under way as part of the State Action to Avoid Rehospitalizations project, supported by a grant from the Commonwealth Fund. As a learning healthcare system and state, we must be able to measure performance improvement in care transitions. Put simply, how will we know a safe and effective transition when we see it?

The Massachusetts strategic plan for care transitions outlines a strategy for tracking progress and measuring successes and challenges. Performance measurement is essential if the best practices and lessons learned from state demonstrations and national research and care models are to be implemented effectively on a statewide basis. The measures described in the plan have been endorsed by recognized national and state panels of experts.

Certain process measures are linked to successful outcomes: the timely transfer of information across settings and professionals involved in care transitions, the effective coordination of transitions across settings and professionals, the timely delivery of care, improvement in patient understanding of and adherence to the treatment plan, improvement in patient awareness of emergency provider contact information, and improvement in patient engagement in care ABIM, Ongoing work to refine measures is part of the Massachusetts strategic plan.

In his book Agendas, Alternatives, and Public Policies, John Kingdon explains how policy issues rise and fall on public agendas Kingdon, He describes three independent streams of activities—problems, policies, and politics—that must occur before effective decision making takes place in government. For a problem to be identified, there must at some point in time be agreement that solutions exist.

Policies are generated by specialists, staffers, academics, and interest groups. The creation of the strategic plan accomplished these first two activities. The third required careful vetting of the plan with interested parties. With the Kingdon policy hurdles passed, Massachusetts has now moved into the implementation phase, with workgroups already engaged in the refinement and deployment of a statewide interfacility transfer form and process, as well as state surveyor education around effective care transitions.

As more cross-continuum teams are established in more communities, Massachusetts will continue to evolve as a learning health system at the state level. Care transitions performance measurement set. Batalden, P. What will it take to lead the continual improvement and innovation of health care in the twenty-first century? Quality Management in Healthcare 11 1 Beck, A.

The Journey to High-Reliability Anesthesia Outside of the Operating Room

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Achieving Safe and Reliable Healthcare — Safe & Reliable

Log in to Wiley Online Library. Purchase Instant Access. View Preview. In , the CDC reported that one in 25 patients in acute care hospitals in the U. Worse, approximately 75, patients with HAIs died during their hospitalization. Medical errors are a major killer in the U. In addition to HAIs, there are other preventable risks in the healthcare environment that could be improved by the adoption of HRO principles.

For example, healthcare workers routinely face serious safety and health hazards in the workplace. These hazards may include blood-borne pathogens, biological hazards, chemical and drug exposures, ergonomic hazards from lifting patients, and workplace violence, to name a few Occupational Safety and Health Administration, According to the Bureau of Labor Statistics, in , there were more injury and illness cases in healthcare than in any other industry Benefits to patient outcomes, financials, safety, and the work environment In the healthcare industry, the benefits of integrating HRO principles and practices are significant.

HRO phenomena are mainly present in large systems that would benefit greatly from anticipating unexpected events to prevent large system failures La Porte, Equally, healthcare systems and hospitals have the potential risk of experiencing large system failures. These risks may include financial and human loss, negative impact on the workforce, or a loss of confidence and trust among members of the community, which could have a devastating effect on any health system or hospital. In embracing HRO practices, health systems and hospitals gain a culture with a strong sense of mission and commitment to reliability in operations and capacity.

Organizations that have adopted HRO practices have seen improvement in organizational effectiveness, efficiency, and culture, as well as in customer satisfaction and documentation The Joint Commission Center for Transforming Healthcare, Such organizations foster and value safety, quality, and management accountability. They also gain a workforce that is highly skilled, knowledgeable, and engaged in the solutions to make their practice and organization safe Shabot, There is also benefit on the cost side.

A further decline in HAI incidence would have a positive financial impact on the healthcare budget, to be reallocated to health programs. As well, a collaborative environment and reward and recognition programs, which are both needed for HRO environments to be successful, could have a positive impact on the work environment and employee turnover. Nurses thrive in environments that provide autonomy and allow for their empowerment, that offer a supportive leadership team, and that promote collegial relationships with their team, and evidence shows that satisfied nurses can have a positive impact on patient outcomes Twigg and McCullough, Summary The current healthcare system is complex and is burdened with inefficiencies.

Overwhelming economic and quality barriers hinder progress in improving quality, safety, and service. The dynamics of the healthcare system are shifting such that HRO is a viable approach to creating a reliable healthcare system for providers, caregivers, and consumers. Evidence suggests that HRO principles create environments that are mindful of anticipating unexpected events and resilient in responding quickly to minimize exposure. In addition, the use of incident reviews in HROs builds institutional knowledge.

Many organizations outside of healthcare have achieved HRO status and have sustained their results over long periods of time Chassin and Loeb, Although many healthcare organizations are on the path to adopting HRO principles—and an elite few are close to becoming HROs—we know for sure that the road to an HRO starts and ends with leadership. Key points. Jane S. Understanding the U. Birk, S. Accelerating the adoption of a safety culture. The Joint Commission.

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Budget and economic outlook — The 7 habits of highly effective people: Restoring the character ethic. DuPree, E. Leading change: The high reliability journey. Hospital Executive Briefing. Improving patient satisfaction with pain management using Six Sigma tools. Field, R.

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Why is health care regulation so complex? Pharmacy and Therapeutics, 33 10 , pp. Griffith, J. Understanding high-reliability organizations: Are Baldrige recipients models? Journal of Healthcare Management, 60 1 , pp. About us.

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To err is human. The Richard and Hinda Rosenthel lecture New frontiers in patient safety. Best care at lower cost: The path to continuously learning health care in America. A new evidence-based element of patient harm associated with hospital care. Journal of Patient Safety, 9 3 , pp. Sentinel event data —3Q About the joint commission.

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The Strategy that Will Fix Healthcare

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