Pragmatics of tracking mental health outcomes in a managed care setting

Accountability, cost effectiveness, and continuous quality improvement are essential features of all managed health care systems. However, application of these principles to mental health treatments has lagged behind other health care services. In this article, administrative, practice, and technical issues are addressed through a joint effort between academically based researchers and administrators from two large managed health care organizations. Principles related to the measurement of outcome, instrument selection, and obstacles to the implementation of an ongoing program to assess mental health treatment outcomes are identified. Finally, principles for successfully changing mental health provider behavior toward outcome assessment and the implications of such for mental health delivery systems are discussed.     

Missouri's Just Culture collaborative

Under the leadership of the Missouri Center for Patient Safety, Missouri set the stage for healthcare providers and regulators to work together to improve patient safety by moving towards a Just Culture. By bringing together 67 healthcare providers, regulators and others with a goal to improve the patient safety culture, the collaborative led to an improved understanding of the key principles of Just Culture, its implementation and barriers to implementation, as well as how regulators could support providers in their efforts to improve the safety culture.     

Creating a fair and just culture: one institution's pat toward organizational change

BACKGROUND: Health care organizations have begun to move toward a nonpunitive, or "blame-free," process when analyzing medical errors and near misses. The Dana-Farber Cancer Institute's (Boston) "Principles of a Fair and Just Culture," define for staff and managers behavioral expectations when an error occurs. CREATING THE PRINCIPLES OF A FAIR AND JUST CULTURE: The principles focus not just on patient safety but on a culture of safety and transparency in all the organization's functional areas, including nonclinical departments such as information services, administration, and research. INCORPORATING THE PRINCIPLES INTO PRACTICE: Introducing the principles is a gradual process, one that requires continual education and discussion among staff at all levels and a commitment to examining and changing many of the systems, policies, and procedures that guide the organization's work. A survey conducted in January 2007 revealed that the clinical areas had sustained higher-than-average scores and that the nonclinical areas showed improvement. DISCUSSION: Changing a long-standing culture of blame, control, and disrespect to one that embraces principles of fairness and justice and standards of respectful behavior is a major undertaking. Educating and involving clinical and administrative leaders, who work directly with staff and play a pivotal role in translating the principles into practice, is especially important.     

Improving Patient Safety in Hospitals: Contributions of High-Reliability Theory and Normal Accident Theory

Objective. To identify the distinctive contributions of high-reliability theory (HRT) and normal accident theory (NAT) as frameworks for examining five patient safety practices.
Data Sources/Study Setting. We reviewed and drew examples from studies of organization theory and health services research.
Study Design. After highlighting key differences between HRT and NAT, we applied the frames to five popular safety practices: double-checking medications, crew resource management (CRM), computerized physician order entry (CPOE), incident reporting, and root cause analysis (RCA).
Principal Findings. HRT highlights how double checking, which is designed to prevent errors, can undermine mindfulness of risk. NAT emphasizes that social redundancy can diffuse and reduce responsibility for locating mistakes. CRM promotes high reliability organizations by fostering deference to expertise, rather than rank. However, HRT also suggests that effective CRM depends on fundamental changes in organizational culture. NAT directs attention to an underinvestigated feature of CPOE: it tightens the coupling of the medication ordering process, and tight coupling increases the chances of a rapid and hard-to-contain spread of infrequent, but harmful errors.
Conclusions. Each frame can make a valuable contribution to improving patient safety. By applying the HRT and NAT frames, health care researchers and administrators can identify health care settings in which new and existing patient safety interventions are likely to be effective. Furthermore, they can learn how to improve patient safety, not only from analyzing mishaps, but also by studying the organizational consequences of implementing safety measures.     

A measuring instrument for evaluation of quality systems.

OBJECTIVE: To develop an instrument for provider organizations, consumers, purchasers, and policy makers to measure and compare the development of quality systems in provider organizations. DESIGN: Cross-sectional study of provider organizations using a structured questionnaire to survey managers. SETTING: The Netherlands. STUDY PARTICIPANTS: Provider organizations of six health care fields: primary health care, care for the disabled, mental health care, care for the elderly, hospital care and welfare care. MAIN MEASURES: Existence of quality assurance and quality improvement activities. RESULTS: The study presents a survey instrument for assessing the quality assurance and improvement activities of health care provider organizations and the developmental stage of quality systems. The survey instrument distinguishes five focal areas for quality improvement activities and four developmental stages. The study also reports data on the reliability and validity of the survey instrument. CONCLUSION: The instrument is reliable, easy to administer, and useful across health care fields as well as different kinds of organizations. Developing quality systems provide a common language across all parts of the health care sector. By assigning the activities to focal areas and developmental stages the instrument gives insight into the implementation of quality systems in health care. Comparable information on quality assurance activities increases the accountability of providers. Because of the efficient (not time consuming) approach, the instrument complements existing accreditation reviews.     

Revealing and resolving patient safety defects: the impact of leadership WalkRounds on frontline caregiver assessments of patient safety

Objective. To evaluate the impact of rigorous WalkRounds on frontline caregiver assessments of safety climate, and to clarify the steps and implementation of rigorous WalkRounds. Data Sources/Study Setting. Primary outcome variables were baseline and post WalkRounds safety climate scores from the Safety Attitudes Questionnaire (SAQ). Secondary outcomes were safety issues elicited through WalkRounds. Study period was August 2002 to April 2005; seven hospitals in Massachusetts agreed to participate; and the project was implemented in all patient care areas. Study Design. Prospective study of the impact of rigorously applied WalkRounds on frontline caregivers assessments of safety climate in their patient care area. WalkRounds were conducted weekly and according to the seven‐step WalkRounds Guide. The SAQ was administered at baseline and approximately 18 months post‐WalkRounds implementation to all caregivers in patient care areas. Results. Two of seven hospitals complied with the rigorous WalkRounds approach; hospital A was an academic teaching center and hospital B a community teaching hospital. Of 21 patient care areas, SAQ surveys were received from 62 percent of respondents at baseline and 60 percent post WalkRounds. At baseline, 10 of 21 care areas (48 percent) had safety climate scores below 60 percent, whereas post‐WalkRounds three care areas (14 percent) had safety climate scores below 60 percent without improving by 10 points or more. Safety climate scale scores in hospital A were 62 percent at baseline and 77 percent post‐WalkRounds (t=2.67, p=.03), and in hospital B were 46 percent at baseline and 56 percent post WalkRounds (t=2.06, p=.06). Main safety issues by category were equipment/facility (A [26 percent] and B [33 percent]) and communication (A [24 percent] and B [18 percent]). Conclusions. WalkRounds implementation requires significant organizational will; sustainability requires outstanding project management and leadership engagement. In the patient care areas that rigorously implemented WalkRounds, frontline caregiver assessments of patient safety increased. SAQ results such as safety climate scores facilitate the triage of quality improvement efforts, and provide consensus assessments of frontline caregivers that identify themes for improvement.     

Competency in health care management: a training model in epidemiologic methods for assessing and improving the quality of clinical practice through evidence-based decision making

This article describes a training model that focuses on health care management by applying epidemiologic methods to assess and improve the quality of clinical practice. The model's uniqueness is its focus on integrating clinical evidence-based decision making with fundamental principles of resource management to achieve attainable, cost-effective, high-quality health outcomes. The target students are current and prospective clinical and administrative executives who must optimize decision making at the clinical and managerial levels of health care organizations.     

Mobile Health in China: A Review of Research and Programs in Medical Care,Health Education,and Public Health

There are nearly 1 billion mobile phone subscribers in China. Health care providers, telecommunications companies, technology firms, and Chinese governmental organizations use existing mobile technology and social networks to improve patient–provider communication, promote health education and awareness, add efficiency to administrative practices, and enhance public health campaigns. This review of mobile health in China summarizes existing clinical research and public health text messaging campaigns while highlighting potential future areas of research and program implementation. Databases and search engines served as the primary means of gathering relevant resources. Included material largely consists of scientific articles and official reports that met predefined inclusion criteria. This review includes 10 reports of controlled studies that assessed the use of mobile technology in health care settings and 17 official reports of public health awareness campaigns that used text messaging. All source material was published between 2006 and 2011. The controlled studies suggested that mobile technology interventions significantly improved an array of health care outcomes. However, additional efforts are needed to refine mobile health research and better understand the applicability of mobile technology in China's health care settings. A vast potential exists for the expansion of mobile health in China, especially as costs decrease and increasingly sophisticated technology becomes more widespread.     

Physician and plan effects on satisfaction of Medicaid managed care patients with their health care and providers

As many Medicaid patients move into managed care, it is important that physicians competing to serve these patients understand the factors that lead to patient satisfaction. This study uses survey data from 7,313 Oregon Medicaid managed care patients to create a model describing how provider effects and health plan effects relate to patients' satisfaction with their medical care and provider. Path analysis was used to test the explanatory power and strength of relationships in the model. Perceived technical and interpersonal physician quality and health plan rating were most strongly linked with these patients' satisfaction with their care and provider.     

How to produce EDMS requirements and cost-benefit data

Electronic document management systems (EDMS) have a profound impact on administrative operations of health care provider organizations. Thorough yet conservative system requirements and cost-benefit data can prove the necessity and priority of the EDMS. This case study-based article provides a methodology for all EDMS implementations, including the preparation of the vision and scope, business analysis, cost-benefit analysis, and system specification and project plan. These are illustrated with EDMS examples. To successfully minimize project risk, the article reviews the importance of phasing, standards, and integration, and it provides six detailed examples of this methodology.