Electronic Health Reporter

Guest post by Kate Jester-Brod, vice president of client success, EoScene.

Since Hurricane Katrina, the healthcare industry has been pushing towards maintaining comprehensive EHRs. The concept of an EHR combined with the concepts of the health information exchange (HIE) creates a means for patients and providers to always have a 30,000-foot view of the patient’s health. Which then begs the question, ‘what about the actual healthcare facilities?’ What does their 30,000-foot view look like? Are facility and staff doing their part to support exceptional and safe patient care?

In the most basic of explanations, enterprise risk covers the overall opinion of others towards your organization. It can affect revenue, staff retention, grant funding, and much more. In the healthcare industry, the enterprise is at risk at many levels. Drug safety, staff and patient safety, clinical outcomes, facilities maintenance, public relations, Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores are some but not all of the components of enterprise risk.

Moreover, reducing enterprise risk in any industry includes reducing not only overhead and operational costs but also consumer costs. In healthcare reducing costs for consumers can increase patient satisfaction, which is an obvious connection. More interesting, however, are recent news stories reporting on suits against major hospital systems for frauds and schemes—or applauding them for lowering healthcare costs.

While telemedicine and home health are increasingly major components of healthcare, much of healthcare operates in a facility like a hospital or clinic. Facilities, along with structural integrities and heating, ventilation, and air (HVA) systems, also include patient equipment and a state of cleanliness. All of these components comprise the environment of patient care and healing, and the enterprise. By taking control of these areas a hospital or healthcare facility becomes one step closer to protecting the enterprise.

The best way to protect it is to predict and manage risk before problems happen. This is even more critical as the healthcare industry works towards the Institute for Healthcare Improvement’s Triple Aim as a means to optimize care. The three components of the Triple Aim complement and overlap the need to reduce enterprise risk.

Fundamentally, the Triple Aim works towards creating system-level metrics to measure success. Enterprise risk is at the center of these metrics that ultimately drive decision making. Understanding the policies and procedures that make up facilities management, patient safety, accreditation, and the overall health of the system can significantly reduce enterprise risk while supporting more effective decision making.

Taking control of facilities management can directly impact the reduction of enterprise risk. Facilities Management holds many different responsibilities in a healthcare system, including emergency management, fire safety, patient and staff safety, infection prevention, environmental services, utilities and equipment, accreditation, and many others.

Improving patient-centered care with consideration for facility compliance results in tangible ways to improve the Triple Aim. The electronics health record is assumed to document all the components of the Triple Aim, but this clinically based monitoring system focuses on provider-patient experience and overlooks other components of the healthcare environment.

Utilizing facilities information technology plays a critical role in establishing the foundation necessary to achieve positive results in achieving the Triple Aim. Recent innovation in health facilities IT has resulted in quality improvement and measurement from the ground up and has the potential to address an often overlooked component of that we all strive for in Triple Aim.

A proper facilities management (includes safety and IT) program should increase accountability, reduce operating costs, maintain internal controls and provide real time insight into the following:

• Enterprise Risk Management – including risk of reputation,
• Patient & Staff Safety – OSHA, liability, infection prevention
• Regulatory and Accreditation Compliance – proper education, accountability, documentation and improvement
• Operational Efficiency – to provide the lowest cost services available
• Continuous process improvement

By collecting data?whether it is on daily equipment readiness checks, monthly fire drills, weekly staff knowledge questions, event-triggered infection prevention questions, or standard environment of care (EOC) rounding questions?healthcare systems can begin to visualize high-risk areas and take appropriate action to mitigate risk and protect the enterprise. Here are five keys to starting that quest from a facilities-first perspective:

1.Understand the current state: Identify problem areas by observing the status of the facility today. Think “back to the basics” with questions and use an electronic surveying tool. Involve an appropriate amount of staff. At this stage, it is not necessary to involve department managers, but keep in mind, the more data collected, the more data to aid in understanding the baseline.

2. Take action: Use the information gathered in the baseline survey to identify top non-compliant areas and create a corrective action plan for resolution and process improvement. Take it a step further though, don’t just solve problems of today, create a full remediation management program to correct and reduce safety and compliance concerns. Remediation management includes a metric to measure severity and a methodology for prioritizing concerns. Remediation management can be as simple as documenting corrective action taken or as complex as revising safety surveys and resurveying areas more frequently.

3. Education and Transparency: Take the current state and your remediation management program and educate staff. Transparency will make everyone aware of their surroundings and create a sense of ownership in everyone for facility compliance and safety. It is important to continue transparency as well, do not stop with initial reports. Create a culture where compliance and safety are on everyone’s minds naturally and where organic process improvements can be made.

4. Expand participation: Once you have established a safety culture, establish ownership. After the current state has been identified, and the remediation management program put in place, start having department leaders take ownership of surveying their areas for continued facility compliance and safety. When department managers are held responsible it amplifies the culture established during staff education. Expanding participation, for example by having department managers doing monthly surveys also, collects more data points. More data will support remediation management programs by uncovering the frequency of non-compliance. The frequency of non-compliance charted with the severity of the issue will help prioritize areas of focus for remediation.

5. Revise as needed: As with any new program or process, revise as needed. Once everyone has transparency into the health of the facility’s physical environment, participation in improvement becomes organic. Department managers begin to recognize they may have unique safety and compliance needs and want to track different pieces of data. A facilities information management system makes this possible. It provides a foundation for safety and compliance, while encouraging flexibility that allows for continued improvement and insight. These elements are required to achieve the real-time.

Conclusion
No single best practice exists for managing all of the components of a healthcare facility. Critical then is to aggregate information leading to informed decisions based on actual data. A good place to start is to push overhead responsibility of the department’s environment to its department leaders. Layer this responsibility with frequent and thoughtful rounding, and you have a good foundation for understanding the health of the enterprise and making predictions about issues before they become problems.