Think Di fff erently about Thinking and Get Di fff erent Results

1. Think Diffferently about Thinking and Get Diffferent Results

2. Keep the Barn Door Closed Does your hospital chase the horse after it has bolted from the barn?

3. HIMSS Patient Safety Primer & Fact Sheet – October 2007

4. HIMSS Patient Safety Primer & Fact Sheet – October 2007

5. The Cost of the Medical Error Problem

6. The Cost of the Medical Error Problem

7. Adverse Medical Event Annual Costs: 400 bed hospital From the Advisory Board in 2001 Patient Safety initiatives are putting pressures on HCOs and physician groups to “overhaul the practice of medicine” in the US

8. How to Fix what is Broken:5 Key areas from the IOM, 2001 • Access to the medical knowledge base • Computer-aided decision support systems • Collection and sharing of clinical information • Reduction of errors • Enhanced patient and clinician communication • Use the Internet to gain access to clinical evidence • Embed knowledge in tools and train clinicians in use • Automation of patient-specific clinical information • IT standardization and automation to ID potential • Change ways of interaction Solution Problem

9. President’s Information Technology Advisory Committee (PITAC) • Federal government must play a role in using It to transform health care. • A call for a national vision and information infrastructure • Federal government must coordinate its own cross-agency activities and establish pilot projects and Enabling Technology Centers • IT technology tools can provide the healthcare sector with unprecedented productivity & quality

10. The Computer-based Patient Record • Make use of IT as an “enabler” in the service of patient care • Use of the CPR is mandatory because of the wide variety of medical errors that can occur • A broad set of tools and capabilities is needed to enable a care delivery organization (CDO) to detect, correct and compensate for errors across this diverse environment

11. Leveraging IT to Improve Patient Safety • Review paper published in the Yearbook of Medical Informatics of the International Medical Informatics Association (IMIA) • Authors Marion J. Ball, Ed.D.; David E. Garets; Thomas J. Hndler, MD

12. Five Generations of CPR Systems • First-generation CPRs • Simple Systems that provide a site specific encounter solution to the need for access to clinical data • Second-generation CPRs • Basic systems that allow clinicians to document care adequately • Third-generation CPRs • Episodic as well as encounter coverage and must work in ambulatory and acute care settings

13. Five Generations of CPR Systems • Fourth-generation CPRs • More complex with integrated documentation, workflow and decision support, and must cover more than just the ambulatory and acute-care settings • Fifth-generation CPRs • Complex, fully integrated systems crossing the continuum of care and designed to be used by heath care providers and healthcare consumers

14. Where are we today? Gartner Projections • In 2003 vendors were predominantly delivering Generation 2 products - documentation. • CPRs are different sets of capabilities • It was estimated that these product would reduce preventable errors by 40% by 2008 • Generation 3 would have a 60% impact 2012 • Generation 4 would have an 80% impact • Generation 5 would have a 100% impact

15. Recording versus Reporting Advantages Disadvantages Negative Reactive Punitive Random Costly Institution-centric Outcome driven • Positive • Proactive • Preventive • Predictive • Productive • Patient-centric • Process driven

16. Riding a Horse backwards …. It’s a Goofy thing to do!

17. Ride the Horse the Way its Running This is not a smart way to do things!

18. It’s all Horse Sense So why do we do it like this? • Is it because ‘it’s the way I was told to do it’ • Or is it ‘the way we always do it’ • Maybe ‘this is how the person before me did it’ • Or ‘every one does it this way’ • Possibly ‘I think this is the best way to do it’

19. Bring the Water to the Horse • You can lead a horse to water, but you can't make him drink • You can show people the way to do things, but you can't force them to act • People do things better when they ‘want to’ rather than when they ‘have to’

20. John F. Kennedy Rice University, Houston, Texas September 12, 1962. “We choose to go to the moon. We choose to go to the moon in this decade and do the other things, not because they are easy, but because they are hard, because that goal will serve to organize and measure the best of our energies and skills, because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one which we intend to win, and the others, too.”

21. Kennedy closed by saying ……. “Well, space is there, and we’re going to climb it, and the moon is there and the planets are there, and new hopes for knowledge and peace are there. And, therefore, as we set sail we ask God’s blessing on the most hazardous and dangerous and greatest adventure on which man has ever embarked.”

22. Critically and systematically examine the past, present and future. • What is the foundation that we must keep in place and continue to build on? • What are the barriers or obstacles that we must overcome to reach our goal? • What do we need to let go of so that we can move forward? • What are promising opportunities that we can capitalize on?

29. A Question What would you think if I told you that the next time you went to the airport - even during times of peak congestion – that you would experience virtually NO wait at the check-in counter? What would you say?

30. Case of the Vanishing Airport Lines • “Those without bags can go immediately to the security-screening lines around the corner. Those with luggage proceed to bag-drop stations where the passengers, not the agents, place the bags on conveyor belts while the clerk checks boarding passes and identification, tags the bags and give the fliers the baggage stubs.”

31. Case of the Vanishing Airport Lines • “Because the transactions are so swift at these stations -- and because the passengers (or, in some cases, porters) do the heavy lifting -- one agent can handle two lines of passengers, and the lines are rarely very long. Elite frequent fliers have dedicated bag-drop stations.”

33. Think this could happen in health care?

34. “No Wait ED’s”

35. General Design & Terminology Traditional Triage Model • Patient arrives in ED Waiting Room or Ambo bay • Nurse does the usual lengthily triage assessment, in series with all the other usual ED intake steps • Patient waits for next available bed “back in the ED”

36. General Design & Terminology REU Model • Patient arrives in ED Waiting Room or Ambo bay • Patients either go directly to REU or directly to a Care Center based on clinical criteria (ESI triage assignment driven) • Simple “treat and street” patients are assessed, treated, and discharged from REU (called “REU only” patients) • Patients requiring more work-up are routed from REU to Staging to be seen by MD - with anticipated discharge within 90 minutes. • Patients requiring more intense work-ups (> 90 minutes) and likely admission flow from REU directly to a Care Center without going to Staging

37. Traditional ED Triage Process vs. REU Patient Flow Traditional Process REU Process

38. Grocery Store Science • It is time to bring a little grocery store science into health care

39. A Long Line for a Shorter Wait at the Supermarket - New York Times June 23 2007 Whole Foods Grocery Store