One of the quality measures reported by hospitals to the Centers for Medicare and Medicaid Services which is published on the Hospital Compare website reports statistics on “surgery patients who were given an antibiotic at the right time (within one hour of surgery) to help prevent infection

Week 12

Real World Case Case 1: Chapter 20 Discussion

One of the quality measures reported by hospitals to the Centers for Medicare and Medicaid Services which is published on the Hospital Compare website reports statistics on “surgery patients who were given an antibiotic at the right time (within one hour of surgery) to help prevent infection.” Answer the following to reflect on your understanding of this quality measure.

Why is it clinically important for patients to receive antibiotics prior to surgery?

In regard to clinical documentation in the health record that would be reviewed to report on hospital performance of this quality measure, which portion of the record would provide the most accurate details to confirm the administration and time of administration of antibiotics prior to surgery?

If a hospital consistently scores low on this measure, what is indicated? 

 If a hospital is scoring low on this quality measure, which clinical quality management process could be used to help the hospital understand why the performance is low, formulate a plan to improve its score, implement the plan, and evaluate the results of this measure in the future? 

Case 2:  Chapter 21 – Lakewood Health System

Lakewood Health System (LHS) recognized the need to update their hospital’s electronic health record system and moved to develop a plan for selecting a new one. The clinic and hospital, though part of LHS, were using two separate and different information systems. The physician group at the clinic was experienced in the use of their current system and was reluctant to change. As the issue developed, three leaders at the facility emerged to facilitate the change: the CEO, CIO, and medical director.

The involvement of the physicians in the decision that would affect them was clearly essential. At the outset of the project, after three vendors had been selected to present their systems, three physicians were asked to volunteer and join the three executives on a vendor selection committee. The requirements for volunteering were made clear: Time demands, travel requirements, and genuine interest in the project were emphasized to involve fully-informed members.

The three leaders explicitly emphasized the importance of an honest, objective, and balanced approach to presenting and evaluating vendor information. One of the vendors did not present as strongly as the others, but all three had an opportunity to discuss the strengths and limitations of their record systems. The CIO led the discussion of the pros and cons of each vendor in an objective manner and encouraged the physicians to voice their concerns and ideas. The hospital departments moved to a consensus on a system while the medical director disagreed and stated the physicians preferred another system.

The CEO and CIO met with the medical director.

Of the three vendor options, one would be operated on-site and the other two would be operated offsite in a shared environment. One of the offsite systems required that Lakewood affiliate with a tertiary hospital and replace their current clinic system. Both off-site systems would require Lakewood to follow upgrade schedules and system enhancement plans of the group sharing the hosted application. Although the physicians were not interested in integrating the hospital and clinic systems or affiliating with one specific tertiary hospital, all three leaders recognized that the clinic and hospital systems could eventually become integrated; hence, an integrated information system would provide the best long-term benefits. Consequently, the medical director believed that the offsite system offered the best hospital system for the physicians; however, the hospital departments believed the physician’s vendor choice had the weakest clinic system, which would be a problem if they merged into one EHR system later. Unfortunately, the vendor for the product that the system desired, which also had a strong clinic system, had made a weak presentation and did not demonstrate the advantages to the physicians.

The leadership team agreed that more specific information customized for the physicians would be a way to start addressing the matter and more accurately understand the pros and cons of each system. LHS brought in physician representatives from each of the vendors who could speak specifically to physician questions and demonstrate workflows. The LHS medical director ensured that the presentation was accurate and made sure the three physicians objectively studied the information presented. Once they examined the information, they changed their minds and selected the system desired by the hospital leaders, which had the best clinic system and long-term advantages if they ever merged the two systems.

The project was resolved due to a combination of effective leadership styles and an understanding of the change process.

Key points:

Leaders facilitating change in the present do so with a strategic view of longer-term needs and consequences.

Leaders need to fully engage, listen to, and inform their constituency about a change and seek representation for the decision.

In some cases, leaders need to challenge the process when their vision reveals flaws in current decisions.

Leaders need to stand up for their beliefs, even against strong opposition and explain their reasoning.

Reviewing and reflecting on decision-making processes often shows flaws that can be corrected.

Questions: 

Discussion Questions

Several ways in which trust was established at LHS were identified in the case scenario. What additional ways can you identify to build trust and credibility as a leader in an organization?

Think about professional and personal concerns that you are reluctant to discuss openly. Who could you call together as a support team to explore these concerns? What are the qualities you would look for in such a support system?

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