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Making ‘Patient Safety Culture’ Results Public

Imagine the staff within your organization being surveyed every two years to reveal just how successful your organization is when manufacturing or delivering safe services to your clients. Further, the results are then shared with the public.  As of July 1, the state of Florida is requiring hospitals and ambulatory surgery centers to do just that.

Over the years, I have written extensively on how having a healthy ‘culture’ is extremely important for any organization as it drives the right behaviors to successfully function internally and externally. In healthcare, having the right kind of ‘culture’ can make the difference between life and death for patients.  It’s that important.

Simply put, culture – both good and bad – is the DNA of any organization. If given truth serum, an organization’s staff can reveal just how functional (or not) it is. An organization’s culture ensures that its purpose and the purpose of its members are aligned. The compatibility of goals will drive the members to perform well, be self-directed and loyal to the organization.

In healthcare, a ‘culture of safety’ is paramount for patients trusting they will receive appropriate care.  When you think about it, who better to ask about quality of service within a hospital than the frontline workers themselves – staff, nurses, technicians, etc.? Research suggests that medical organizations with higher staff perceptions of working in a safe culture translated into better overall safety and quality outcomes.

Hospital Survey on Patient Safety Culture

A 2018 blog that I wrote touches on the importance of having patient safety culture information available on a public basis. In fact, this blog suggested a simple idea for Iowa policymakers and stakeholders to pursue:

Have ALL Iowa hospitals and outpatient surgery centers undertake the hospital staff survey generated from the Hospital Survey on Patient Safety Culture. The survey would happen every other year (biennial) with the results becoming public.

Having this state-wide policy, I argued, could put Iowa on the map as being one of the more proactive states on safety measures and patient outcomes. In 2018, no other state required this type of information to be reported publicly.

Florida Becomes First State

In early March, right before COVID-19 hit our state and country in full force, I learned that Florida lawmakers were about to pass legislation to require hospitals and ambulatory surgery centers to report – on a biennial basis – results from the standardized patient safety culture surveys that are developed by the federal Agency for Healthcare Research and Quality (AHRQ).

Fast forward to now. The proposed legislation was passed and approved by the Florida Governor and took effect July 1, 2020.  Iowa, unfortunately, will not be the first state to enact this patient-centric legislation.

Florida’s Agency for Health Care Administration, which licenses and regulates health facilities in that state, would receive the anonymous survey results from each facility and then display the results publicly by showing an aggregate of the composite measures by unit and at the facility overall. The composite measure includes teamwork and hospital management support for patient safety. This Agency provided me with the final version in s. 395.1012(4),F.S.

Florida lawmakers believe that displaying this critical information publicly will pressure hospitals and ambulatory surgery centers to change problematic safety cultures.

In addition to including the standardized core survey questions found in the Patient Safety Culture questionnaire, Florida’s law also requires that the survey includes whether or not each respondent would seek care for the “respondent and the respondent’s family at the surveying facility, both in general and, for hospitals, within the respondent’s specific unit or work area.” In other words, would staff members seek care from their own units or hospital system?  This can be quite compelling on whether the organization is fostering a safe culture of care.

Florida Hospital Association

Interestingly, the Florida Hospital Association (FHA) supported this legislation, only asking that composite results be used so that results would be easier for consumers to understand. The FHA also lobbied for a biennial requirement, to allow hospitals enough time to make changes based on the survey results. The Florida Society of Ambulatory Surgical Centers was not opposed to this legislation, but also did not lobby to have it enacted.

I give the Florida providers a great deal of credit for attempting to ensure that the care provided to Floridians will be the best possible care that is tied to a culture of safety. This new law provides the right intent needed to ensure that appropriate change is made in the healthcare delivery system.

Summary

I hope to see Iowa policymakers and providers do the same for Iowans. Iowa can still become the leader in safe, effective care, but it does require grit, honesty, and a great amount of passion to make transparent quality of care become wildly successful.

Marketing optics that care is always safe is not adequate. Florida has given Iowa a blueprint to implement practical steps to move best-in-nation care forward. Why can’t our state also embrace this approach?

Iowans certainly depend on it.

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New Trend or Passing Fad?
Smoking Rates will Drop with COVID Pandemic

This blog is the FOURTH in a series regarding the ‘unintentional consequences’ of the COVID-19 pandemic. As our lives have been abruptly altered due to social distancing requirements – both at home and in the workplace – unplanned ‘disruption’ of previous normal activities could permanently replace sacred elements once believed to be unyielding to any change. But COVID-19 just may have dictated new approaches to how we live and work.

In late April, over one month into the COVID-19 pandemic, a piece from Kaiser Health News (KHN) was published discussing how the virus may prompt some smokers to quit their habit, primarily to avoid respiratory risks. Past research has shown that smoking makes it more difficult to fight off respiratory infections. Because of this, one can reasonably assume that smoking will increase health complications, if infected by the virus. It was, therefore, a natural topic to cover how the pandemic may favorably shape smoking habits in the U.S.

Since publication of the KHN article, however, the science between smoking and COVID-19 is not as clear as one might think. Please read on…

Smoking and COVID-19

One early study about COVID-19 health factors suggests that smokers are 14 times more likely to need intensive treatment compared with nonsmokers. Such findings push doctors to use this connection between COVID and smoking, as yet another reason for people to quit this habit.

Yet, using the coronavirus as a valid reason to quit smoking, could possibly backfire. New research from UCLA’s psychology department shows that stigmatizing smokers may actually INCREASE their urge to smoke. Known as a ‘stereotype threat,’ people become anxious about being identified in a negative way and, consequently, end up confirming the behaviors they are trying so hard to disprove.

As we learn more about the impact of this virus on humans, more studies will likely ensue on how smokers are impacted by newly-evolved viruses. Perhaps the development of a reliable and widely-available antibody test could reveal connections between smoking and the coronavirus.

Countervailing Study – Smokers are LESS likely to contract COVID-19

There is contradictory evidence that smoking may actually keep smokers from contracting COVID. French researchers believe that nicotine protects cells from coronavirus attacks. In fact, the Pasteur Institute found that four times fewer smokers contracted COVID than non-smokers.

In lieu of this finding, the French government banned online sales of nicotine replacements – nicotine gum and patches – and warned that pharmacies that dispense treatment for tobacco addiction must limit the amount issued per person. The concern is that “excessive consumption or misuse in the wake of media coverage” may push people to inappropriately consume nicotine replacements to combat COVID.

How true is the French finding? There is much skepticism. More information is needed to learn the truth about nicotine and COVID. For now, a helpful piece can be found in USA TODAY regarding the facts associated with nicotine and COVID.

Conclusion

Given the varied lifestyle behaviors of individuals, some smokers may decide to curtail the habit, while others will maintain the status-quo regardless of having conclusive evidence that their health is at greater risk by holding on to this habit.

As we have found in the past few months in our country, science can play an important role for those who embrace well-documented research, but it can also be discarded by others. In 2017, smoking rates in Iowa mimicked national rates – 17.1 percent of adults smoked. Smoking rates have decreased over the years, and whether the pandemic will accentuate this trend in the future is, at best, uncertain.

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Reflections of a Privileged White Male

This title is redundant. I am privileged because I am white and male.

I usually write about healthcare, employee benefits and insurance issues, but given the racial unrest in our country, I feel compelled to write about a much more complicated and emotional topic.

The senseless killing of George Floyd, another black man while in police custody, has rightfully brought shock and outrage to our country. But with our history of racism, prejudice and social injustice, shock and outrage has never been enough to overcome the inequalities that consistently plague racial minorities.

It is time to be honest with myself, and I implore you to do the same. I am a white male who is protected by our status-quo society, given unwarranted power and prestige at the expense of others. This privilege buffers me from the naked truth of what is happening to non-white citizens. I don’t know what life would be like without having that privilege. Consequently, how can I possibly understand the perspectives and struggles experienced by those without privilege? I simply can’t.  But it is imperative that I begin to try harder.

In 1984, while unknowingly taking a wrong turn on a one-way street in downtown Minneapolis, I was stopped by a police car, sternly directed to step out of my vehicle and place my hands on top of the car. I quickly complied. The officer then forcefully kicked my feet apart and told me that I was driving the wrong way – the interaction felt unnecessarily aggressive.

Despite my privilege – power through wealth, health and opportunity that others are not afforded because of the color of their skin – this simple traffic stop made me feel demeaned. I was humiliated, frightened and incensed about how I was treated. But, unlike George Floyd and too many other people of color, my life was never at risk.

Watching George Floyd’s brazen killing changed everything for me – in a very fundamental way.

Upon reflection, that experience of feeling demeaned 36 years ago makes me realize that privilege is the ability to get angry and see that moment as an isolated incident. That experience lasted 10 minutes…not a lifetime. My societal privileges have shielded me from the reality that people of color are at risk of experiencing much worse every day. I have been complicit by not speaking up about such social injustices.

Dr. Martin Luther King Jr. described this complicity: “A man dies when he refuses to stand up for that which is right. A man dies when he refuses to stand up for justice. A man dies when he refuses to take a stand for that which is true.”

I have not stood up as I should have.

It is said that any society, any nation, is judged on the basis of how it treats its vulnerable members. Dignity should not be discretionary and should be afforded to all people.

So how can we as Americans move forward from this history of systemic racism? I don’t have the answer. However, I do know for real change to happen, it must begin with a confession from me, and from each white American who comfortably accepts the privileges enjoyed. Merely believing you are ‘not racist’ is not enough. We must learn how to be anti-racist in our core beliefs and practices.

I am responsible for educating myself and can no longer remain silent. I must not tolerate ignorant or intentionally harmful actions or words aimed at people of color. Listening and learning are the first steps in the very long and critically important journey ahead. Voting is a necessity – insisting on policy and political reform to eradicate social injustices. We, as a society, must step up.

I do not write this because I am more enlightened than others. But change must start with me – and each of us, individually.  I must recognize that my societal privileges have been at the expense of those who are without. I can certainly do better. Our country can do much better – and together, we must.

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