Leveraging the Tools You Have Instead Of Waiting for the Perfect Process: Introduction of an...
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Transcript of Leveraging the Tools You Have Instead Of Waiting for the Perfect Process: Introduction of an...
Leveraging the Tools You Have Instead Of Waiting for the Perfect Process: Introduction of an EMedication
Reconciliation Process in a Rural Hospital EMR
“Managing the Unexpected”
By Karl E. Weick &Kathleen M. Sutcliffe
High Reliability Organizations
• Tracks Small Failures• Resists Oversimplifications• Remains Sensitive to Operations• Maintains Resiliency• Takes Advantage of Shifting Areas of Expertise
Business as Usual
• Small Failures Go Unnoticed• Simple Diagnosis were Accepted• Frontline Operations were Taken for Granted• Recovery was Treated as Routine• Experts Deferred to Authority
Medical Staff Impression of eMR
Herding Cats
• MMC Hospitalist Practice
Prior eMR Implementations
• CPOE• Nursing Documentation• Medication Management• Diabetic Management• Documentation• PACS
eMedRec Implementation
• Not My Responsibility• ER and ICU too Busy• Not Using Pharmacy MedEx to Properly Identify
Home Medications• Free Texting Medications• Incomplete Home Med Entries• Physicians Workflow Impeded, Especially at Time
of D/C• Physicians Stopped Using eMedRec, 0 Utilization!
What We Did Wrong:
Did Not Track Small Failures!
What We Did Right!(We had to Get IT Right)
• Resist Oversimplification• Remain Sensitive to Operations• Maintain Capabilities for
Resilience• Take Advantage of Shifting Areas
of Expertise
Maintain Capabilities for Resilience
• The Ability to Absorb Strain and Preserve Functioning Despite Adversity
• An Ability to Recover from Adversity• The Ability to Learn and Grow• Team Approach
Deference to Expertise
• Re-educate Nurses, Especially at Point of Initial Contact with the Patient
• Asked Nursing for Their Input• Health IT in Almost Constant Contact with
Vendor, Nursing and Physicians• Getting the Health Care Providers We Could
Leverage to Continue eMedRec• C-Suite Support, Especially CNO
Results
• In 2 Months 52% eMedRec Use• Ortho and OB/Gyn Began to Use• Ability to Use Clinical Decision Support at D/C• Improved Communication of Medications to
the Patient and Family• Improved Communication with Primary Care
Providers
The new age of medicine practiced in the same way that High Reliability Organizations are run--tracking small failures, resisting oversimplifications, remaining sensitive to each patient, finding a way to be resilient and taking advantage of shifting locations of expertise. Suddenly, I felt the wheels hit the runway, maybe a little too hard, but reliably with every one of those 234 passengers safely transitioned back to the ground.
"Physicians are essential to progress in improving healthcare systems. Unprepared or unwilling they can be barriers to badly needed change. If they do not understand-indeed if they do not thrive in-the world of interaction and interdependency in which they work now, and if they unscientifically regard their own deeds as sufficient in excellence, they can confound systemic excellence and impede needed system changes. At their best, well prepared and willing, they can lead and accelerate changes in care processes that are grounded in good clinical data and sound theory". (Berwick & Finkelstein, Acad. Med 2010)
'A physician equipped to help improve healthcare will not be demoralized, but optimistic, not helpless in the face of complexity, but empowered; not frightened by measurement, but made curious and more interested; not forced by culture to wear the mask of the lonely hero, but armed with confidence to make a better contribution to the whole.” (Berwick & Finkelstein, Acad. Med. 2010)