Readiness Rounds - Blog , Electronic Rounding

Thankful for American Healthcare

Wed, 16 Apr 2025 22:01:40 -0600

Once again, we find ourselves approaching Thanksgiving, the time of year when we reflect on all our blessings. We do, indeed have much for which to be thankful. Here are just a few ideas. Please feel free to post other “thankfuls” in the comments below!

Dedicated, highly skilled healthcare workers.

Last year, we started our list with gratitude to the doctors, nurses, technicians, pharmacists, engineers, housekeepers, administrators, and all the other workers in healthcare who spend their lives taking care of others. Their caring and hard work make a difference to us all.

Increased use of electronic health records continues to improve providers’ ability to deliver timely and accurate treatment.

Although the rapid shift from paper to electronic record keeping has been stressful for some providers, a national study published in the February 2014 issue of Health Services Research found that a whopping 78% of providers reported that using electronic records enhances the care they provide, especially in the areas of alerting them to critical lab results and warning of possible adverse medication interactions.

www.forbes.com/sites/scottatlas/2013/11/28/on-thanksgiving-lets-be-thankful-for-what-remains-of-americas-healthcare/

In addition, the same study found that the longer a provider had used electronic records, the more like she was to find it beneficial, suggesting that as more providers become accustomed to the new systems, the number reporting positive effects will increase. From the patient’s perspective, this means increased safety and reliability in their healthcare experience.

The U.S. has the greatest number per capita of advanced medical technology.

For example, according to the Organization for Economic Co-operation and Development (OECD), the U.S. has more CAT scanners and MRIs per capita than any other country. In practical terms, because they are so common, these powerful diagnostic tools are available to a greater part of the population and with shorter waiting times than anywhere in the world.

Patient empowerment is improving.

As transparency measures continue to advance in hospitals and, increasingly, in other healthcare settings, patients have more access to information that allows them to make educated decisions when choosing healthcare providers and hospitals. Furthermore, when things do go wrong, patients have a greater ability to find out exactly what happened and to help their providers find ways to prevent future occurrences of similar events.

America leads the way in healthcare innovation.

Americans have early access to cutting edge treatments and newly developed information. According to statistics reported by the Cato Institute, the U.S. consistently out-performs the E.U., Australia, and Japan in developing healthcare innovations as measured by Nobel Awards in Medicine per capita and as measured by country of origin of major medical technologies.

More and more hospitals are developing a Culture of Safety and striving to be High Reliability Organizations.

Despite the difficulties inherent in creating and implementing a new kind of hospital culture, the number of organizations embracing safety culture values, continuous improvement processes, and high reliability practices continues to increase. As a result, patient safety and positive outcomes also improve in these organizations.

No doubt, the American healthcare system faces challenges, but as the examples above illustrate, we have much for which to be thankful!

6 Reasons to Be Thankful for Our Healthcare System

Sun, 06 Apr 2025 01:27:00 -0600

The current public dialogue on our healthcare system seems to be mostly negative, generating a lot of anxiety and fear about our personal access to healthcare. However, it is always appropriate to pause and be grateful for the healthcare system we have today.

In this season of giving thanks, here are the

6 Reasons We're Thankful for Our Country's Healthcare System:

1. Dedicated Nurses & Physicians

We are indeed fortunate to have a wide range of dedicated healthcare providers. We have huge numbers of nurses and physicians working on the frontline every day to provide effective and quality care, and work tirelessly to see our needs are met when we are weakest.

“To do what nobody else will do, a way that nobody else can do, in spite of all we go through; that is to be a nurse.” – Rawsi Williams, J.D., B.S.N., R.N., CQRMS-LTC

2. It's More than Nurses & Physicians

Add to the nurses and physicians all of the other staff that make our healthcare system work:

• Pharmacy staff

• Laboratory staff

• Radiology staff

• Engineering staff

• Administrative staff

• Housekeeping staff

And the list goes on. We have staff at all levels and departments looking after us and aiding in our care. All of these people work every day to provide a quality healthcare system for all of us.

3. Quality of Hospital Care is Becoming More Transparent

The ability of any individual to judge quality of care is improving.

• Is it simple yet? - NO

• Is it confusing as many parties (The Joint Commission, US News, The Leap Frog Group, etc.) publish different lists that show wide variation at different times? - YES

• Is arriving at a simple, consumer-relevant system that accounts for the complexity of healthcare easy? - NO

• Is the proposed CMS five-star rating using Hospital Compares arguably significant progress? - YES

4. Obesity Rates Leveling Off

Although obesity is still a major concern, we’ve seen the efforts of many national and local healthcare organizations attempting to change the increasing obesity trend and they appear to be working.

U.S. residents spend as much as $147 billion annually on obesity-related healthcare costs, according to the CDC. While we have an individual and collective challenge with obesity rates, studies show that from 2010 to 2012, the adult obesity rate dropped nearly one percent. The mid- and long-term benefits of the obesity rate trending down on the improvement of our overall health and associated cost reductions is significant.

5. Access to Care is Improving

There doesn't seem to be any coherent moral, ethical, religious or spiritual basis to not having healthcare available to all. Yes, it's contentious and political; however, the latest changes move us significantly down the path of greater access.

With the noise level dropping, or increasing, depending on the day and the source, the implications of this change are becoming more widely understood. If you are looking for an understandable non-partisan explanation, the Kaiser Family Foundation has a well-done short YouTube video, The YouToons Get Ready for Obamacare.

6. Emphasis on Patient Safety & Quality of Care is Improving

Patient safety and quality of care is getting more attention from senior healthcare management. With the increasing public transparency of comparative quality results, most senior healthcare managers are becoming increasingly engaged in driving improvements in patient safety, particularly in correcting perhaps the most alarming number of all in healthcare—the preventable death rate, which has remained unchanged for more than ten years.

- Don Death, CEO

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8 Must-Haves for Any Hospital Checklist

Wed, 02 Apr 2025 00:18:00 -0600

Building Effective Checklists for Hospitals

As one of the cornerstones of high reliability, much is made of utilizing checklists in hospitals as a means to build, support and sustain high reliability efforts by proactively checking the reliability of systems and processes. For all hospital staff designing, conducting and analyzing checklists, it’s important to keep in mind some key elements that make an effective checklist with sustainable outcomes.

Here are the 8 must-haves for any hospital checklist:

1. The Design Must Streamline the Process

The design of the checklist and deployment by process needs to be carefully thought through. Avoid layering on “another” thing to check. Gather all existing rounding tools from all parts of your hospital (you will be stunned by the number). The design must eliminate all current tools to avoid duplicative effort and maximize internal support for the approach.

2. A Single Platform – Checklists Must Not Sub-optimize

Data collection tools, rounding formats and tracers abound in every hospital environment. For example, nursing alone currently has or responds to anywhere from 15 -25 different formats all built in isolation. This contributes significantly to nursing documentation time burden and frustration. Instead, make sure all checking conducted outside of the Electronic Health Record is consolidated to a single platform. This will significantly reduce hospital-wide time spent on production, conducting and analyzing data along with improving the overall integrity of the process.

3. They Must be Electronic

The vast majority of checklists used in hospitals today are manual - often Word documents aggregated in Excel. The sheer volume of data overwhelms this approach very quickly, creating a format that will not be sustainable. The effective deployment of real time service recovery is another key driver of ensuring a reliable electronic system is in place.

4. They Must Be Deployable in Any Work Environment

Do not find the “ideal” hand hygiene tool and charge ahead. Do not find the “ideal” patient rounding tool and charge ahead. Solving for one or two functions is simple and a very basic software function. Adopting this approach will lead to moving 20 different paper-based rounds to 20 different software rounds and replicates the current data silos. Ensure your solution is intuitive to a nurse conducting a CAUTI checklist and also a pharmacy technician conducting medication safety checks.

5. They Must Be Sustainable

With the pressure on IT resources and the extreme complexity of this data-gathering (often well in excess of 300,000 annual quality observations) and management effort, it is likely that you will want to use “off the shelf” programs. Shift your operational focus to conducting the checklists, correcting items failing and launching performance improvement efforts, not developing a platform to conduct the checklist.

Ensure your package is not reliant on the hospital to update system, standards, etc. Find a supplier who specializes in hospitals and who has dedicated service support to not only provide special design and set up, but to maintain the system over time. This approach is likely to come with a higher price tag but it will avoid the almost certain failure with any other approach.

6. They Must Be Flexible

When buying “off the shelf”, ensure that there are well-developed templates to support every checklist. Ensure that the checklists are easily customizable to your local conditions. A word of caution about customization: if you have selected the right checklist system, the pre-built templates will meet the vast majority of your needs.

Invest your initial time in working on teamwork and safety culture components of high reliability:

Leadership commitment
Patient safety culture
Teamwork

Customize based on widespread use and deployment. There is a huge culture shift to manage to make checklists a part of daily workload in hospitals. Focus on this effort and tweak checklists on the fly from user feedback.

7. They Must Manage Follow-up Automatically

Effective closed-loop follow-up is worth a 1 to 2 point improvement in patient safety, quality of care and experience. The checklist must be properly designed to manage, notify and escalate items that need correction. Frequency must be customizable. A patient request needs immediate action; a Human Resources file audit doesn’t have the same urgency. Ensure your operational management is not overloaded by the system. This is also a key issue in ensuring you have a single system for managers to correct items from a variety of sources.

8. They Must Link to Regulatory Standards

While regulatory compliance will be a simple by-product of high reliability, insist that all template questions are linked to The Joint Commission / CMS / HFAP / DNV standards. Ensure this linking is available for any custom questions.

In the Joint Commission environment, as an example, annual submission data is generated in real-time at the time of scoring, providing immediate verifiable data point for any measure of success items as an example.

CAUTION: A Tracer is Not a Checklist

Tracers are appropriate if you want a specialist team to conduct a limited number periodic assessments in patient treatment areas. Tracers by design do not support a comprehensive approach to high reliability. Tracers by design are extraordinarily time intensive and disruptive to staff and daily operations. Tracers by design do not place accountability for high reliability with frontline staff.

Choosing the appropriate checklist software will directly affect the success of adoption, implementation and results the hospital will see. Take the time to truly investigate the features, flexibility and customization of any software you are considering.

What are YOUR must-have features for a patient safety checklist? Comment below. We’d like to know!