Aside from practicing as an OB/GYN, Dr. Charles Zonfa is the physician director of risk management and patient safety for Ohio Permanente Medical Group. In that position, he links three major programs: quality, patient safety and risk management.
“Because a lot of our patient safety initiatives are aimed at improving quality, it’s essential that once you identify areas where there are quality deficits or areas to be focused on for improvement, you have to have a way to address those gaps with patient safety initiatives,” Zonfa says.
“For example, there are a lot of governing bodies that say there are certain aspects of patient safety that should be the focus for each individual year. We try to incorporate those within our quality programs and develop initiatives or do process improvement around certain safety initiatives.”
Smart Business spoke with Zonfa about several new patient safety initiatives and why employers should care about them.
Why should employers shift their concentration to patient safety and a health plan’s quality programs?
When you are looking for a health care plan to assume the care of your work force, the first thing you want is a company that is dedicated to or obsessed with patient safety. If they aren’t, you face a higher risk of medical error and other problems. Then, your employees are not just going to be out of work for the procedure they had done, but for any complications or other unnecessary outcomes that could affect their ability to come back to work for weeks.
Health plans can impact the actual productivity employees have in the workplace by focusing on the quality they provide. There is a true dollar value attached to how long employees are out of work, which is related to the health plan’s ability to provide top-notch care.
One of the biggest concerns we hear from employer groups is if a part of their work force is out, their entire company’s productivity is impacted. That’s why it’s important to have a health plan that supplies high-quality care.
Say an employee goes in for an outpatient procedure and is only supposed to be out one to two days. If there is a complication because of a medical error, now the person is out for three to four weeks.
You can’t really argue with the fact that if the clinical staff had been better prepared for any situation, it would have lessened the chance of the employee missing four weeks of work.
How are health care providers developing ways to improve patient safety?
A major patient safety initiative study showed there are nearly 98,000 deaths related to medical errors per year. To address this issue, we looked at other industries with an obsession with safety, like nuclear power plants or air travel. Why is their error rate so low? What is inherent in these industries that allows them to achieve such high results?
We found that these industries have certain characteristics, like this obsession with safety, and a culture where everyone from the newest hire to the CEO can identify safety risks and feel comfortable addressing those risks.
Medicine was the complete opposite. Doctors were at the top and everybody else had to fall in line. Front line employees didn’t feel secure enough to bring up any safety concerns. By empowering people to speak up and bring safety concerns up to administrators, you can promote a culture of safety.
What types of programs have been developed to improve patient safety?
One major initiative is medication reconciliation. Basically, this process checks if patients are taking the medications prescribed for them correctly and with consistency.
Many patients aren’t taking their medications correctly, not because they don’t want to, but because the instructions leave room for interpretation.
So we developed a process to make sure that when someone has an interaction with a caregiver at one of our facilities, we check the medication list and ensure that they are taking the medications prescribed to them correctly.
What is being done to reduce medical error?
There are three key components: communication between individuals, human factors and simulation training.
Seventy-five percent of medical errors are due to communication problems. So we used a method of communication called SBAR to develop a concise way to communicate more effectively between everyone in the organization.
S stands for situation, the headline. B is the background what led up to that point. A is your assessment of the situation. R is your recommendation. So if you have a patient in cardiac arrest, instead of giving too much information, you can communicate quickly and clearly.
We train our people on the human factors innate human characteristics that can lead to errors: fatigue, fixation on certain tasks, tunnel vision. Then, we determine what we can do in our systems to reduce those types of errors.
We also rehearse emergencies, like they do in the airline industry. Every pilot has to clock so many hours in a flight simulator. We created something similar. Say someone goes into cardiac arrest in a doctor’s office. You have to train the staff for what to do in that situation.
One of the first areas we looked at was the perinatal arena (the time period immediately before and after birth). Based on the amount of payouts we have, we know that that is where there is the highest risk. Studies of medical errors in the perinatal unit show you can boil them down to five main causes. So we started rehearsing these causes in real time, with real staff performing their normal functions. These medical simulations have been expanded to almost every department in the ongoing effort to reduce adverse events and prevent the preventable.
Dr. Charles Zonfa is the physician director of risk management and patient safety for Ohio Permanente Medical Group.