PSOs tout benefits of membership
They claim delay shouldn’t deter hospitals
When the Centers for Medicare & Medicaid Services (CMS) announced in March that there would be no mandate for hospitals to join patient safety organizations (PSOs) until January 2017, at the earliest, rather than January 2015, many probably breathed a sigh of relief. After all, while many hospitals had jumped on the PSO bandwagon in the wake of the 1999 Institute of Medicine report, To Err is Human, others had dragged their feet, thinking it was more work — akin to what they were already doing so much of: feeding bits of data into an organization, often paying for the privilege of it, and not getting anything out of it that they weren’t getting from somewhere else in another format.
But that’s not at all what PSOs are about, says Rory Jaffe, MD, executive director at the California Hospital Patient Safety Organization (CHPSO), and after several years as voluntary organizations, some with thousands of hospitals participating, the benefits of having a great deal of data available on troublesome issues is just becoming apparent.
Jaffe says that at a recent PSO meeting held by the Agency for Healthcare Research and Quality, CMS spoke of the final rule (http://www.gpo.gov/fdsys/pkg/FR-2014-03-11/pdf/2014-05052.pdf), saying it came about largely because of a possible shortage of hospitals and providers who could participate in the health insurance exchanges if they were also required to participate in PSOs as early as 2015. But in the comments in the Federal Register, he notes, there were many who disputed that, and objected to the length of the delay, if not to the delay itself.
"We think a delay is fine if they are clear about the intent and what happens after that," Jaffe says. "A lot of people had been confused about the mandate the way the law was written. But this will allow for hospitals to join, and to have much broader participation in healthcare exchanges. That’s what they are doing everything they can to facilitate."
What he believes is noteworthy and worth underlining to those on the fence is that Congress has twice chimed in to say that participating in a quality organization is so important that they are going to make a law about it — first in 2005, and then with the Affordable Care Act. "Congress has expressed its will, and regardless of the delays, this is something that with a virtually unanimous vote has become the law of the land."
Few hospitals would meet the exceptions that will be granted in 2017 when the delay expires, Jaffe says — hospitals in states with really robust reporting systems such as Pennsylvania, for instance. If you aren’t in one of those, then you should really be thinking about joining a PSO if you haven’t already, he adds.
Benefits can accrue quickly
"There are a lot of benefits that accrue really quickly," he says. "I can’t overstate it enough. With the confidentiality and privilege protections that we have, you can share information with other organizations, and learn things with a degree of transparency and without fear of legal repercussions that will have a great impact on your safety and quality."
ECRI, a Plymouth Meeting, PA-based PSO with more than 1,000 hospital members, has been touting the benefits of joining since 2008, says Amy Goldberg-Alberts, MBA, FASHRM, CPHRM, program director for patient safety, risk, and quality. "We have published three deep-dive reports — on medication safety, health IT, and most recently on lab safety," she says. The latter one took information gathered from participating hospitals and was able to find that errors in the lab aren’t just of the lab, but often are systems-related problems. They were able to discern these patterns because they had data from a large number of organizations that were participating in an open, collaborative, sharing environment.
"You can’t think in isolation anymore," Jaffe says. "And the great thing is, you don’t have to. For years, think of the things you have been itching to share with your peers but couldn’t. Now you have a way to share the burden with a peer in another organization or ask a question. PSOs are the tool that can facilitate that. Can you imagine other industries not sharing information on problems in the manner healthcare has NOT shared information?"
He brings up the airline industry and ponders what might happen if one airline had a problem with a wing or another part but didn’t share that information with another airline. It’s unthinkable, says Jaffe, but that’s the way the healthcare industry has worked when it comes to errors, mistakes, near misses, and problems. At least until now.
"We are really helping organizations understand the social technical system, evaluate issues, and bring them to the attention of people designing systems and equipment so that we won’t have to wait for a crash to learn from these things," Jaffe notes.
Solace in sharing
One recent issue CHPSO uncovered related to the way information was displayed on a PACS imaging system. The PSO started researching and found that there was an organization with a near miss related to the PACS system display of information, too. So they called other PSOs and found that there were other instances of harm and near misses. This kind of data will be put together and provided to the manufacturers so that the problem can be addressed. Again, without the data collection and collaboration of the PSO members and of the PSOs with each other, this might not have happened until there had been much more harm.
There is also solace in sharing, says Jaffe. "We had an event recently where a patient died, and one of the feelings that was most prevalent among the people involved was that they wanted to be sure this didn’t happen anywhere else. They needed to share the information. The PSO is the intermediary that can make that happen."
One of the big fears is that PSO participation will be difficult, but Jaffe says most of them make it easy. "Once you are hooked up to most PSOs, it’s minimal work," Jaffe says.
Healthcare needs a common way of looking at events, a culture of reporting and learning, and a legal protection for patient safety and quality information, he says. "That’s the purpose of a PSO. It’s everything that quality and safety advocates have been asking for, and it’s here now."
CHPSO has 300 members, and like ECRI, has capacity for more. "A mandate isn’t going to do anything for us, though. We have to demonstrate our value, and I think we are starting to do that. We are seeing the information we gather pay off, even to the point of influencing design of systems and equipment."
Goldberg-Alberts notes that another benefit for hospitals is that PSOs aren’t just for inpatient facilities. Indeed, other healthcare organizations also take part, such as physician practices, long-term care facilities, home care, and ambulatory surgical centers. As care coordination matters more and more, having the kind of data that relates not just to one kind of facility, but to patient care across the continuum will be another asset to organizations that become early joiners of PSOs.
"I don’t think you should put this off," she says. "Look around at the PSOs in your area. Evaluate your options, and consider your next step."
For more information on this topic, contact:
• Rory Jaffe, MD, Executive Director, California Hospital Patient Safety Organization. Sacramento, CA. Telephone: (916) 552-2600.
• Amy Goldberg-Alberts, MBA, FASHRM, CPHRM, Program Director for Patient Safety, Risk, and Quality, ECRI, Plymouth Meeting, PA. Telephone: (610) 825-6000.
