Wednesday, November 2, 2011

Could Performance Improvement Systems Reduce Communication Errors, Malpractice Payments?

From this recent article in FierceHealthcare, failures to communicate have resulted in 40% increases in malpractice premiums from 1996 to 2003.

Some of the common reasons cited for communication breakdown: "Physicians and patients might not receive results, report findings may be delayed, and there may by lengthy turnaround time. Together, these three communication failures across all specialties totaled $91 million in payouts in 2010, compared to $21.7 million in 1991."

Automation is touted as one of the potential solutions to this issue, which it certainly is. Automation can take out the human element from the workflow equation, which generally improves the reliability of a process (as long as the workflow is otherwise designed properly). However, automation has its limitations as well:
  • The wrong fax numbers may be entered in the system, thereby sending documents either to wrong parties, or to a document neverland. This can create more quality and risk issues.
  • Changes to the system can lead to breakdowns in other parts of the system, requiring constant vigilance.
  • Not all parties use the same technologies thereby making the connectivity more problematic.
  • Automation can convey the false-sense of reliable transmission, but it is generally unidirectional, and as such, may not be able to ensure that the recipient has actually received the document (no matter if the fax machine confirms that it was sent) nor that the matter is handled with the same urgency as the sender intended. 
  • In the "clinical emergency arena", nothing beats the direct phone call, provider to provider, to ensure that the communication and intended actions do not fall through the cracks.
Beyond issues with automation, however, the biggest opportunities to improve communication lie in developing and implementing reliable systems for communication:
  • Are there clear protocols for which tests and what test results are considered critical, thus, requiring "critical communication"?
    • Is this list as appropriately narrow as it can be, and are the cutoffs for the test results truly clinically meaningful? 
    • Having a comprehensive list can dramatically increase the number of times "critical communication" is expected to take place, and increases the likelihood of "communication fatigue" or "overload".
  • Is there a clear process for "critical communication"?
  • Is there a reliable system for training and re-training all staff in the "critical communication" process?
  • Is the process for "critical communication" as streamlined as it should be?
    • Are there staff involved in the process that don't need to be?
  • Are the key steps in the critical communication process being monitored and measured?
    • How often do the steps breakdown in the critical communication process, and when they do, what action is taken to address the systems or staff issues related to the breakdown?
Unless an organization develops a performance improvement framework for critical communication - implementing systems, defining protocols, redesigning processes and workflow, and monitoring data - it is unlikely that any technology or automation will resolve the communication breakdown.

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