Archive for September, 2008

Ensuring that Never Events Never Happen

September 23, 2008

Last week, this blog focused on the importance of talking to your staff about the external environment. In today’s blog I want to focus on one of those external changes that will impact every hospital in the country: beginning next week, CMS will no longer pay for certain hospital-acquired conditions such as falls and pressure ulcers.

On our website you can see the full list of 11 conditions that CMS deems to be preventable, and therefore no longer reimbursable. Several of these are also known as “Never Events”.

As leaders of progressive healthcare organizations, I know that you are committed to eliminating these errors. We are, too, which is why you will see an aggressive mobilization at Studer Group to help you eliminate these Never Events. Because of the size of our national lab, we have the ideas, tactics and passion to help you bring this number down to zero.

We have created four short videos that you can access at no charge on our website. The first video provides an overview of the Never Events and specific tactics that we suggest implementing to prevent them. The other three videos are focused on how to prevent the most prevalent and costly of these conditions: falls, pressure ulcers and infections. We hope they will help you spread the word faster in your organization.

A few facts:

  • Each year, more than 650,000 patients experience one of these preventable errors, leading to needless pain, injury, even death.
  • Some of these events, such as an infection after having a coronary artery bypass graft, can cost as much as $300,000 to treat. That’s the same amount hospitals will no longer receive if the event occurs during the patient’s stay.
  • This reimbursement change is only the beginning. CMS views this as a major step forward in their shift toward Value-Based Purchasing, a philosophy of paying hospitals based on their performance on certain measures (such as these events and HCAHPS results), rather than the amount of service provided.

But that’s not the reason I’m writing about the “Never Events.” I’m writing to share specific tactics that will help prevent these conditions. Here are just a few to get started:

  • Communicate: Now is the time to ensure that your entire organization understands the significance of this external force and how it will impact employees’ daily activities. You can use the free videos on our website to help with this. Also, add this as an agenda item for your next senior leader and departmental meetings.
  • Identify the impact: Determine how you are performing now on these 11 conditions and calculate the reimbursement impact.
  • Harvest and share stories: Eliminating these adverse events requires the full engagement of everyone in your organization. Numbers don’t engage people to act; but individual, human stories do. Publicly celebrate when solid prevention efforts avoid harm from occurring. Also share stories of when events did occur that caused harm, since they require everyone’s attention in the future to ensure that others will not need to experience the consequences.
  • Tighten up assessment, documentation and coding: These are important areas to focus on during any change in reimbursement; and even more so with these “Never Events” since this change also introduces new “present on admission” codes that must be applied correctly to ensure full reimbursement if a condition was already present.
  • Focus on your biggest opportunities: For most organizations these are falls, pressure ulcers and infections. We created quick videos on each of these three adverse events, where you’ll hear tips of how you can eliminate these events without spending additional time or dollars, such as: how to use specific Key Words to engage patients in preventing these errors; Pre-Visit Phone Calls to reduce surgical infections; and bedside shift reports to conduct visual assessments of catheters and wound sites.

I hope you take a moment to visit, where you can access the free videos I’ve mentioned above. You can also read more about these 11 hospital-acquired conditions and review the latest evidence on how to prevent them. We’ll keep this site updated as new information comes in.


The External Environment: Understanding is Only Half the Battle

September 18, 2008

How well does your leadership team understand the external healthcare environment? If you were to assign a letter grade, A-F, where would your leadership team rate?

Our experience is that senior teams generally score well on this exercise, around an A or A-minus. The top ranks of your organization are very likely up-to-speed on the latest changes affecting reimbursement, technology, accreditation, as well as actions and potential actions your competitors are taking.

However, what we often find is a wide gap between the C-suite and the rest of the organization. The senior team’s understanding of the external environment rates an A, but our deployment of this knowledge often rates far lower. This gap is a major contributor when organizations fall short of achieving their desired outcomes. After all, the goal isn’t to understand the environment; the goal is to apply this knowledge to execute your strategy and achieve your desired outcomes. Let me explain how this gap occurs and what you can do to close it.

While the senior leaders set the direction, the day to day decisions are made (or not made) far deeper within the organization. These decisions, and the time available to make them, often require an understanding of the external environment. Ask these questions about your own organization:

  • Do the people making the decisions know the external forces that will influence the outcome?
  • Do your leaders move as quickly and skillfully as needed?
  • Do your frontline employees align their actions to achieve the organization’s goals?
  • Is the medical staff engaged and aligned to achieve the organization’s goals?

A few years ago we began working with a large system in which leaders and medical staff had a healthy appetite for creating new buildings, adding new acute care beds, and acquiring the latest technology. The C-suite worked very hard, and through debt financing made significant commitments to replace buildings, increase inpatient and outpatient capacity, and implement the latest technology. I had the opportunity to participate in their leadership training, where I heard from some leaders who felt they were being micromanaged in expense reduction, position replacement and a number of other operational items. During a break I learned from their CFO that, because of their latest round of borrowing, they had very little capital access until the new projects showed increased revenue and efficiencies. They were also very tight on days cash on hand, putting their bond covenants at risk.

When we returned from the break the CFO and I repeated this discussion for the larger group of leaders. It turned out that very few had an understanding of how debt financing worked; what level of days cash on hand was needed; what would happen if the system fell below that level; or how the newly acquired debt impacted operations. After hearing this information, I asked the group whether they now had a better understanding of why the senior executives were managing the operations so closely. They agreed that this helped explain the leaders’ actions. The point is this: when the information improved, so did their understanding. Most importantly, so did their ability to make decisions and execute according to the plan. Today, this organization’s performance is much improved.

I find that the C-suite works very hard to choose the best strategy for the organization. When the desired results of that strategy aren’t achieved, very often it’s because the senior team does not sufficiently share their understanding of the external environment throughout the organization.

Just like the organization above, leaders, line staff, physicians and other stakeholders appreciate when senior leaders connect the dots between the external environment and their day to day actions. With this improved information, the entire organization is engaged to bring forward fresh ideas that are in line with the challenges and opportunities in the external environment. Taking time to share the environmental context leads to faster and better decision making, improved alignment and heightened accountability. The result is much improved execution of your strategic plan.

In my next blog I’ll dig deeper into one of the most significant external forces shaping healthcare today: the reimbursement changes from CMS that no longer reimburse for certain “never events.” If you want to broaden your organization-wide understanding of how the external environment will affect your operations, never events are a powerful topic to discuss.