Summary

Our healthcare system is only as strong as our ability to keep patients safe. The most important oath that a physician takes is to do no harm. Unfortunately, our healthcare system too often fails patients; rather than healing them, it further harms them. Doctella proposes a fairly simple and thus far untapped solution to the growing challenge of patient safety.

First, Doctella operates under the belief that patients are themselves a critical part of the solution to the problem of patient safety. Second, it provides patients with evidence-based checklists of key questions to ask. preferences to share, and things to do during their health care process and empowers patients to be their own safety advocates as well as more informed decision-makers. Patients and families act as a second pair of eyes and ears in the system to look out for their own and their loved ones’ well-being.

Let’s Fix it!

The Institute of Medicine’s (IOM) 1999 report To Err is Human created a national mandate to reduce and ultimately eliminate preventable harm, with a focus on reporting adverse events to increase accountability and the creation of “cultures of safety” within healthcare institutions (1). In 2005, the United States Congress passed the Patient Safety and Quality Improvement Act, which focused on creating reporting structures for adverse events. As a result, numerous Patient Safety Organizations (PSO’s) were formed in states across the country as a repository for adverse event data. (2)

As the 2013 ProPublica article, “How Many Die from Medical Mistakes in US Hospitals?” (3) documents, every study that has been released since the IOM’s landmark report in 1999 has only raised the estimates of harm. A few reasons for this are that these studies are getting more robust and therefore their data is more reliable, as well as working with more recent data. (the IOM report relied heavily on a 1984 and 1992 study) The Journal of Patient Safety released a report in 2013 estimating that the number of preventable deaths in the United States was somewhere between 210,000-440,000 – making it the third leading cause of death in the United States. (4) These estimates translate into approximately $19.5 billion in medical expenses (5). Rocketing healthcare costs is a critical national priority, and providers are evaluating strategies and tools to reduce costs.

Patient Safety in the National Spotlight

Providers and payers have shown their commitment to reducing patient harm by investing in Patient Safety Officers, a relatively new role for hospitals that focuses on institutional commitment to safety and creating a culture that supports transparency, support for staff, and an acknowledgement that safety is an organizational issue rather than an individual one. Patient Safety Officers and experts have identified a critical gap in prior strategies.

Patient and Family Engagement (PFE) has been growing in attention, as provider systems and health care researchers have realized that one of the main things missing in our current healthcare system is the voice and opinion of the patient receiving care. There is also a growing body of evidence that suggests that involving patients in their care more actively has the potential to reduce harm and increase better outcomes. (6) In 2012, the Centers for Medicare and Medicaid Services (CMS) introduced the Partnership for Patients, a $218 million funded initiative with two aims: reduce preventable hospital-acquired conditions by 40% and preventable hospital readmissions by 20% by the end of the year 2014 (7).

Doctella Solution

Doctella has created a simple solution that aligns actions and incentives across the vast and complex healthcare system and democratizes critical information that has thus far been only accessible to highly trained medical professionals. This is particularly important given that patients and families are the only constant in their continuum of care, starting with the discussion of symptoms with family and friends, progressing onwards to specialized surgical care, and finally post-operative recovery and hopefully a return to health and wellness.

Checklists are a proven and tested way to ensure that complex tasks are completed in a high-quality manner. Doctors and nurses use checklists every day to help them effectively perform their difficult jobs. The complexity of the healthcare system also makes the job of being a patient a hard one. Using checklists can activate and engage patients and families in ways that have been shown to increase patient satisfaction, adherence, and ultimately better health.

Doctella helps patients to benefit from checklists. Our new mobile, web, and print platform hosts checklists created for patients. The platform is designed with easy-to-use search technology, reminders, and step-by-step questions patients can ask their healthcare providers.

Culture, Habit, Trigger, and Rewards

Today, when experienced doctors, nurses, staff and patients walk into a provider setting everyone expects a certain routine, and many actions have become habit. In other words, health care culture is a collection of our behavioral habits and expectations. Most patients know that their doctor and healthcare team want the best for them. However, due to this belief, patients and families assume that nurses and doctors can manage their health care without any major mistakes. A Harvard study published in Massachusetts, one of the most aggressive states to tackle the issue of medical error and patient safety, showed that almost no patients, with the exception of hospital care workers themselves, researched quality or safety when choosing their hospital. (8)

We need to help patients understand the risks of our health system and give them the tools to be their own best advocates.

Implementation and Deployment

Providers are at the forefront of preventing harm because they have the ultimate responsibility to do no harm. Within the cultural framework discussed above, providers have many simple opportunities today to fit Doctella seamlessly into their workflow.

The easiest and quickest deployment is online. Patients visiting the provider’s’ website or health portal will be able to search for their specific procedure, get checklists, customize the checklists, and generate print-outs. Patients with smartphones can download the mobile app and have access to all lists in the palm of their hand. Mobile app users can also set reminders for items and a to-do list. After the provider evaluates analytics and sees traction, the provider can move to the next phase of surgical clinics, followed by speciality clinics and then in-patient wards.  The next phase of clinical deployment consists of adding brochures to appointment letters, waiting room materials, and posters, as well as bedside materials and posters. Training doctors, nurses, and staff will be a parallel effort to ensure the proper context and response to patients asking questions.

Payers have an important role to play in changing patient and provider habits and incentives as well. When payers authorize a patient to see a specialist they can provide information to the patient that will help the patient make the most of their office visit and limited time with the specialist. For family members who cannot accompany the patient on a visit, the checklist is a simple way for patients to log important information and share with loved ones.

Integration and Customization

Integration of Doctella’s search technology into provider and payer websites and/or health portals is easy and can typically be completed within hours. Doctella’s search technology seamlessly integrates with any existing web infrastructure.

Providers and payers can easily customize Doctella’s content by editing our checklists or adding new, internally developed content. The institution’s logo, color scheme, and disclaimers can be added to their customized web search bar and app.

Integrating Doctella in your Hospital

Doctella recognizes that creating a culture of patient safety in a hospital is ultimately about change management. Like all change management on an organizational level, it must be led. Patient Safety leaders need to encourage their teams and get buy-in from management. While Doctella is only one piece of this, we are one tangible way that a health care provider can prioritize patient safety. We have created a pilot plan for patient safety leaders to follow (below) which outlines each step of a Doctella pilot plan, using change management principles to ensure success. (9)

Preparing for a Successful Doctella Launch:

Step One: Choose a Hospital Unit/Dept/Clinic in which to Deploy Doctella

  • Factors to consider when choosing where to deploy Doctella should include a) size of unit – too big and it may not be realistic for an initial pilot, b) leadership within the unit – change always needs champions, and c) patient demographics for that particular unit (i.e. choose a unit that treats patients you judge somewhat likely to use Doctella)

Step Two: Introduce Doctella to Hospital Staff

  • Identify one or more champions for Doctella, individuals who have two critical qualities: 1) the respect of their colleagues, and 2) the enthusiasm to drive change
  • Champion(s) will meet regularly with Doctella staff to develop a roll-out plan to patients and to receive training and support
  • Champion(s), with support from Doctella, introduce Doctella to staff with a launch event. We suggest that the spirit of this event be fun, team-based, and that goals are set in which each staff member feels they can compete and help the whole unit. Goals should be achievable and tied to some type of reward for the staff, something that they choose.
  • Staff training and support will be ongoing, and Doctella will be consistently involved to help set goals and address issues as they arise.

Step Three: Introduce Doctella to Patients

  • Similar to staff launch, have a patient launch day. This can include banners, blown up waiting room checklists, greeters who ask surgery patients one or two key questions from the Doctella platform, such as “What is your major concern coming in to the hospital today?” or “Do you know the goal of your surgery?” “Have you discussed the risks of your surgery and your non-surgical options with your surgeon?” to start teaching patients that asking patients is ok, and helping staff learn that a dialogue with patients should be the new norm.

Step Four: Celebrate Small (or BIG) Wins

  • Find patients willing to share their “win” stories; share them
  • Find staff willing to share their “win” stories; share them
  • Celebrate goals that have been achieved in ways that are meaningful to hospital staff
  • Set new goals

Innovative institutions using Doctella will inherit the ability to expand interaction with patients by supplying answers to patients’ questions and push reminders and timely information with relevant context.

Conclusion

Doctella can provide Patient Safety Officers with a simple solution to engage patients as effective advocates to prevent harm and improve quality of care. Deploying Doctella online is simple and can be done within hours. Doctella’s offline and online tools easily integrate into existing outpatient and inpatient work flows. Starting an online pilot with Doctella is free of cost and requires minimal technology resources. During the pilot program Doctella will provide analytics regarding patient engagement for patient safety organizations to evaluate Doctella.

Contact Doctella to start a free pilot (for limited time) by sending an email to info@doctella.com. For more information please visit http://www.doctella.com

References

  1. Kohn L T, Corrigan J M, Donaldson MS (Institute of Medicine) To Err is Human: Building a Safer Health System. Washington, DC: National Academy Press, 2000.
  2. Patient Safety and Quality Improvement Act of 2005. http://archive.ahrq.gov/news/newsroom/press-releases/2008/psoact.html
  3. Allen, Marshall. How Many Die from Medical Error in US Hospitals. ProPublica. September 19, 2013. Accessed at http://www.propublica.org/article/how-many-die-from-medical-mistakes-in-us-hospitals.
  4. James JT. A New, Evidence-based Estimate of Patient Harms Associated with Hospital Care. Journal of Patient Safety: September 2013 – Volume 9 – Issue 3 – p 122–128.
  5. American Society of Actuaries. The Economic Measurement of Medical Errors. http://www.soa.org/research/research-projects/health/research-econ-measurement.asp. 2010.
  6. Agency for Healthcare Research and Quality website. http://www.ahrq.gov/professionals/systems/hospital/engagingfamilies/
  7. Centers for Medicare and Medicaid website. Partnership for Patients. http://partnershipforpatients.cms.gov/.
  8. The Public’s Views On Medical Errors in Massachusetts. Commissioned by Betsy Lehman Patient Safety and Medical Error Reduction Health Policy Commission. Harvard School of Public Health. December 2014. Accessed at https://cdn1.sph.harvard.edu/wp-content/uploads/sites/94/2014/12/MA-Patient-Safety-Report-HORP.pdf.
  9. Harvard Business Review on Change. Harvard Business School Publishing. Boston, MA. 1998.

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