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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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New Trend or Passing Fad?
Reliance on Foreign Drugs

This blog is the THIRD in a new 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.

NOTE: Running the risk of writing a xenophobia-like piece about foreign countries, this particular blog is intended to address a serious national security issue that has been neglected for at least two decades.

To borrow a phrase from the ‘Apollo 13’ movie, “Houston, we have a problem.” No, wait, we have a BIG problem!

If the COVID-19 pandemic has taught us anything, it’s that we must not become too dependent on outside countries for drugs and certain medical supplies – such as masks, gloves, ventilators and other personal protective equipment (PPEs). These dependencies can seriously undermine our health security, which is critical to our national security. But, over the past two decades, our country HAS increasingly become more reliant on foreign countries, especially China.

Interestingly, the pandemic just may serve as the catalyst to help remedy this problem.

The China Situation

A major event occurred in the year 2000 that triggered the U.S. to rely more on China for the supply of medications. Congress and the White House agreed to grant China access to the U.S. market, and permitted China to join the World Trade Organization. Shortly after, China developed the penicillin and Vitamin C ‘cartels,’ by basically replacing American manufacturers through the dumping of low-cost product into our country. As a result, American manufacturers could no longer compete against China’s government-financed manufacturers. China’s monopolizing behavior is also commonly found in many other manufacturing products from various industries. Pharmaceutical dependence on China can be found in an earlier blog that I wrote in 2019, “Dependence on China – The ‘Weaponization’ of our Medicine.

In 2019, The U.S. Food and Drug Administration (FDA) estimated that 80 percent of active pharmaceutical ingredients (APIs) and 40 percent of finished medications were manufactured overseas, primarily in China and India. Most generic drugs, including antibiotics, accounting for more than 90 percent of all U.S. prescriptions, are imported from India, but India imports 70 percent of their active ingredients from China.

Having a high concentration of our medicine coming from just one country, no matter the country, can become a major strategic risk to the health and security of our population. To function, the U.S. (and other countries) rely on having appropriately-manufactured medicine of high-quality with safe ingredients, reasonably-priced, and readily available. In fact, by ceding the manufacturing of medicine elsewhere, any country could be held hostage by a new warfare that has never been waged in the past – the weaponization of medicine.

During a congressional testimony in October of last year, Janet Woodcock, the FDA’s director of the Center for Drug Evaluation and Research, pointed out that drug production has moved out of the U.S. into other countries.  According to Woodcock, “The FDA doesn’t know whether Chinese facilities are actually producing APIs, how much they are producing, or where the APIs they are producing are being distributed worldwide, including in the U.S.” In short, the FDA does not know how dependent the U.S. is on China for its drugs!

National Emergency Order – Stafford Act

Addressing the pandemic on March 13, President Trump declared a national emergency under the Stafford Act, a 1988 law that presidents can use to declare disaster areas after storms and other natural disasters. This declaration granted that certain medical products and supplies, such as disposable gowns and drapes, be excluded from the 25 percent tariff imposed by the U.S. since September 24, 2018, on $200 billion goods imported from China.

These tariffs have increased concern about relying heavily on a single market (e.g. China) for critical medical and pharmaceutical products, forcing many U.S. organizations to rethink their China-based supply chains. It’s additionally anticipated that the Administration is preparing an executive order that would require certain essential drugs be made in the U.S. This executive order is believed to streamline regulatory approvals for “American-made” products and encourage the U.S. government, including the Departments of Defense, Health and Human Services and Veterans Affairs, to buy only American-made medical products.

To maintain independence from foreign control, streamlining regulatory approvals for American-made products and more detailed labeling of the origin of drug products could help facilitate American production at home.

Conclusion

Whether the novel coronavirus will be the tipping point for drug makers to adopt new technologies and resist the offshoring trend is yet to be determined. Preventing an interruption in the supply of vital medications and other medical products that save lives and treat diseases – whether during pandemics or in routine care – is a matter of national security. As our population ages, Americans will become even more dependent on medications indispensable for treating heart disease, cancer, stroke – and viruses. Mobilizing resources to mitigate the supply shortages is a strategy that must be paramount to our government and all policymakers.

The COVID-19 pandemic serves as a wake-up call for our government and the pharmaceutical industry to take notice – and act. If this particular opportunity is somehow tragically missed, then policy malpractice has been undeniably committed. Regardless of the political leanings one may have, we can all agree this should not be a red or blue issue – but an American one.

Next Week’s Discussion:  Fear of virus will propel smokers to quit.

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