Fay Rozovsky, JD, MPH, DFASHRM Marsh Health Care Practice Richmond, VA THE BUSINESS CASE FOR PATIENT SAFETY April, 2003.

Fay Rozovsky, JD, MPH, DFASHRMMarsh Health Care Practice

Richmond, VA

THE BUSINESS CASE FOR PATIENT SAFETY

April, 2003

Michigan Presentation 2

THE DRIVING INFLUENCES

CONSUMERS PAYERS

STATESFEDs

ACCREDITATION TRADE ASSNs

PROFESSIONALGROUPS

MEDIA

UNIONS

It is allabout

patient safety

“THE COMBO”

Michigan Presentation 3

MULTIPLE PLAYERS SETTING STANDARDS AND EXPECTATIONS

STATES ENACTING “REFORMS” GEARED TO PATIENT SAFETY

JCAHO

– PATIENT SAFETY ACCREDITATION STANDARDS

– “PERFORMANCE REPORTS”

– LINK ERROR TO STAFFING

THE STATE OFPATIENT SAFETY

Michigan Presentation 4

THE PAYER PERSPECTIVE

HEALTH INSURANCE PREMIUMS INCREASING

DISSATISFACTION ABOUT OUTCOMES OF CARE

FRUSTRATION WITH “NO ONE” DOING ANYTHING TO FIX THE SYSTEM

Michigan Presentation 5

THE PATIENT

FEAR, DISTRUST, LACK OF CONFIDENCE

MORE ASSERTIVE IN MANY INSTANCES

RECEIVING NEW “DATA” ON HOW HEALTHCARE ENTITIES “MEASURE UP”

BEING TOLD TO “SPEAK UP” AND ASK QUESTIONS

Michigan Presentation 6

PROFESSIONAL LIABIILTY

WHAT “FIRST DOLLAR” COVERAGE?

WHAT INSURANCE?

LARGE PREMIUM INCREASES, LOWER LIMITS

SOME CANNOT PURCHASEPROFESSIONAL

LIABILITY INSURANCE

Michigan Presentation 7

THE INSURANCE CONUNDRUM

ESSENTIAL: THE ABILITY TO SHOW “HOW” PATIENT SAFETY STRATEGIES ARE WORKING JUST TO GET IN THE DOOR

A NEED FOR ALTERNATE

RISK FINANCING

Michigan Presentation 8

THE STATES

MORE “REFORMS” GEARED TO REPORTING

INCREASE IN JUAs

CAPS ON MED MAL

Michigan Presentation 9

THE FEDs

GREATER USE OF “QUALITY OF CARE” ENFORCEMENT

CHALLENGING CONGRESS TO ENACT REFORMS

PUT INTO A “RESPONSE MODE” BY IOM

TRYING TO ENACT REFORM LEGISLATION THIS YEAR, BUT…….

Michigan Presentation 10

AS CONSUMERS

AS HEALTHCARE PROFESSIONALS

PATIENTSAFETY

QUALITYSAFECARE

STAFFING EFFECTIVENESS

COMPETENCY TRAINING

UNIONS

Michigan Presentation 11

SYSTEM STRESS

INCREASED SCRUTINY FROM ALL QUARTERS

MORE UNFUNDED MANDATES

STAFFING SHORTAGES

LACK OF “EVIDENCE BASED” STUDIES TO JUSTIFY MAJOR SYSTEMIC CHANGES

TOO MANY CHEFS IN THE KITCHEN: NQF, CMS, JCAHO, NADER GROUP. ETC.,ETC.

Michigan Presentation 12

THE SYSTEM IS IN TRAUMA AND NEEDS AN OVERHAUL

WHAT’S MISSING?

COMPREHENSIVE SYSTEMTIC CHANGES COST-EFFECTIVE, EVIDENCE BASED SOLUTIONS FUNDING TO DRIVE CHANGE

Michigan Presentation 13

PREVENTIVE HEALTHCARE

COMMUNITY HEALTHCARE “GROUP”

HEALTHCARE

MANAGE “AT RISK”

EVIDENCE BASED ACUTE CARE

SERVICES

COMPREHENSIVESOLUTION

THE COMPREHENSIVESOLUTION - I

A PUBLIC HEALTH REPONSE FROM RM

ELIMINATE, CONTROL, MITIGATE PRECUSORS TO HIGH ACUITY - HIGH RISK SITUATIONS

Michigan Presentation 14

INFRASTRUCTURECHANGE

THE COMPREHENSIVESOLUTION - II

COMMUNICATIONS CONSENT AS A PATIENT

SAFETY TOOL PATIENTS & FAMILY AS THE

“PRIMARY” PATIENT SAFETY OFFICER

CLINICAL COMPETENCY CREDENTIALING

EVIDENCE BASED CLINICAL CARE SOLUTIONS

Michigan Presentation 15

FAILURE MODE ANALYSIS

ROOT CAUSE ANALYSIS

SYSTEM CHANGES TIED TO MEASURABLE QUALITY, CLINICAL OUTCOMES

METRICS THAT DEMONSTRATE THE “RETURN ON INVESTMENT” IN PATIENT SAFETY

THE COMPREHENSIVESOLUTION - III

UTILIZING A BUSINESS MODEL FOR CHANGE

Michigan Presentation 16

CREDENTIALING COMPETENCYPREP

EVISICUOPEN

DISCLOSURE

“SPEAK UP”

PENMANSHIP 101

MHAUS CONSENT AS PT SAFETY TOOL

QUALITY OUTCOMES FROM INFRASTRUCTURE CHANGE

PT/FAMILY AS “SAFETY OFFICER”

COMMUNICATIONS

EXAMPLES OF CHANGE

Michigan Presentation 17

TECHNOLOGICALSAFETY

PUBLIC HEALTHRISK MANAGEMENT

EXAMPLES OF CHANGE - II

TIME INSENSITIVE PREDICTIVE INSTRUMENT ECG

ORANGE JUICE STUDY - LOWER MORBIDITY-MORTALITY IN MFM

Michigan Presentation 18

DOING THE BUSINESSCASE FOR CHANGE

BUSINESS NEEDS RISK ASSESSMENT

STRATEGIC PLAN FOR CLINICAL RM - TIED TO HCO STRATEGIC PLAN

USING FMEA - RCA BUSINESS TOOLS TO IDENTIFY NEEDED PROCESS CHANGES

SHOW THE ROI IN PATIENT SAFETY

Michigan Presentation 19

HCO

• Cash flow problems• Adjusting to

capitation payments

• New competitors• Management succession• New technology• New government regulations

• Fire, flood, windstorm• General liability• Medical malpractice

• HIPAA Compliance: Privacy

• Workers Compensation• Unionization• Employment practices• Recruitment of nurses or

systems analysts

Financial Risk: CFO

Strategic Risk: CEO

Operational Risk: COO

• Access to capital markets

• Achieving net income targets

Hazard Risk: RM

Business Needs Risk Assessment

Michigan Presentation 20

THE ROI OF PATIENT SAFETY

FMEA RCA ROI

IDENTIFY

SIGNIFICANT FEW THAT

MERIT FAILURE MODE EFFECT

ANALYSIS

DO A ROOT CAUSE

ANALYSIS, TRACKING

BEFORE AND AFTER COSTS

AND PROJECTED

SAVINGS

DEVELOP A BUSINESS CASE FOR

“WHY” CHANGE IS NEEDED AND “HOW”

TO DO IT

Michigan Presentation 21

BUILD A LOGIC TREE WITH VALIDATION OF HYPOTHESES

TRACK VALIDATION COSTS

ANALYZE THE EVENT

Michigan Presentation 22

SUMMARY REPORT

ROI FOR EACH RECOMMENDATION

THE ROI OF ANALYSIS OUTCOMES

Michigan Presentation 23

THE BOTTOM LINE

PROVIDES A BUSINESS CASE FOR CHANGE DEMONSTRATE THE VALUE PROPOSITION FOR

KEYSTAKEHOLDERS FOCUS ON MEANINGFUL CHANGE RETURN THE MONEY SAVED TO THE SYSTEM REFLECTS AN ACCOUNTABLE

ORGANIZATION IN PATIENT SAFETY

Michigan Presentation 24

WHAT IT MEANS TO THE ACCOUNTABLE ORGANIZATION

A BUSINESS MODEL TO SHARE WITH THE MARKETS TO SHOW YOU ARE MAKING A DIFFERENCE

A SOLID, EVIDENCE-BASED APPROACH TO SHOW PAYERS AND THE PUBLIC YOU ARE SPENDING MONEY WISELY TO PROMOTE QUALITY, PATIENT SAFE CARE

AND….YOU CAN SLEEP AT NIGHT KNOWING YOU DID THE RIGHT THING