Category Archives: JCI Standards GLD

EHR-related Safety Events

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Hospitals around the globe are fast implementing or are now expanding on the use of Electronic Health Records (EHRs). The notion is that hospitals are able to provide better quality of care and at the same time, ensure improved productivity for providers with computer equipment hosting the EHRs.

While we watch the whole world marching onwards in implementation and expansion of EHRs, readers are reminded of the aspects of patient safety as defined by the World Health Organisation, which is to prevent errors and adverse effects to patients that are associated with health care.  Safety is what patients, families, staff, and the public are likely to expect when they are at hospitals. Thus the safety net must not only safeguard patients but staff caring for the patients and visitors to hospitals. As such, safety controls from hazards or risks posed by buildings, grounds, and equipment (JCI 2013) such as computers and EHRs to patients, families, staff, and the public must be in place at hospitals to prevent safety related events.

In this post I have summarised graphically into three (3) charts contributing factors for EHR-related Safety Events and on how to prevent, mitigate, and react to them. The facts presented in the charts are based on the opinions given by three (3) Joint Commission Resources (JCR) and JCI consultants on the ever-increasing EHR lawsuits in the United States between 2013 and 2014, as was reported recently in Becker’s Health IT and CIO Review.

The Charts 1 and 2 show eight (8) common causes of EHR-related safety events as follows:

  1. user error
  2. EHR builds
  3. workflows
  4. limited EHR interoperability across all three levels of health information technology interoperability i.e. foundational, structural and semantic levels
  5. deficient provider EHR education
  6. poor post-deployment vendor or institutional support
  7. losing sight of EHR best practices
  8. organisations that do not have a well-organised paper medical record cannot describe what they want in an EHR thus leading to work arounds 

EHR-related-Safety-Events-1

EHR-related-Safety-Events-2Chart 3 presents six (6) ideas on what can be done to decrease the number of EHR-related safety mistakes which are:

  1. need to make end users aware of the potential this technology has to contribute to safety events
  2. encourage the reporting of events that may be related to EHRs
  3. if an EHR-related safety event occurs, the event should be analysed
  4. resources should be available to address post go-live optimization
  5. third party consultants
  6. use patient safety and standards and processes as the structure for appraisal and guidance

EHR-related-Safety-Events-3As we in this part of the world are implementing quality standards from the JCI, appraisal and guidance to focus on and prevent EHR-related Safety Events can be found in the Leadership chapter and the Management of Information chapter found in Joint Commission International Standards for Hospitals, as recommended by these three (3) Consultants.

I like to conclude that while hospitals worldwide are riding the wave of implementing or now expanding on the use of EHRs, it is best to be aware of whatever the contributing factors to EHR-related Safety Events maybe including those identified in this post, and to be accountable to prevent or minimise such events with awareness and the necessary knowledge as outlined by the above mentioned Consultants.

References:

  1. Healthcare Information and Management Systems Society(HIMSS) 2015, What is Interoperability?, viewed 18 June 2015, < http://www.himss.org/library/interoperability-standards/what-is-interoperability>
  2. HealthITInteroperability 2015, HealthITInteroperability Definitions, viewed 18 June 2015, <http://healthitinteroperability.com/glossary>
  3. James,  S., The Book on Healthcare IT: Volume 2, 2015
  4. Joint Commission International 2015, JCR and JCI Consultants on Reducing and Preventing EHR-related Safety Events, viewed 18 June 2015, <http://www.jointcommissioninternational.org/jcr-and-jci-consultants-on-reducing-and-preventing-ehr-related-safety-events/>
  5. Joint Commission International 2013, Joint Commission International Accreditation Standards For Hospitals, 5th edn, JCI, USA
  6. Margret, A., Process Improvement with Electronic Health Records A Stepwise Approach to Workflow and Process Management, 2012, CRC Press, Florida, United States of America
  7. World Health Organisation 2015, Patient safety, viewed 18 June 2015, <http://www.who.int/patientsafety/about/en/>

JCI Standard GLD.3.2 – leadership role in the dynamics of communication within a hospital, Part 2

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effective communication

Image credit: Carnegie Speech Company

Effective communication throughout the hospital occurs when individuals possess high-level competency to perform their communications role and when information or meaning has been shared by at least two people.

To perform their communications role with high-level communication competence, they must possess a cluster of related knowledge, skills, and attitudes or motivation. High-level communication competence is to possess the knowledge to know behaviours that are effective and appropriate for a given situation, the skill to apply the behaviour in the given context with the ability to be sensitive to the perspectives of others, and to have the attitudes or motivation to communicate in a competent manner. For example to have the attitude or motivation to communicate in a competent manner when we leave voice mail, the effectiveness of the communication is when two parties (the receiver and the sender) are responsible. The receiver is responsible as he or she responds back to the sender, as the sender cannot know whether the message has been conveyed as intended if there is no feedback from the receiver.

High-level communication competency is also accomplished by choosing communication behaviours that convey messages clearly and precisely, by offering and seeking clarifications to ensure a high probability that messages are interpreted as intended leaving interpretation less open to chance.

We already know that hospitals are most frequently and typically divided into cohesive subgroups such as departments, services, or units for effective and efficient daily delivery of clinical services and management of the hospital as an organisation. These subgroups consist of clinical departments such as medicine, nursing subgroup(s); diagnostic services or departments such as radiology, pharmacy services, and ancillary services such as transportation, among others.

Leadership of these subgroups to collaboratively guide the hospital in meeting the hospital’s mission, strategies, plans, and other relevant information is distributed among a group of leaders collectively accountable for their expectation(s). Each subgroup is managed under the direction of a department/service leader(s) and assisted by a manager(s) as found at most larger hospitals.

Each hospital will have its unique set of hospital leadership individuals with a variety of responsibilities and accountability. Hospital leadership individuals usually consists of an individual to represent the medical staff of the hospital, a chief nursing officer representing all levels of nursing in the hospital, senior administrators, and any other individuals the hospital selects.

In order to set the parameters of effective communication, there must be coordination of clinical services which comes from an understanding of each department’s mission and services and collaboration in developing common policies and procedures, understanding the hospital organisational goals, and to be aware of their responsibilities to patients and other employees among all subgroups of the hospital.

Given this understanding about effective communication within a hospital setting, I think the hospital leadership is the most suitable to be given the responsibility to ensure effective communication throughout the hospital.

In exercising effective communication, the hospital leadership must understand the dynamics of communication between professional groups; between structural units, such as departments; between professional and nonprofessionals groups; between health professionals and management; between health professionals and families; and between health professionals and outside organisations.

One example of facilitating co-ordination between the above mentioned groups is the case in medicine for the patient medical record making information about patients available to the increasing number of personnel involved in treatment and payment. Alison, Jon and Virginia (2010) recognised the importance of medical records which operate as important ‘boundary objects’ crossing “organisational boundaries and which can be accessed by a variety of users, including doctors, reimbursement agents, insurance companies, legal professionals, medical researchers, billing coders, audit contractors, and the patient.” (eds. Alison, Jon and Virginia 2010, p. 134 ). Alison, Jon and Virginia (2010) also noted from findings of a study of record – keeping practices in a psychiatric clinic, that hospitals must enforce ‘institutional accountability’ to ensure their medical records are competent accounts of a given medical encounter. This accountability covers formatting of medical records to widely recognisable standards so that they are recognisable and meaningful to other healthcare professionals and to the increasing number of potential ‘witnesses’ to the event increases when the encounter becomes an accessible record crossing organisational boundaries.

Hospital leadership also serves as role models with the effective communication of the hospital’s mission, strategies, plans, and other relevant information to staff, ensures that processes are in place for communicating relevant information throughout the hospital in a timely manner, and develops a culture that emphasizes cooperation and communication among clinical and non-clinical departments services and individual staff members to coordinate and to integrate patient care.

If you are reading this post as a Health Information Management (HIM) / Medical Records (MR) practitioner department/service leader of your hospital, I am sure you are already automatically selected to be a part of the hospital leadership. This means you need to be trained and learn a cluster of related knowledge, skills, and attitudes or motivation to possess a high-level communication competence for your communications role.

And, if you are indeed this HIM / MR practitioner I referred to above and working at at a hospital which is already Joint Commission International Accreditation (JCI) accredited or seeking JCI accreditation status or undergoing re-survey for accreditation status, then you need to be aware that you will no longer be working with the “Management of Communication and Information (MCI)” team of your hospital to coordinate and monitor the JCI Standard MCI.4 and Standard MCI.5, simply because the MCI Chapter not found in the 5th edition JCI as it was in the previous edition (4th edition). The MCI Chapter is now known as the “Management of Information” (MOI) chapter in the 5th edition as I have posted in the post JCI Standard GLD.3.2 – leadership role in the dynamics of communication within a hospital, Part 1 (this link will open in a new tab of your current browser window).

To reiterate, the Standard MCI.5 now combines with MCI.4 in the Governance, Leadership, and Direction (GLD) chapter of the 5th edition “to better align hospital leadership requirements; revises standard, intent, and MEs to clarify expectations” (JCI 2013, p.161) to form the Standard GLD.3.2 in the 5th edition which states that “Hospital leadership ensures effective communication throughout the hospital.

Perhaps you as a HIM /MR practitioner have been recently active in ensuring effective communication in your hospital as been part of (i) formal activities for example as a leader or member of standing committees and joint teams, and (ii) informal activities for example publishing newsletters and posters as methods, for promoting communication among services and individual staff members of the hospital.

References:

  1. Joint Commission International, 2010, Joint Commission International Accreditation Standards For Hospitals, 4th edn, JCI, USA
  2. Joint Commission International, 2013, Joint Commission International Accreditation Standards For Hospitals, 5th edn, JCI, USA
  3. Pamela McHugh, S & Linda.N., 2010, Communication for nurses : how to prevent harmful events and promote patient safety, F. A. Davis Company, Philadelphia, PA, USA
  4. Ricky, WG & Gregory, M, 2014, Organizational Behavior: Managing People and Organizations, 11th edn,, South-Western, Cengage Learning, Mason, OH, USA
  5. Alison, P, Jon, H & Virginia, TG (eds), 2010, Communication in healthcare settings : policy, participation, and new technologies, Wiley-Blackwell, West Sussex, United Kingdom

JCI Standard GLD.3.2 – leadership role in the dynamics of communication within a hospital, Part 1

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This afternoon, I am to write about the Joint Commission International (JCI) Management of Communication and Information (MCI) Standard MCI.5 which states that “The leaders ensure that there is effective communication and coordination among those individuals and departments responsible for providing clinical services.”

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Image credit: http://www.danieldecker.net/

Surely, the Health Information Management (HIM) / Medical Records (MR) practitioner’s practice is not responsible for providing clinical services, thus Standard MCI.5 will definitely not require any HIM / MR practitioner to comply with it.

However because Standard MCI.5 is included among other standards found in the MCI Chapter of the JCI manual (4th edition) that mostly apply to the practice of HIM / MR (all of which I have completed posting on this blog), I still wish to write about this standard so that HIM / MR practitioners will be aware and also that they will appreciate the ongoing communication and coordination among those individuals and departments responsible for providing clinical services in a typical hospital setting. A HIM / MR practitioner will perhaps then understand and appreciate the demand for medical records use in the dissemination of patient care information among fellow colleagues operating from different departments responsible for providing clinical services.

From the post The JCI Manuals, 5th Edition are effective 1 April 2014  (this link will open in a new tab of your current browser window), readers will now know that hospitals need to begin to focus their hospital accreditation program based on the 5th edition of the JCI international standards for hospitals.

Examining this 5th edition of the JCI international standards for hospitals, I found that there are many changes to this 5th edition of the hospital manual. Expect to find requirement changes that “raise the bar” on compliance expectations in addition to finding more clarity over and above nearly all of the text that appeared in the 4th edition.

One major change I found on further examination of the 5th edition is that you can no longer find the MCI Chapter in the 5th edition. The “Management of Communication and Information” (MCI) in the previous edition (4th edition) is now known as the “Management of Information” (MOI) chapter (5th edition).

Nonetheless, I looked for the Standard MCI.5 in the MOI chapter of the 5th edition, but it was no longer there among the rewritten MOI chapter. Delving deeper, I found that Standard MCI.5 is now moved and consolidated with similar requirements of Standards, and in this case to the “Governance, Leadership, and Direction” (GLD) chapter in the 5th edition.

The Standard MCI.5 now combines with MCI.4 (also from the 4th edition) in the GLD chapter of the 5th edition “to better align hospital leadership requirements; revises standard, intent, and MEs to clarify expectations” (JCI 2013, p.161) to form the Standard GLD.3.2 in the 5th edition which states that “Hospital leadership ensures effective communication throughout the hospital. “

I shall be writing about the Standard GLD.3.2 of the 5th edition in the next part. What I plan to write in this next part will also relate to the Standard MCI.4 which states that “Communication is effective throughout the organization.” which I have already posted in the post JCI Standard MCI.4 – accuracy and timeliness of information in the hospital through effective communication (this link will open in a new tab of your current browser window).

References:

  1. Joint Commission International, 2010, Joint Commission International Accreditation Standards For Hospitals, 4th edn, JCI, USA
  2. Joint Commission International, 2013, Joint Commission International Accreditation Standards For Hospitals, 5th edn, JCI, USA

JCI Standard MCI.4 – accuracy and timeliness of information in the hospital through effective communication

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My intention in bringing this post to a Health Information Management (HIM) / Medical Records (MR) practitioners reader specifically and to all other readers in general, is to understand the dynamics of communication and your role in managing patient-specific information in a hospital setting when the leaders of the hospital agree to an essential condition  whereby effective communication must prevail among and between professional groups; structural units, such as departments; between professional and non-professional groups; between health professionals and management; between health professionals and families; and with outside organisations.

In making this agreement for effective communication throughout the hospital setting, I agree the stipulations that this issue is primarily a leadership function of the hospital’s leaders. This agreement is stipulated in the Joint Commission International (JCI) Standard MCI.4 which states that “Communication is effective throughout the organization”, especially so if you are practising in a hospital accredited or seeking JCI accreditation status or undergoing re-survey for JCI accreditation status.

The reader as a leader of a structural unit setting and relevant service needs to be aware of the following conditions in this agreement for effective communication:

  1. for patient care to appear seamless, processes must be in place for communicating relevant information in an accurate and timely manner throughout one’s structural unit, such as the HIM / MR department and between other structural units in the hospital; this is to ensure that the processes are designed and implemented to support continuity and coordination of care as patients move through the hospital from admission to discharge or transfer, several departments and services and many different health care practitioners may be involved in providing care; for example from emergency services to inpatient admission
  2. the hospital defines the patient-specific information, example patient’s weight and other physiological information available from the medical record, required for an effective review process and is facilitated by a record (profile) i.e via medication administration records (MAR) or medication list, also to be found within a medical record for all medication administered to a patient except emergency medications and those administered as part of a procedure; the medical record folder is updated after a review of a patient receiving medications, example the folder is tagged with an alert sticker for allergies or sensitivity; this review also facilitates the medication reconciliation process across the continuum of care and the process continues upon discharge and transfer of the patient, and the complete list of patient medications is shared with the next provider of patient care
  3. effective communication occurs in the hospital among the hospital’s programs ranging from the emergency services, inpatient admission, diagnostic services and treatment services, surgical and non-surgical treatment services and outpatient care programs for seamless care
  4. since patients frequently require follow-up care to meet on-going health needs or to achieve their health goals, there is a plan by the hospital’s leaders with the leaders of other health care organisations in its community for effective communication to occur between the leaders of these other health care organisations in its community during referrals; the plan establishes contact with known resources i.e. the patient’s home community and identified specific individuals and agencies that are most associated with the hospital’s services and patient population in order that they help support continuing health promotion and disease prevention education
  5. there are policies and procedures developed to support and to promote patient and family participation in care processes to ensure that continuity and coordination are evident to the patient; effective communication thus occurs with patients and families in these circumstances:
    1. patients and families are involved in care decisions by effective communication thus occurs with patients and families when (i) they understand how and when they will be told of planned care and treatment(s), (ii) understand their right to participate in care decisions to the extent they wish and learn about how to participate in care decisions
    2. inpatients and outpatients who leave against medical advice when patients, or those making decisions on their behalf, may decide not to proceed with the planned care or treatment or to continue care or treatment after it has been initiated guided by a process for the management and follow-up of such cases
    3. effective communication thus occurs with patients and families when those who provide education encourage patients and their families to ask questions and to speak up as active participants
    4. effective communication occurs with patients and families when indicated, planning for referral and/or discharge begins early in the care process ie. soon after admission as inpatients and, when appropriate, includes the family
    5. effective communication occurs with patients and families when patients are reassessed to plan for continued treatment or discharge
    6. effective communication occurs with patients and families such that symptoms and complications are prevented to the extent reasonably possible during the care of the dying patient
  6. and finally. the reader as a leader must not only set the parameters of effective communication but also serve as role models with effective communication of the hospital’s mission and appropriate policies, plans, and goals to all staff.

I acknowledge the role of effective communication and its pervasiveness in creating, gathering and sharing health information in meeting challenges and improving health care outcomes. In this post, I think I have achieved to address some pertinent issues relevant to effective communication when implementing the requirements of the JCI Standard MCI.4 specifically and also delving into the issues of effective communication in general.

References:

  1. Dale, EB & Daena, JG (eds.) 2009, Communicating to manage health and illness, Routledge, London, UK
  2. Joint Commission International, 2010, Joint Commission International Accreditation Standards For Hospitals, 4th edn, JCI, USA
  3. Michelle, AG & Mary, JB 2011, Essentials of Health Information Management: Principles and Practices, 2nd edn, Delmar, Cengage Learning, NY, USA
  4. Sheila, P & Sandra, H (eds.) 2007, Health communication Theory and practice, Open University Press, McGraw-Hill Education, England, UK

JCI Standard MCI.1 – Communication with the Community

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It is natural to think of the Public Relations (PR) department of a hospital when a hospital needs to deal with a community it serves to facilitate access to care and access to information about its patient care services. Thus, it is not surprising to pass the buck to a representative of the PR department of a hospital sitting in a Management Of Communication And Information (MCI) Committee to deal with, and in order to comply with the Joint Commission International (JCI) Standard MCI.1 which states “The organization communicates with its community to facilitate access to care and access to information about its patient care services.”

I think if you are a leader championing the JCI MCI standards, this leader must not merely delegate this MCI standard to the PR department representative to deal with, but must also nurture as teacher, mentor, colleague, and friend to guide and be responsible to coach in the implementation and compliance of this standard, thus to care for and encourage the growth or development of MCI standards for the hospital. In this scenario, it is important for this leader to be knowledgeable in PR by at least researching the subject matter and linking his or her literature reviews with this standard.

From my interactions with representatives of PR department of hospitals, they normally deal with the management of both internal and external communications. They told me they are responsible for promotions of the hospital and implementation of the hospital’s marketing programmes that are related to overall mission and vision of the hospital, also manage and improve the flow of information within the hospital and between the hospital and the community it serves. Public relations professionals also serve as liaisons to the community and work closely with other health partners in the locality in preventive health. The responsibilities of a PR person in a hospital setting includes writing and distributing news release, feature articles to the press, compiling press list, witting of newsletters, handling and maintaining a media information service, arranging press, radio and television interviews for management, preparing marketing plans for various programmes and create strategies in promotional and marketing efforts. In summary, the PR department is responsible for community relations, hospital publications, media relations special events and support for fundraising.

Since the measurable elements for this standard requires a hospital to (i) implement  a communication strategy, (ii) provide information on its services, hours of operation, and the process to obtain care through mass media interventions, such as those delivered by leaflets, booklets, posters, billboards, newspapers, radio and television, and (iii) provide information on the quality of its services, “the quality of services as is always determined by certain attributes that they have or should have. The most important attributes health services should have, are accessibility and availability,usage facility, public’s acceptance and all these always in relation to their cost.” (Athina and Andriani, 2012, p. 205) which is provided to the public and to referral sources with defined communities  and populations of interest,  I personally think that the PR department in a hospital is best suited to manage and measure this standard based on what I have already said in the preceding paragraph.

With all what I wrote above and what I intend to say in the next paragraph, let me remind you that all of us serving in the socioeconomic system of healthcare, including doctors and patients carry on our lives as person-systems within a hierarchy of multiple and overlapping systems of family, community and wider society. The internal needs of patients as person-systems, i.e. the patient is unwell, the patient’s family, workmates, employers and hospitals will tend to accept the sick role of this patient. After a defined length of time, the patient seeks the professional endorsement of a doctor for a clinical transaction, which is a subsystem of the hierarchy of systems comprising health care.  At the end of the day, the person-systems of doctor and patient constituting of the patient, members of family, community systems and professional (e.g. the doctor) or economic systems, all support a speedy and complete return to health for the patient.

Members of the MCI Committee must be aware that the approach it chooses in understanding and measuring as well as complying with this standard, is driven by the care delivery for the population served by the hospital in advising patients on how to leverage the system to ensure coordination of care across the continuum, integrated across the continuum among defined communities and populations of interest with healthcare specialists in the hospital.

So what is this “defined communities and populations of interest”,  if you are a member of  a  MCI Committee, you need to focus on?

Marie and Sandra (2011, pp. 46-47) define population of interest as “a population at risk or those with a common risk factor leading to the threat of a particular health issue. It also may be defined as a population of interest known as a healthy population who may in fact improve their health by making certain choices that will further promote health and/or protect against disease or injury. For example, an adolescent population that engages in alternative sports and chooses to wear protective gear avoids serious injury.”

I have been asked how and what does the PR department do in order to understand patterns and trends within this population of interest. First, I think it is the best interest of the PR department to be comfortable enough with information technology to collect and organise data, initiate and develop appropriate databases for their practice to better assess and serve the population of interest. I also think the PR department must design cross-sectional studies at finding out the prevalence of a phenomenon, problem, attitude or issue by taking a snap-shot or cross-section of the population. Pre-test/post-test studies could also be undertaken to measure the efficacy of a program on the same population to determine if a change has occurred.

I have also been asked how and what does the PR department do when identifying defined communities. My advice is that the PR department must be involved in gathering census data that provide the PR department with evidence about the overall health status of the population living in a particular community. The PR department could use the Internet which provides a wealth of data such as geography and history of a community as well as census track boundaries and data.

Armed with knowledge on defined communities  and populations of interest, the PR department  must surely be able to show evidence that there is (i) a communication strategy to reach the defined communities  and populations of interest , (ii) information on its services, hours of operation, and the process to obtain care, and (iii) information on the quality of its services, which is provided to the public and to referral sources with defined communities  and populations of interest, in order to fully comply with Standard MCI.1.

All this is possible when the hospital and the PR department jointly develop and revise strategic and operational plans to address community needs for a healthier community within larger geographic or political areas as reflected in the hospital’s mission and required by the JCI Standard GLD.3.1 which states that “Organization leaders plan with community leaders and leaders of other organizations to meet the community’s health care needs.”, thus recognising that they have responsibility for and can achieve an impact on the community.

References:

  1. Athina, L & Andriani, D, 2012, Quality assurance in healthcare service delivery, nursing, and personalized medicine: technologies and processes, Medical Information Science Reference, Hershey, PA, USA
  2. Joint Commission International, 2010, Joint Commission International Accreditation Standards For Hospitals, 4th edn, JCI, USA
  3. Kingsley, N & Sam, S 2009, Problems With Patients: Managing Complicated Transactions, Cambridge University Press, Cambridge, UK
  4. Louise, LI & Carolyn, LB 2008, Public Health Nursing: Leadership, Policy & Practice, Delmar Cengage Learning, New York, USA  
  5. Marie, TL & Sandra, BL (eds.) 2011, Public health nursing : practicing population-based care, Jones and Bartlett Publishers, Sudbury, MA, USA
  6. Stephan, J & Frank,  MG 2011,  Information and Communication Technologies in Healthcare, CRC Press, Boca Raton, FL, USA