Early Detection: Stop Small Problems before they are Big Problems

Across the country, hospitals are finding themselves on the receiving end of unannounced regulatory surveys. Failure to be prepared for such surveys can, in the worst cases, lead to Preliminary Denial of Accreditation by The Joint Commission (TJC) or findings of Immediate Jeopardy by the Centers for Medicare and Medicaid Services (CMS). But, hospital leaders can avoid adverse survey findings and ensure patient safety by paying attention to seemingly small issues before they become big problems.

So, how do small problems grow? We have found that small problems become big problems for two reasons. They either go unseen, or are perceived to be smaller or less consequential than they actually are.

Lack of visibility is probably the most common factor that allows small problems to grow. Often, unseen patient safety issues lurk behind seemingly positive data. Executives and board members should look critically at the quality reports that they receive, not just for the information that is included, but also for the information that’s missing. Are scores for select core measures consistently reported to be in the top percentiles while others aren’t mentioned? Are certain departments regularly highlighted for good performance but there is no discussion of problems? In other words, are you getting almost entirely good news?

When it comes to quality and patient safety, no bad news can be a red flag. Given the numerous patient interactions involved in day-to-day operations, every hospital should experience some level of failure. If, as a hospital executive, you don’t routinely hear about little problems, you’re probably missing the big issues, too. You can’t improve performance if you don’t know what needs to be improved.

So, when examining quality reports, look for the following signals that problems may be hidden or their gravity underestimated.

• Compliance with select core measures is consistently in the top percentiles.
  Core measures are important; there’s no denying that. But, they rarely tell the whole story when it comes to patient safety and regulatory compliance. Hospitals with nearly perfect core measure scores can still get into trouble on survey. Focusing on boosting core measure scores can divert attention away from day-to-day care. Also, CMS surveys are focused on compliance with minimum standards. So in many cases, core measures don’t correlate to compliance with CMS standards. For example, restraint and seclusion, a classic hot-button issue on CMS surveys, is not represented by a core measure.
• Certain departments are regularly highlighted for good performance.
  Every hospital will have stand-out departments that always do a good job of ensuring quality and patient safety. But, it’s important that you have a comprehensive view of all departments, not the just the best ones. Reports should cover every department at least once a year, with emphasis on patient outcomes. This type of strategy ensures that executives and board members and objective view not only of the entire hospital, but of the most important data.
• Reports focus solely on data and activities.
  While the current trend is to focus on risk reduction by improving processes, don’t forget that it’s important to understand how process improvements translate to better care. Be wary of reports that feature lists of actions and data without providing the analysis to show how those actions or data correlate to better patient outcomes. For example, reporting on the hours of sitter use is meaningless if those hours of supervision don’t lead to reduced use of restraints and fewer patient injuries. Also, appreciate that quality indicators are linked to other important business indicators. When more sitters are used, ask how this affects hitting productivity targets and how management responds to a productivity deviation.

Bringing minor problems to light before they have a chance to grow is perhaps the most important step toward preventing big problems. By keeping a critical eye and looking for warning signs, hospital leaders can ensure quality and patient safety by uncovering these small issues early.

To learn about one hospital where small problems turned into big problems, read “Hospital Near-Death Experience: How Medicare Termination Can Push Your Hospital to the Brink of Closing.”

Filed Under: Clinical Improvement • Compliance Recovery • Featured Articles

Tags: better hospitals, CMS compliance, Featured Articles, hospital management, patient safety, Regulatory Compliance, The Joint Commission