In this episode of Illuminated Path, host Evan Danis welcomes guest Daria Byrne, vice president of clinical and medical surgical solutions at Intalere. Byrne shares her thoughts on what progress has been made with patient safety and quality since The Institute of Medicine released its “To Err is Human” report nearly 20 years ago. Learn more about why the C-suite is paying closer attention to things like survey and accreditation readiness, palliative care planning and sepsis identification. Byrne also provides ideas for how healthcare providers can deliver patient-centered excellence at maximum value.
You are listening to Illuminated Path, shining a light on health care's best operational practices brought to you by Intalere. I'm your host, Evan Danis, senior director of corporate communications at Intalere. Joining us in the studio today is Daria Byrne, vice president of clinical and med surg solutions at Intalere. Daria has extensive clinical informatics, value analysis, leadership, and educational experience, particularly in conceptualizing, developing and implementing key strategies in improving operations and analyzing processes and healthcare trends. Specifically prior to joining Intalere, Daria led the launch of two new products for clinical surveillance. In addition to managing the entire product portfolio for Perahealth, she's also lead the development of a next generation sepsis surveillance solution and worked as an outcomes measurement solutions designer and a clinical solutions manager patient portals strategist. Finally, there is clinical background, includes positions as a circulating nurse and the ER, Med surge units, critical care and emergency departments, and for 11 years she taught associate degree and baccalaureate degree nursing students and continues to occasionally teach graduate nursing informatics courses. We sat down with her to talk specifically about promoting quality based care to improve outcomes. Daria, welcome. Let's start off with taking a look at the past a bit and perhaps where the current focus on quality and outcomes focus was initiated. The Institute of Medicine released their "To Err is Human" report 19 years ago, so from your perspective, where are we today and what progress has been made.Speaker 2:
I think it's important to reflect on why "To err is human" was originally written and the intent of it was really to encourage clinicians and politicians and other healthcare advocates, even patients, to understand why preventable harm and healthcare was occurring in order to garner a greater awareness into quality and healthcare. In that report, in 2000, the experts who wrote the report estimated as many as 98,000 people died in any given year from medical errors that occurred in hospitals, specifically acute care settings. Since 2000. There has been a significant reduction in hospital adverse events, but we still have a long way to go. As such, from that report, clinicians really do have a heightened awareness of reducing preventable medical errors. I know that firsthand from being in the hospital when that report was originally published and spending at least 11 years at the bedside, but again, there's still a lot of room for improvement in patient safety and there continues to be much focus on that initiative today, even 18, 19 years later. For example, the National Patient Safety Foundation continues to focus on obvious preventable harm. The obvious factors include things like a patient expired or had a sentinel event which didn't have to happen, but it also reflects on the things that could be changed with a more proactive approach in healthcare such as identifying patients who are deteriorating long before code blue occurs, unintended or preventable ICU stays and then longer length of stays, which are often not seen as an adverse event, but yet they are a reaction or a consequence of something occurring in that facility which could have been prevented. And then specifically speaking from like an EHR vendor perspective, they have instituted quite a bit of technology within the EHR intended to help prevent adverse events. So specific EHRs have functions called rules or algorithms that run in the background. These rules are algorithms are intended to catch patients at risk for serious or adverse events. It could be something as simple as a drug drug interaction related to an allergy. It could also be something as severe as Sepsis, so while we're continuing to establish a culture of safety within healthcare organizations today, it is paramount that patients, family members, clinicians, whether that be housekeeping up to the physician level, to the C level Exec, have to acknowledge that a culture of safety must be established in healthcare organizations today because that culture is critical to business success and patient success. So in your mind, who are the key contributors to instilling that that safety culture in the clinical environment? It's the natural response to say that it begins with the executive leadership in the institution, which then trickles down, from an organizational analysis perspective, we always tend to focus our or even point fingers at the executive leadership, so they are in part responsible for instilling a culture of safety. However, every single person working in the healthcare organization makes an impact on safety and is responsible for the culture within the clinical environment. When all team members know that their contribution is meaningful, there's greater pride and engagement at work. I think we know that that leads to less attrition, greater retention, greater professional satisfaction, specifically amongst the clinician base. Leaders who encourage transparency and promote a blame free culture, which is a pivotal component to a safety culture, cultivate trust and accountability for every role that that person has in that institution. They see their role as pivotal to the high level success or high level functioning of that organization as they care for the patient in the bed. So I mentioned earlier, housekeeping up to the physician level, the CNA, certified nurse's aide, the dietician, materials management, the registered nurse, and of course the physician, the surgeon and the C level execs all play a significant role. And sometimes I imagine if every worker believed that it was their personal responsibility to create a culture where safe, quality care was everyone's business the kind of impact we would see. And I believe we would see a significant shift in thinking as it relates to whose responsibility it is to ensure that the patient in the bed has the best outcomes possible. All work in the hospital would inevitably become patient centered again, regardless of role.Speaker 1:
And I think that's very, very important point to make is it is ultimately all about the patient. So I think that's a great point to end that thought on. Next, I was interested to know what kind of safety nets are in place to promote this consistently safe quality care or for these better patient outcomes that we're talking about.Speaker 2:
improving how healthcare is delivered and continues to be essential. It's at the forefront of everyone's mind. It's more than likely what keeps C-suite execs up at night. There are many organizations like the National Patient Safety Foundation, the national quality forum, IHI, or the institute for healthcare improvement, the HRQ, which of course is the agency for healthcare research and quality. Other organizations like the joint commission, CMS, which stands for Centers for Medicare and Medicaid, all have efforts focused on quality improvement initiatives. State surveys, accreditation surveys are all intended to keep organizations on their toes, giving organizations a structure around which to focus quality improvement efforts. They're all mandated under specific regulations that stem from CMS. Any organization that receives Medicaid or Medicare reimbursement for services must meet the federal requirements outlined by CMS. The standards range from everything from a patient rights perspective, patient education perspective, infection control, medication management, preventing medical errors, so wrong med to the wrong patient or a reaction due to an allergy to how the hospital verifies that it's doctors, nurses and other staff are qualified and licensed and frankly competent. Today, healthcare organizations, we're seeing a shift in the industry. Obviously when the joint commission switched to unannounced surveys that organizations are always preparing for continuous readiness, or at least we hope they are. This continuous preparation ensures their compliance with the standards for CMS, and it allows an organization to be in a perpetual state of readiness which thereby promotes a culture of safety and accountability and continual improvement.Speaker 1:
So following again from there, what do you believe are some of the key focuses in the healthcare industry today? Is it about, maybe palliative care or things around sepsis identification? Obviously it seems like it's not about revenue anymore and increasing patient volume, but it's more about that, that quality of care that keep talking about.Speaker 2:
So what do you believe are some of those key focuses right now? So, Go to any trade show where technology is being sold, trade shows like HIMSS or the ANA or CCNE or IHI and you will see quality outcomes and value as strong buzzwords for the healthcare industry today. And those have frankly been at the forefront for quite some time, but they continue to be emphasized more than ever. And so thinking of those buzzwords, quality outcomes and value-based care. I know that healthcare organizations are focused on achieving greater revenue with an increasing patient volume that is sicker than ever before, especially as we see our baby boomer population continue to age and so focusing on value over volume is a mind shift for clinicians, but so paramount as the market and consumers move beyond a transaction based treatment to the holistic health of populations, so we in turn switch from a more reactive function to a proactive function as we care for these patients across diverse populations and so from a holistic perspective, this means treating and offering available services to patients in their greatest time of need. Palliative care, like you mentioned, it's just one example of a service which research proves, bends the cost curve, allowing patients to live quality lives while living with chronic conditions. It bends the cost curve by reducing readmissions because those patients are able to stay at home where they frankly want to be, improve length of stays by reducing unnecessary length of stays and insurers. Patients receive appropriate services specifically around critical care units where perhaps they don't need to be because their pain can be managed on a lower level acute care floor. Sepsis, again, something that you mentioned, it will continue to remain a focus of the healthcare industry. It really has been for quite some time. Although the focus on sepsis has continued. It remains a difficult condition to detect specifically non present on admission Sepsis, so meaning sepsis which develops during the hospital encounter versus present on admission sepsis which is already present when that patient hits the ER. And now Hospital Compare just this month is releasing healthcare organizations' 2017 sepsis performance. And so this really turns the heat up on healthcare organizations as their data becomes public. So healthcare organizations have to continue to focus on change management in this area in conjunction with available technology. Like I mentioned, a lot of the EMRs are out there trying to solve this problem by firing alerts, running algorithms in the back end, but coupled with technology is also a change management process that has to be present in order for clinicians to buy in and leverage that technology in conjunction with changes in clinician workflow.Speaker 1:
Now you alluded to this a little bit earlier, but I wanted to talk a little bit more specifically about teamwork in the clinical environment. It's something that everyone talks about, but what are your thoughts on how how teamwork is really evolving in healthcare? I think you've touched on it a little bit earlier, but I'd love to know and a little bit more detail about that.Speaker 2:
So in the 18 years that I've been in healthcare, there has been a strategic shift in thinking around how a healthcare team functions. So part of curriculums now is a concept called interprofessional teamwork. It ensures that from every layer or level of care within a facility, clinicians, again back to housekeeping, back to dieticians to OTs to PTs are all communicating because they're focusing on the patient in the bed. So healthcare continues to be a team sport. I think it's more so now than ever. Ineffective interprofessional teamwork jeopardizes patients' safety, frankly. So if the vision of the hospital is to provide patient centered care than teamwork becomes a significant component or attribute or characteristic of the care team. Research shows that when multi-disciplines work together, patient outcomes are improved, enhanced interprofessional teamwork counters that working in silo effect, the physician and the nurse are heavily relying on one another for stronger communication. And anyone who walks into a patient room who delivers a food tray, who cleans a restroom in a room or changes linens in a room all have significant priority to ensure that that patient is taken care of in order to achieve the best outcomes possible. So this notion of multidisciplinary teamwork, it's not new, operating rooms are an example of teams that have functioned this way for years, and they have been quite successful as they care for that patient laying on the operating room table. But it's a semi newer concept to the floors. There's a strong culture in healthcare. I think, again, within the last 18 years since I hit the floors, hit the bedside, there's a strong strategic shift in thinking because we're all focused on the patient. And so again, I think it's, it's a culture shift that we will continue to see morph and a continual thinking of how we could do things differently from a healthcare perspective. With healthcare reform, we know that interprofessional practice will be even more crucial as new care delivery initiatives are being tested today that involve team-based care, such as accountable care organizations or patient centered medical homes.Speaker 1:
So there are, based on some of the things we just talked about, what are some of the things that you're really excited about that we're working on at Intalere and you and your team can offer to our membership.Speaker 2:
Intalere is really, well specifically my team, is really looking to extend our reach into the clinical workflow space. So we know with the subject matter expertise that we have on my team, my team is comprised of registered nurses, a certified scrub tech, data analysts, and subject matter experts in the operating room, specifically related to physician preference items, we can take our knowledge and extended into the clinical space, meaning we have a solution which supports survey and accreditation readiness. So we have the ability to conduct mock surveys, evaluate conditions of participation, make recommendations for respective members of any healthcare organization, team, specifically quality or safety officers. We really are also focused on some of the other key words that we discussed just a few minutes ago as it relates to sepsis identification, so being more proactive with sepsis detection, specifically non POA through technology and change management which accompanies or should accompany all technology implementations and then also with the palliative care consulting solution which allows us to analyze existing data related to palliative care programs which are in existence currently or or potentially organizations that have the opportunity to form a palliative care team in order to improve patient outcomes within their respective facility. One of the things that I would say I'm most proud of is our ability to connect with key stakeholders in an organization outside of materials management, but really connecting with chief nursing officers, VPs of quality and safety, showing that ROI to chief financial officers so that they feel comfortable with us coming in and delivering a solution which then impacts their bottom line. So those are several of the things I'm most excited about really from a nursing perspective. From an organizational perspective, the fundamental premise of our team is still that we are transforming healthcare by impacting the patient's outcomes, and family members who are taking care of those patients, but also improving the way clinicians are able to operate within the healthcare setting. So not adding to their existing workflow or, or bombarding them with new technologies, but considering ways that they could do things differently, do things better for the patient.Speaker 1:
Information there. Thank you so much. I really appreciate you coming in to talk to us a little bit about teamwork and the focus on quality and how that's so important in the healthcare setting. Validation. Thank you very much. Thank you. If you enjoyed this episode, make sure you subscribe to the Illuminated Path podcast wherever you listen to podcasts. To learn more about Daria or Intlalere, check out our show notes and visit our website at Intalere.com and follow us on Linkedin, Twitter, and Facebook to learn when the latest episodes will be available and to keep up with all things Intalere.