Friday, February 22, 2008

Lessons in Quality Management

Here are some ideas I picked up from chapter 7 (Quality Management in Military Medicine) of Chip Caldwell's Handbook of Managing Change in Health Care:
1. "Throwing money at a problem usually only makes it worse"
2. Crisis management is bad. It is used to demonstrate that something is getting done. It causes processes to break down and for people to make shortcuts in order to save time. "Quick productivity takes precedence over quality".
3. "The fear or inability to say no in an organization is enormously destructive to any QM initiative. It immediately creates distrust and stifles productive feedback. Employees are fearful of being fired. Exposing any weakness or faults labels the employee as a troublemaker. Employees are then very distrustful of any management scheme that talks about empowerment. If they don't see empowerment or trust in action, they will correctly decide that it doesn't really exist. If their evaluations are based on the quantity of work performed, process improvement will be seen as a waste of time. Their view is, 'Why spend the time required to fix processes?' For them, management's over-focus on short-term tasks or projects give visible (but false) evidence that real work is being done."

I find this last item particularly true. It is interesting that this comes from a chapter about quality in military medicine, as I once heard someone say that calling CNAs the 'front line' makes it sound as if we are fighting a war. Perhaps we are.

Thursday, February 21, 2008

Employee vs Patient Centered Healthcare

Hospital Impact blog had a post on this recently. What are your thoughts on this delicate balance?

Saturday, February 16, 2008

Why nursing homes have poor quality

I was thinking about this last night and realized something quite obvious. JCAHO, the organization that accredits virtually every hospital in this county, has established standards for hospitals to go by. These standards are considered optimally achievable outcomes -- what a facility should aspire to be. CMS standards, the ones that nursing homes are required to comply with, are minimum standards -- the absolute bare minimum you can do to get by with. Literally every single nursing home I have worked with has regarded the CMS minimum standards as optimal achievable outcomes. The prevailing thought in the long term care industry is that a deficiency free survey is something you should aspire to. The problem with this thinking is that a deficiency free survey only means that you are providing a minimally acceptable level of care. Facilities must truly desire to go above the minimum standards, which requires blowing up the box and getting the hell away from the status quo. Unfortunately this is too scary for most providers and corporate owners. Nursing homes have the worlds worst case of "we have never done it this way before" that anyone has ever seen.

Tuesday, February 12, 2008

Medication Regimen Review Resource

If your facility's QA committee needs some help with medication regimen reviews, there is a course page from the University of Washington School of Pharmacy here that you will find useful. There are a number of course handouts that address things like breakdown of drug delivery systems (ie, how things can and do go wrong), classification of med errors, how to actually do a drug regimen review, Beers criteria, drug delivery systems in nursing homes, and lots of stuff on the law.

Monday, February 11, 2008

Great new MDS site

I found a great MDS site this morning, run by the state of Missouri's MDS help desk. Check it out here.

Handwashing, Semmelweis, and Quality Improvement

Did you know that the best way to prevent infections is to wash your hands frequently? Apparently the only people who didn't know this worked in nursing homes. There was an article in this month's AHCA Provider about this suprisingly new concept that was just recently discovered about, what, 100 years ago by Semmelweis. Ironically, the so-called "Semmelweis Reflex" is an outright dismissal of any information that is radically out of sync with the status quo. Kind of like introducing *real* quality improvement to nursing homes (by real, I mean the prospective, quantatative kind that actually gets results, not some half-arsed PDSA crap). If you need proof that this truly non-existant, take a look here.

Monday, February 4, 2008

Testing interviewees for honesty

Check out this idea from Service Untitled, "Find More Honest Employees". There might be some legal issues with this, as the author warns, but it is an interesting way to test prospective employees for honesty. I would certainly appreciate knowing who might and might not wind up being a thief.

Food for thought on suggestion boxes

I was killing time at a used book store on saturday and bought a cheap copy of Nuts!, a book on how Southwest Airlines is driven by innovation. There was a blurb on suggestion boxes that I would like to share here: "One of our managers mentioned to me that he wanted to put up a suggestion box. I responded by saying, 'Sure--why don't you put up a suggestion box right here on this wall and then admit that you are a failure as a manager?' Our theory is, is you have to put up a box so people can write down their ideas and toss them in, it means that you are not doing what you are supposed to be doing. you are supposed to be setting your people up to be winners. To do that, you should be there listening to them and available to them in person, not via a suggestion box...I think that most people employed here know that they can call any one of our vice presidents on the telephone and get heard, almost immediately." The book then goes on to say that at Southwest, managers are expected to spend a minimum of 1/3 of their time walking around. That's exactly what the NHA and DON need to do.