Christy I Sandborg1, Gary E Hartman2, Felice Su1, Glyn Williams3, Beate Teufe4, Nina Wixson4, David B Larson5, Lane F Donnelly1,4,5. 1. Department of Pediatrics, Stanford University, School of Medicine, Palo Alto, Calif. 2. Department of Surgery, Stanford University, School of Medicine, Palo Alto, Calif. 3. Department of Anesthesia, Stanford University, School of Medicine, Palo Alto, Calif. 4. Center for Pediatric and Maternal Value, Lucile Packard Children's Hospital, Stanford, Stanford Children's Health, Palo Alto, Calif.; and. 5. Department of Radiology, Stanford University, School of Medicine, Palo Alto, Calif.
Abstract
Healthcare organizations are focused on 2 different and sometimes conflicting tasks; (1) accelerate the improvement of clinical care delivery and (2) collect provider-specific data to determine the competency of providers. We describe creating a process to meet both of these aims while maintaining a culture that fosters improvement and teamwork. METHODS: We created a new process to sequester activities related to learning and improvement from those focused on individual provider performance. We describe this process, including data on the number and type of cases reviewed and survey results of the participant's perception of the new process. RESULTS: In the new model, professional practice evaluation committees evaluate events purely to identify system issues and human factors related to medical decision-making, resulting in actional improvements. There are separate and sequestered processes that evaluate concerns around an individual provider's clinical competence or behavior. During the first 5 years of this process, 207 of 217 activities (99.5%) related to system issues rather than issues concerning individual provider competence or behavior. Participants perceived the new process as focused on identifying system errors (4.3/5), nonpunitive (4.2/5), an improvement (4.0/5), and helped with engagement in our system and contributed to wellness (4.0/5). CONCLUSION: We believe this sequestered approach has enabled us to achieve both the oversight mandates to ensure provider competence while enabling a learning health systems approach to build the cultural aspects of trust and teamwork that are essential to driving continuous improvement in our system of care.
Healthcare organizations are focused on 2 different and sometimes conflicting tasks; (1) accelerate the improvement of clinical care delivery and (2) collect provider-specific data to determine the competency of providers. We describe creating a process to meet both of these aims while maintaining a culture that fosters improvement and teamwork. METHODS: We created a new process to sequester activities related to learning and improvement from those focused on individual provider performance. We describe this process, including data on the number and type of cases reviewed and survey results of the participant's perception of the new process. RESULTS: In the new model, professional practice evaluation committees evaluate events purely to identify system issues and human factors related to medical decision-making, resulting in actional improvements. There are separate and sequestered processes that evaluate concerns around an individual provider's clinical competence or behavior. During the first 5 years of this process, 207 of 217 activities (99.5%) related to system issues rather than issues concerning individual provider competence or behavior. Participants perceived the new process as focused on identifying system errors (4.3/5), nonpunitive (4.2/5), an improvement (4.0/5), and helped with engagement in our system and contributed to wellness (4.0/5). CONCLUSION: We believe this sequestered approach has enabled us to achieve both the oversight mandates to ensure provider competence while enabling a learning health systems approach to build the cultural aspects of trust and teamwork that are essential to driving continuous improvement in our system of care.
Authors: Valerie P Jackson; Trudie Cushing; Hani H Abujudeh; James P Borgstede; Kenneth W Chin; Charles K Grimes; David B Larson; Paul A Larson; Robert S Pyatt; William T Thorwarth Journal: J Am Coll Radiol Date: 2009-01 Impact factor: 5.532
Authors: Tarik K Alkasab; H Benjamin Harvey; Vrushab Gowda; James H Thrall; Daniel I Rosenthal; G Scott Gazelle Journal: J Am Coll Radiol Date: 2013-10-15 Impact factor: 5.532
Authors: Andrea K Johnson; Jenna F Kruger; Sarah Ferrari; Melissa B Weisse; Marie Hamilton; Ling Loh; Amy M Chapman; Kristine Taylor; Jessey Bargmann-Losche; Lane F Donnelly Journal: Pediatr Qual Saf Date: 2020-04-07
Authors: Élan Burton; Brenda Flores; Barbara Jerome; Michael Baiocchi; Yan Min; Yvonne A Maldonado; Magali Fassiotto Journal: JAMA Netw Open Date: 2022-05-02