Process-Oriented Healthcare Management Systems

Development, Use, and Maintenance for Patient-Safe Healthcare

Anita Edvinsson

• Publisher: Business Expert Press
• Year: 2020
• Print ISBN: 9781951527303
• eBook ISBN: 9781951527310
• Topic: Business
• Subtopic: Management
• Index: Business

This handbook provides tools for designing a structure for a management system, as well as the tools for documenting processes within it.

When people need healthcare, few worry about being harmed by someone from the medical team making a mistake. Unfortunately, mistakes do happen, and many of the adverse events are not only serious but also preventable. Many countries struggle with top-heavy systems, in which decisions are made about how care is provided by those who are far from experienced in caring for patients. This must change. Professionals at the sharp end need support, structure, and help organizing necessary information to create a safe culture, a learning environment, and safe patient care—all at lower costs.

This handbook provides tools for designing a structure for a management system, as well as the tools for documenting processes within it. The starting point is based on current safety research.

The book is designed for medical professionals, managers, project members, politicians, public officials, and executives—all who work with patient safety matters. The content shows a new way to healthcare management, presenting an alternative approach together with concrete advice on how healthcare executives and practitioners can begin to think and act differently in order to provide safe healthcare.

CHAPTER 1

Introduction—Why This Book

The purpose of writing this book can be summarized in one sentence—saving lives and reducing suffering. Saving lives and reducing suffering are the main driving forces for most people who work in delivering health care. These driving forces have their source in a basic ethical value: to help and not to harm.

I have been working within the healthcare sector since 1985. Over the years, I have been working in various types of hospitals, wards, care settings, ICU (intensive care unit), and primary care. I have a specialist nursing degree in anesthesia and oncology, and I have also worked as a ward manager and an operations manager. Alongside that, I also have experience of being a patient and a relative.

Consequently, I have collaborated with a variety of healthcare professionals such as nurses, doctors, mental health nurses, hospital physicists, physiotherapists, social workers, dieticians, radiotherapists, and many more. We have wholeheartedly devoted our time, knowledge, and engagement to giving highly skilled health care, aimed to cure, relieve pain, and bring comfort to our patients and their families. The many unforgettable meetings with patients and their relatives as well as educational collaborations across the boundaries of the professions used to fill my soul not only with desire and a joy for work, but also with courage and vigor to continue, despite a hard workload and often demanding situations.

In my experience, people who work in healthcare professions put high demands on themselves and experience high expectations from others to act professionally. Those demands come from the patients, colleagues, and authorities, meaning, among other things, that the work should put our patient’s needs as a starting point. There should be a good collaboration between involved professionals, and care should be given based on science and professional experience. Less experienced colleagues should have the chance to gradually learn increasingly difficult tasks. The personnel are expected to handle advanced technical equipment flawlessly and make many decisions when time is short. Furthermore, healthcare staff have a statutory duty to keep updated with new knowledge, to work promoting patient safety, and to collaborate in the development of operations while always following applicable legislations. This list can be made much longer.

Working in the healthcare business is complex and takes place in a vast context. The workplace consists of different parts that more or less interact with each other, often at many organizational levels. Health care has become increasingly specialized and the patient’s pathway to receiving health care is rarely easy. Moreover, the variation in the work is not predictable. Unexpected events occur all the time, for example, the patient’s condition may rapidly deteriorate, and it may be very difficult to instantly understand why. The extent of knowledge needed to deliver safe health care is so vast that it is simply impossible to keep all the parts updated in the human brain.

In every workplace I have been working in, information has been written down and at least partly gathered in binders, containing checklists, PMs, instructions, procedure descriptions, telephone lists, caches, and more. The contents of these bindings have been partially overstated, sometimes out of date and sometimes out of context. Occasionally the staff have been informed that information about new procedures has been provided to only some of the staff or written down on loose notes. Subsequently, the notes were hung on message boards and could have ended up under lunch menus. Therefore, a lot of the working time that should have been devoted to direct patient care has instead been taken up looking for correct information. All this wasted time looking for information could have been spent on valuable patient care.

Along with the computerization and introduction of IT in health care, most of the information has been moved to the companies’ own intranets and shared storage disks. But even there it is often difficult to find relevant information. There are an enormous number of documents that are far from updated, reviewed, or relevant. In Region Skåne1 intranet alone there are approximately 7 million documents stored. In addition, the intranets are rarely designed in a user-friendly way. Personnel, who depend on accurate and easy-to-access information in their clinical everyday life, are having difficulties finding information they need. Many times, instead of searching for information on the intranet, a colleague is to be asked a question, or people just do as they once have learned. For example, it can take 15 minutes to find the forms to be filled in and to accompany a deceased patient from an ICU to the morgue (I have witnessed that at one of the largest hospitals in Sweden), because of a changed procedure followed by poor information and an inefficient search engine showing irrelevant options.

The need for information may, for example, include questions about how a new piece of equipment works or what blood tests are included in a particular disease investigation. Another example of information needed may be checklists for an examination or a description of the equipment that should be prepared before a certain procedure, for example, inserting a central line.

Each and every time it is difficult to find such information, or if there is doubt as to whether the content can be trusted, there is a risk of missing out. Not only do a waste of time and a waste of resources occur, but risky situations can also emerge. Knowledge that everyone needs can run the risk of becoming individual property rather than being a shared asset. In a state of stress, due to time constraints, complex contexts and difficulties to access important information have made it easier to make mistakes. Mistakes can have serious consequences for the patients and for healthcare personnel. Working in health care involves taking risks. This is a fact that we never can get away from. But it is possible to create conditions for as much as possible to go right. One of those prerequisites when thoroughly designed and maintained is a management system.

A management system is a structure for systematically and organically describing the work that is performed on a daily basis in the workplace. It sounds simple, and basically it is simple, but it requires consistent thinking, a certain logic, and an organization that keeps the management system vivid and practically useful. I dare to say it but there is an enormous amount of money wasted in health care, because of poor patient safety, and there are plenty of poorly functioning management systems.

For decades the authorities have reported thousands of people who have been injured or have died in hospitals due to the so-called avoidable harm. This means injuries that have caused patients “suffering, physical or mental injury or illness and death that could have been avoided if adequate measures had been taken in the patient’s contact with the health care.”2 In practice, this means that every 10th hospital bed in Sweden is occupied by a patient who is injured by the health care.3 These damages cost society a great deal of money.

The suffering of patients and their relatives is not priced in this context. Other social costs, such as extended sick leave, reduced tax incomes, reduced purchasing power, healthcare workers’ work-related stress, high staff turnover, difficulties in recruiting, staff on sick leave, and staff time to correct the errors, are usually not included in the statistic calculations. Moreover, data concerning costs and amount of avoidable harm to the patients should be interpreted with caution as there is a great deal of underreporting of the adverse events. The lack of recognition of unsafe conditions or practices is one important reason they are not reported.

Based on my experience, I am convinced that a well-designed management system based on knowledge gained from safety research can greatly help to create order and work out procedures, instructions, and much of the information that the staff closest to the patient (which I call personnel at the sharp end) need daily. Safety is created at all organizational levels but shows up next to the patient and that is also where the mistakes occur.

Knowledge in the context affecting the delicate boundary between success and failure is crucial in order for successful development of patient safety. To succeed in making health care safer, a great deal of courage is needed from everyone involved: politicians, boards, owners, managers, professionals, students, and patients. It is necessary to build a strong safety culture, to invest in conscious and present leadership, and to support the work of the committed staff. These three parts—safety culture, conscious leadership, and committed staff—constitute the real management system.

The written information given in a management system is one of many ways to formulate and visualize what happens at the sharp end, when delivering health care. Understanding this is a way to strengthen patient safety and thereby save lives.

My intention for writing this book is to instill courage in all the wonderful and brave people who devote their professional life to the pursuit of doing good and not harm.

Acknowledgments

A huge warm thank you to everyone who has contributed in making this book about management systems for patient-safe health care possible. The professionals who helped me bring the book to life—Linda Keller and Hazel Clarke, for eloquently simplifying the complicated prose; Bethany Walmsley, Ron Gantt, Susan Burnett, Kristina Iritz
Hedberg, Synnöve Ödegård, Monica Carlson, Erik Hollnagel, David Dilts, and Amy Edmondson for their support, valuable comments, and engagement; finally, for the unwavering love and support from my wonderful husband Håkan. My writing process would not have come into fruition without all these lovely people and knowledgeable contributors.

Anita Edvinsson

How to Use This Book

Step by step, this book outlines how a management system can be formed, the prerequisites for having a management system that supports the daily work, and how it can result in increased patient safety. The examples are from health care and care settings.

The book contains many practical tips for work procedures, for both process descriptions, and for formation and administration of a management system and primarily addresses medical professionals who have recently acquired leadership and management responsibilities. It is also useful for anyone involved in reviewing or building a management system or students who, following graduation, are going to work within healthcare or other care settings. The book can also be used as a guideline for politicians, public officials, and executives at all levels who work with patient safety.

The content will provide you with practical hints on how a process-oriented management system can be designed, based on a set of principles aimed at accomplishing a solid structure that is both easy to use and easy to maintain. It also illustrates the importance of the change in the patient safety management approach. Another purpose is to bring about insights into the direct dependency between safety and leadership helping you lead toward cocreating a corporate safety culture driven by managers, together with personnel at the sharp end. The expression “at the sharp end” is often used in saf...

Table of contents

• Cover
• Halftitle
• Title
• Copyright
• Abstract
• Contents
• Foreword
• Endorsements
• Chapter 1
• Chapter 2
• Chapter 3
• Chapter 4
• Chapter 5
• Chapter 6
• Chapter 7
• Chapter 8
• Reference
• About the Author
• Index
• Backcover