Home 30,000 foot success, 30-inch failure Ergonomics Done Right®

Written by: Kent Hatcher on June 9th, 2008

It’s difficult to say which is the sadder situation; a county (community) hospital having excess operations (taxpayer) money in hand or the quality issues described in the Star –Telegram articles that Mark Graban from Leanblog discussed the other day.

That the Tarrant County Hospital Commission can permit either situation is galling. County Hospitals such as John Peter Smith are responsible for delivering quality care for those most challenged by caring for themselves, the local Medicaid and Medicare populations.

JPS is part of the Federal network agency Centers for Medicare and Medicaid Services. CMS has a fully staffed and funded Office of Clinical Standards & Quality (OCSQ) that “Provides leadership and coordination for the development and implementation of a cohesive, agency-wide approach to measuring and promoting quality and leads the Agency’s priority-setting process for clinical quality improvement”.

CMS is a key member of The Hospital Quality Alliance, a public-private collaboration “to improve the quality of care provided by the nation’s hospitals by measuring and publicly reporting on that care”.

The goal of the program is “to identify a robust set of standardized and easy-to-understand hospital quality measures that would be used by all stakeholders in the healthcare system in order to improve quality of care and the ability of consumers to make informed healthcare choices”.

And if we’re to follow recent survey results, as of January 2008, JPS is performing well. Let’s look at one measure – the indicators for surgical infection and complication prevention that reports on the hospital’s overall performance for improving patient safety by reducing post-surgery complications.

JPS, in spite of the newspaper’s findings, outperformed the national average in six out of six categories.

Core Measures

JPS Health Network
January ‘08 Preliminary Results

National Average*

Prophylactic antibiotic received 1 hour prior to incision

89.8%

82%

Prophylactic antibiotic selection

97.9%

90%

Antibiotic discontinued within 24 hour post surgery end

91.7%

78%

Surgery patients with VTE prophylaxis ordered

92.2%

79%

Patients received appropriate VTE prophylaxis within 24 hours prior to surgery to 24 hours after surgery

84.3%

75%

Patients on beta blockers PTA who received beta blockers perioperatively

86.7%

83%

*Source: Hospital Quality

Alliance

The national situation for Medicaid and Medicare patients must be a tragedy on a very large scale if, in the eyes of some, JPS is a profitable, above average quality performer.

Just shows that elaborate oversight, frequent benchmarking quality surveys and all the mission and value statements can not substitute for the one key ingredient of knowing what the client (patient AND staff) wants (needs) and committing to its delivery. Execution means succeeding at the 30-Inch level!

2 responses to “30,000 foot success, 30-inch failure”

  1. Mark Graban says:

    Interesting points on the quality data. It just goes to show that sometimes you get what you measure… and not much else. People are clever about learning how to game the system.
    Dr. Deming is often misquoted as saying “You can’t manage what you can’t measure.”
    It’s more accurate to say that some things that are critically important, such as how you treat people, can’t be quantified or measured.

  2. Mark,
    Perhaps another misquote seems suited to JPS quality:
    “Every morning is the dawn of a new error”.
    Thanks for bringing the story to light.

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