Buttoning loose lips focus of privacy campaign
Medical center emphasizes confidentiality
The cardiac technician was preparing to demonstrate a new medical device in which a picture of a beating heart is displayed on a monitor. The person waiting to see the demonstration was fascinated and mentioned that her husband had undergone that procedure; let’s demonstrate by using his results, she suggested.
"Can’t do it," the technician replied. "Patient confidentiality, you know."
When Kathleen Haak heard about this incident, "My heart just leaped. I was so pleased," she says. Haak, RRA, is health information systems coordinator at the Austin (TX) Diagnostic Medical Center, and she’s part of an ambitious effort to convince her colleagues that loose lips and other slips sink patient confidentiality.
Change in emphasis
The effort began with a focus on confidentiality issues in computerized patient records, which the center uses. It was quickly expanded, though, following a survey of what center staff perceived would be the most likely source of confidentiality breaches. The winner was behavioral violations. (See chart listing survey results, p. 36. The actual survey is on p. 37.)
"We’re taking it to the next level," says Lisa Ball, RRA, director of quality, resources, and health information management. "Most hospitals focus on the computerized records but don’t think about the behavioral problems. We don’t know that any of these violations have occurred, but we want to be proactive about this."
As part of the confidentiality campaign the HIM staff sent out a multiple choice and true/false questionnaire to determine the staff’s awareness of confidentiality practices. The questionnaire presents a workplace scenario and asks the reader to choose the best course of action. (See sample questionnaire, inserted in this issue. The answers are at the end of this story.)
To improve the response rate, HIM arranged a drawing for a cash prize for everyone who got a perfect score.
Answers to the questions are analyzed and used for a key phase of the effort, says Haak department-specific inservice training programs.
Haak says she has no illusions that this will be easy. People in an HIM department have a greater appreciation for confidentiality than other units. "Other departments make patient care their top priority," she says. "In my mind, respecting the patient’s right to confidentiality is part of caring for that patient. But sometimes we get resistance because the other departments have so many patients to see and only a certain amount of time to see them, and it’s not a priority to consider the patient’s privacy. Our job is to show them that this needs to be a priority."
But she also notes that the idea of patient confidentiality contains more gray than black and white.
For example, she notes an admitting clerk registering an older person with a hearing problem may have to ask for personal medical information in a louder than normal voice. That could potentially be considered a breach of patient confidentiality.
"It may not be realistic to take them into a private area," Haak notes. "I can understand that. Do you bring in the contractors and have them tear down the walls so they can have that privacy? It’s a tough question. But my point is that we need to do what we can do. At least make some effort to make the patient feel comfortable."
One goal of the department inservice training sessions will be to try to work out solutions to specific problems.
Haak says she also wants to hold special sessions for managers who are in charge of enforcing patient confidentiality.
"They have to know how to address this, how to enforce it," Haak says. "We’re not out there. They’re the ones on the front line. They need to reinforce it."
Currently, all new hires attend a day-long orientation which includes a half-hour session covering general confidentiality awareness. The employees watch a video on the legal and ethical concerns, then Haak addresses specifics. A year later, the employees attend a half-day reorientation where they take a one-hour refresher course, see the same video, and take a test on the hospital’s policies.
All employees at the center also must sign an agreement of confidentiality. Haak is currently writing a contract for outside vendors as well.
If employees breach confidentiality, their manager will take corrective action in accordance with the hospital’s standard protocol for any violation. The employee will receive a verbal or written warning or automatic termination.
For computer breaches, specific violations have been categorized according to severity. Some examples of corrective actions include:
• Verbal warning and education.
An employee accesses his/her own record without following procedure.
• Written warning and counseling.
An employee commits a breach after being verbally warned for failing to log off the computer, sharing a password, or accessing another person’s patient record (depending on circumstances, could be automatic termination).
• Automatic termination.
An employee accesses patient records without authorization, then shares the information with someone else.
No figures on enforcement actions are available, but "There have been terminations," Haak says. One key to enforcement is to have support from the upper echelons of the hospital, which is the case at the medical center, she says.
As a highly visible reminder of the confidentiality policy, signs have sprung up in the cafeterias, elevators, and other common areas where behavioral breaches usually occur. The signs depict the three fabled monkeys illustrating the qualities of seeing no evil, speaking no evil, and hearing no evil.
"We want people to see those monkeys and remember what they mean," Haak says. "We’re making this a priority."
Lisa Ball, RRA, Director of Quality Resources and Health Information Management, Austin (TX) Diagnostic Medical Center. Telephone: (512) 901-1605.
Kathleen Haak, RRA, Health Information Systems Coordinator, Austin (TX) Diagnostic Medical Center. Telephone: (512) 901-1604.
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