Transcription
Ethics and Integrity inHealthcare Quality PracticeNAHQ Annual MeetingSeptember 2011
Objectives Today Define a challenge to ethics andintegrity in healthcare quality practice –Susan Goodwin Review what NAHQ has done to explorethe issue – Cindy Barnard, MichaelCallahan Share preliminary recommendationsand solicit your thoughts – GrenaPorto
The Issue of Ethics and Integrity inHealthcare Quality PracticeSusan GoodwinPresident, NAHQ
The IssueIntimidation, retaliation against, andprosecution of healthcare qualityprofessionals have profounddeleterious effects on the safetyand quality of the entire healthcaresystem.
A Shocking Headline
More Headlines Ensued
NAHQ’s Role LeadershipProtecting integrityRaising awarenessInfluencing policymakers
Environmental Scan (External) Transparency and accountability– Serious adverse events– Infections– Value-based purchasing– Hospital-acquired conditions– Medical necessity enforcement– RAC For the first time, quality measuresdo drive revenue
Environmental Scan (Internal) Reduced operating marginsProduction pressureComplexity, clinical and operationalQuickly changing rulesErosion of trust
Professional Dilemmas “Up-coding” qualityperformance Clinical/documentationworkarounds Suppressedacknowledgement ofadverse events Public accountability(reportable events) Medical necessityconcernsunrecognized Peer reviewfunctionality Steep gradient ofauthority Harassment orinsidious intimidation
Healthcare Quality ProfessionalLeadership Development Model
Desired HealthcareCulture/EnvironmentFor patients/communities Patient-centered care Data integrity Transparency in quality ofcare and patient safetyFor healthcareprofessionals Respect and trust Safe work environment Internal and externalchain of command Meaningful improvement Protection fromintimidation, retribution,or harassment
NAHQ Task TeamCindy BarnardTeam Leader
NAHQ Task Team Cindy Barnard, Team LeaderSusan T. GoodwinLee HamiltonClaire M. DavisSandra W. JonesColleen M GallagherRuth NaykoRoya NassirpourGrena PortoJoan Kram, NAHQ StaffReview and Comment: Michael Callahan Barbara Youngberg Susie White
Professional Dilemmas “Up-coding” qualityperformance Clinical/documentationworkarounds Suppressedacknowledgement ofadverse events Public accountability(reportable events) Medical necessityconcernsunrecognized Peer reviewfunctionality Steep gradient ofauthority Harassment orinsidious intimidation
NAHQ Member Feedback Lack of authority in QI/QM Organizational resistance– Gaps in peer review Not an infrequent problem: 1-2x/ year? Not just physician performance andbehavior issues
Your Concerns We have a culture that hides qualityconcerns Medical peer review committees fail tohold their colleagues accountable stafffails to report serious adverseoutcomes
Your Concerns Nothing is done about these issues I was put on discipline Shoot the messenger I was asked to resign
Protecting Robust QM & Peer Review Peer Review is profoundly importantand can be highly effective Privilege and confidentiality aredeserved and necessary, and should beprotected But we must assure integrity
The IssueIntimidation, retaliation against, andprosecution of healthcare qualityprofessionals have profounddeleterious effects on the safetyand quality of the entire healthcaresystem.
Understanding The Problem There is an Ethics Problem– Lack of sufficient recognition of potentialharm to patients from disregard of qualityprocesses There is a Practical Problem– Lack of standards, structures, andmechanisms to assure reliable operation ofthe quality process
NAHQ Task TeamInputsOutputsMember inputCode of EthicsLiterature review Standards of PracticeExperiencePlansNAHQ educational effortsCall to ActionNational communicationsIdentified need for broaderprofessional engagementThought Leaders’ Panel andassociated outputs22
NAHQ Actions Code of Ethics Standards of Practice Educational Resources
Working Toward A Call to Action Logos of endorsing orgs, such as ACPE,AHIMA, AMA, ANA, AONE, ASHRM, TheJoint Commission, NAMSS, NAPH,NPSF
High-Priority Aims Improve culture of quality/safetyPrevent intimidationMitigate severity/impact on patient careProtect the professionalAdvance professionals’ effective pursuitof their responsibilities
Legal PerspectiveMichael Callahan, Esq
Legal Perspective External pressures to monitor/maintainquality– Joint Commission/CMS/accreditationstandards– Doctrine of CorporateNegligence/Respondeat Superior
Legal Perspectives Existing Legal Tools– Code of Conduct Policy, Disruptive BehaviorPolicy, Conflict of Interest, Medical staffbylaws– State peer review confidentiality andimmunity protections– Within a Patient Safety Organization,special privilege
Legal Perspectives Health Care Quality Improvement Act ‘86– Immunity protections for professional review– Data bank reporting State common law protections for “goodfaith” reporting, voluntary or mandatory State and federal whistleblowerprotections
Legal PerspectivesThe goal is to encourage full disclosure andacknowledgment in a protected environmentwithout fear of reprisal or ability to usedisclosure for disciplinary purposes
Legal Perspectives Do we need new structures andprocesses to protect patients andhealthcare professionals?and How do we build and foster the will andcommitment to act vigorously to protectpatients and healthcare professionals?
Legal Perspective Reflect on your own organization To what extent do existing legalprotections (including regulatory andaccreditation requirements) advanceyour ability to conduct qualityevaluation with integrity?
The Call to ActionGrena PortoTask Team Member
The Call to Action Problem Recommendations– Provider organizations– Individual healthcare professionals– Accreditation/regulatory agencies– Professional associations
The IssueIntimidation, retaliation against, andprosecution of healthcare qualityprofessionals have profounddeleterious effects on the safetyand quality of the entire healthcaresystem.
Call to Action: Provider Organizations1. Protect the quality and safety of care– Establish zero tolerance for intimidation andretaliation; Build and sustain a just culture2. Protect patients and healthcare staff– Respond effectively to any threats anddisruptive behavior that underminequality/safety evaluation; support staff;and listen to patients/familiesDRAFT
Call to Action: Individual Providers Implement principles of patient safetyand quality of care Adhere to professional codes of conduct Report substandard or unsafe care Encourage patients and families to– play an active role in promoting safe care– share their concerns with appropriateproviders and organizationsDRAFT
Best Practices: Beyond Providers Advocate for and enact comprehensive,robust legislative solutions (i.e.,protections for whistle-blowers)DRAFT
Call to Action: Patients and Families Patient complaints can be reliableindicators of potential quality problems.– Create patient family councils or advisorygroups– Engage patients and families in patientsafety activities.DRAFT
Call to Action: NAHQ and Others Provide educational resources anddisseminate best practices Support research to develop newstrategies/techniques to improve cultureof safety and integrity in healthcarequalityDRAFT
Is This a Robust Solution? Improve culturePrevent intimidationMitigate severity/impact on patient careProtect the professionalAdvance professionals’ effective pursuitof their responsibilities
What Can Leaders Do? Promote the principle that intimidation/retaliation is not tolerated at yourorganization Begin to develop infrastructure Advance a just culture Adhere to high standards ofprofessionalism
Our GoalProvide safe, high quality care, withIntegrity of practice in quality evaluationand improvement, inA just, transparent, and supportiveenvironment
Discussion The draft Call To Action is for YOUDo we have the problem statement right?Is the Call to Action robust? Complete?Does it speak to YOUR needs?Will it advance professionalism?Will it make care safer, better?What are YOUR needs and ideas?
Thank you Susan Goodwin, President, NAHQCindy Barnard, Chair, Task TeamMichael Callahan, EsqPartner, Katten, Muchin, Rosenman, LLPGrena Porto, Principal, QRS Healthcare Consulting,LLC
Healthcare Quality Practice NAHQ Annual Meeting September 2011. Objectives Today Define a challenge to ethics and integrity in healthcare quality practice - Susan Goodwin Review what NAHQ has done to explore the issue - . QRS Healthcare Consulting, LLC. Title: Slide 1
