Milestone Three: Implementation

Patient Safety Indicators (PSIs) helps healthcare organizations to establish adverse situations that might require further study. PSIs include indicators for complications occurring in the healthcare facility that may signify the patient’s safety events alongside are level referents designed to identify safety events on a regional level. Implementing PSIs is a milestone in developing a methodology to identify and respond to patient safety events.

Quality Outcomes

World Health Organization defines health outcome measure as “change in the health of an individual, group of people, or population that is attributable to an intervention or series of interventions.” Quality outcome indicators inform whether the initiative helps patient stay alive and healthy (World Health Organization 2019). The desired quality outcome from the standardized PSIs implementation includes reduced mortality rates, minimized readmission rates; improving patient experience and effectiveness.

Reduced Cases of Hospital Mortality Rates

Mortality is a vital population health outcome measure. Implementing standardized PSIs is projected to help reduce mortality rates for pneumonia patients by at least 50% in not more than 15 months following the implementation. Patients with pneumonia account for approximately 400 emergency room visits, 1 million inpatient hospitalization, and over 5 million impatient days, about 51 000 deaths annually in the United States. The primary cause of pneumonia-related deaths is due to the lack of standardized care pathway for pneumonia treatments. The care provided for pneumonia patients do not adhere to evidence-based patient safety guidelines, including antibiotic selections (Weems et al., 2019). However, a study shows that accessing detailed case information with the help of analytics, PSIs implementation can help identify and develop best practices for pneumonia treatment, reducing variations that reduce care quality and increasing treatment costs (Vallier et al., 2015).  Approximately 56% relative decrease in pneumonia mortality rate can be achieved through standardization of patient safety measures (Weems et al., 2019).

Reduced Readmissions

            The implementation of PSIs aims to reduce the overall readmission rate by 50% in less than one year. Readmission after hospitalization is an essential outcome measure. Hospital readmission is costly but often preventable (Arana, Harper, Qin, & Mabrey, 2017).  Study shows that about US$25 to US$45 billion is spent on unnecessary readmissions and avoidable complications. After increasing measures to reduce readmission rates, the “University of Texas Medical Branch (UTMB)” witnessed a 14.5% decrease in the hospital’s 30-day all-cause readmissions, translating into about US$1.9 million cost-saving. The hospital reduced its readmission rate by implementing several evidence-based programs, including PSIs, and improving analytical programs to enhance the accuracy and timeless data-informed decisions and patient monitoring (Tinker, 2018).

Communication

Most experts would approve that communication is an essential ingredient for a significant change initiative, and there is extensive research evidence to support this assertion. Communicating change in the organization begins by sharing the vision about how the healthcare organization can benefit from the initiative. Healthcare staff must know that the change is beneficial for them and the organization overall. Study indicates that organizations that have successfully adapted to change initiatives tend to be transparent in their change efforts, communicating a clear vision for stakeholders to rally around (Newell & Jordan, 2015). Such include telling members what to do and the expected outcomes.

Charting the path is the second phase of communicating change initiative. Researchers argue that successful change implementation requires equipping stakeholders to become leaders for change communication. For instance, once you reach a common/shared vision, which staff believes is beneficial for the organization, it is the leadership’s role to develop and direct a path to get them there (Newell & Jordan, 2015). Keep communicating even after the initial change.

Data Flow

Clinical pathways play a vital role in data flow in the change implementation process. A clinical pathway is a standardized comprehensive plan of care, which interprets evidence, guidelines, and expert opinions or consensus into local care. There is currently a standardized flow (standardization) of data, ensuring quality data needed for the change initiative. The adoption of healthcare data standards is the foundation for allowing interoperability across healthcare organizations and between “electronic health record (EHR)” systems (Lavelle, Schast & Keren, 2015). Continuous quality improvement and process management are adopted to measure processes and patient satisfaction outcomes.

Clinical pathways are one approach useful to accomplish these goals. When integrated with electronic health decision support alongside robust measurement, clinical-pathways help establish dynamic learning clinical systems that support quality improvement even for the next generation. A clinical pathway provides a “mental model” for healthcare teams, helping to manage complexities. Each flow chart’s decision node signifies a process and outcomes, sub-processes, or supplemental guidance, with varying results (Lavelle, Schast & Keren, 2015).

Needed Leadership

Effective leadership is essential to lead and drive the change process at all healthcare organization levels to actualize the ongoing reforms’ objectives. The leadership needed for a change process is collaborative, transformative, and evidence-based management. There should be a collaboration between the management and the clinical workforce, using evidence-based data to implement the change. Researchers argue that creating a conducive workforce environment for clinical workers that ensure patient safety requires critical changes throughout the healthcare organization, cutting across the design of works, deployment of personnel, and organization culture concerning safety science. The changes necessitate leadership that can transform the physical environment and the systems, beliefs, culture, and practices of the clinical workforce and management (Reichenpfader, Carlfjord, & Nilsen 2015) to ensure the success of the change initiative.

Conclusion

Implementing change initiatives such as patient safety indicators (PSIs) programs require stipulation of the expected quality outcome, including reduced mortality rates, minimized readmission rates, and overall patient experience and effectiveness. Effective communication, data flow, and leadership are also vital for successful implementation.

References

Arana, M., Harper, L., Qin, H., & Mabrey, J. (2017). Reducing the length of stay, direct cost, and readmissions in total joint arthroplasty patients with outcomes manager-led interprofessional team. Orthopaedic Nursing, 36(4), 279-284.

Lavelle, J., Schast, A., & Keren, R. (2015). Standardizing care processes and improving quality using pathways and continuous quality improvement. Current Treatment Options in Pediatrics, 1(4), 347-358.

Newell, S., & Jordan, Z. (2015). The patient experience of patient-centered communication with nurses in the hospital setting: a qualitative systematic review protocol. JBI database of systematic reviews and implementation reports, 13(1), 76-87.

Reichenpfader, U., Carlfjord, S., & Nilsen, P. (2015). Leadership in evidence-based practice: a systematic review. Leadership in Health Services.

Tinker, A. (2018). The Top Seven Healthcare Outcome Measures and Three Measurement Essentials. https://www.healthcatalyst.com/insights/top-7-healthcare-outcome-measures

Vallier, H. A., Moore, T. A., Como, J. J., Wilczewski, P. A., Steinmetz, M. P., Wagner, K. G., … & Dolenc, A. J. (2015). Complications are reduced with a protocol to standardize timing of fixation based on response to resuscitation. Journal of orthopaedic surgery and research, 10(1), 155.

Weems, L., Strong, J., Plummer, D., Martin, J., Zweng, T. N., Lindsay, J.,  & Peabody, J. (2019). A quality collaboration in heart failure and pneumonia inpatient care at Novant Health: standardizing hospitalist practices to improve patient care and system performance. The Joint Commission Journal on Quality and Patient Safety, 45(3), 199-206.

World Health Organization (2019). Improving healthcare quality in Europe: Characteristics, effectiveness, and implementation of different strategies. World Health Organization. Regional Office for Europe.