Education key to helping administrators accept ORYX
Stress benefits, not burdens of ORYX compliance
It’s a given by now that ORYX and its core measurements won’t be going away soon. And even though hospital administrators and quality directors are begging for relief from more compliance standards, more expense, and more paperwork, ORYX may offer results and advantages that many administrators and physicians aren’t able to see yet.
Many administrators view the ORYX plan as more paperwork and a waste of time and money. But Sandra Banahasky, RN, CPHQ, CPUR, director of quality and risk management at Labette County Medical Center in Parsons, KS, sees it differently. "It’s so easy to say this takes time," she says. "But you’re going to pay the fiddler now or later. If quality isn’t there, neither are patients."
"ORYX is part of a huge initiative to move accreditation away from standards like documentation and into meaningful areas like performance," says Luke Skelly, director of clinical services for the MEDSTAT Group, an ORYX vendor based in Ann Arbor, MI.
In January, the Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, IL, issued a statement explaining that its long-range ORYX goal is to establish a data-driven, continuous survey and accreditation process to complement the standards-based assessment of the Joint Commission. A standardized set of "core" performance measures will be identified for use in each Joint Commission accreditation program. The use of these core measures will allow for benchmarking based on processes and actual outcomes of patient care. The Joint Commission says these measures:
• have precisely defined specifications;
• can be uniformly embedded in multiple performance measurement systems;
• have standardized data collection protocols based on a uniform medical language so they can be uniformly implemented across accredited organizations;
• meet established evaluation criteria;
• can be implemented in stages within and across accreditation programs;
• permit comparisons of organization performance over time;
• foster the use of national performance benchmarks.
Watching a weakness evolve into a strength
Is there a meaningful message in there? Banahasky thinks so. "It’s so easy to be complacent and bemoan these requirements without looking at the benefits," she says.
Those benefits include: identifying problem areas and working to make them better; identifying areas of strength and feeling good about it; and developing serious plans to improve on weaknesses and measuring them regularly. "Watching a weakness evolve into a strength can be very uplifting for everyone from unit nurses to medical staff to administration," Banahasky contends. "If you can’t measure it, you can’t improve it."
All that sounds good on paper, but how does a quality manager get everyone from the top down to buy into additional standards, paperwork, and expense?
"First of all, I think education," Banahasky says. "Secondly, administrators and directors who are involved want a how-to.’ And that requires constant communication. They’re good leaders, but it’s difficult for them to understand how ORYX directives work for the organization." She stresses the need to permeate the organization with information about the program and where it’s going with the individual hospital. "This includes the Board of Trustees, the full medical staff, the medical staff quality improvement people, hospital quality control, all medical staff committees, and all departments."
In Banahasky’s case, she started with the CEO, the board of trustees, the medical executive committee, and the various medical staff committees, and began reporting regularly to each. Then she went to the hospital coordinating council and explained the ORYX measures and her quality improvement plans. "From then on, I continually updated all of them on ORYX," she says.
She organized a plan for educating the administrators, department directors, and medical staff at her medical center. "I arranged to have every director in the hospital report on the quality levels in their own departments. At first, they turned in their reports to me, and I presented them to the top administrators. But that wasn’t working. I wasn’t able to answer the questions posed by some of their reports. I had no real backup. So we had these people make their reports personally at administrative meetings. When the department directors had to give their own reports, then we started to make some headway. They began to make recommendations and work on their selected indicators."
Concentrate on processes, not people
Within the organization, Banahasky has a group of people who understand the quality process. They meet separately and have substantive discussions regarding department reports. "We concentrate on processes, not people," she emphasizes. "It’s the processes that need examination in order to measure quality outcomes."
"The medical staff has its own set of indicators and meets each month," she says. Bringing the medical staff on board was particularly difficult for her. For them, the ORYX indicators were like the straw that broke the camel’s back. "But when they began to study their own indicators, I was able to educate them on what quality was all about and what the Joint Commission required. I sit on every medical staff committee in the hospital, and I constantly discuss ORYX with them. I drilled and talked a lot with the medical executive committee and compelled them to take a close look at ORYX, what it means, where it came from, where it was going. I showed them data on our internal indicators. When they began to see how we rate on ORYX indicators, they were impressed."
The entire process of communication slowly created a can-do attitude that still requires constant communication.
Banahasky explains that the business of measuring and improving quality takes patience. "You have to track and trend over time," she explains. "That’s not rocket science. It just takes time. I prioritized the ORYX indicators and asked what we wanted to do with this. I went to the board of trustees, the medical staff, the department directors. I asked to be put on the agenda quarterly."
According to Banahasky, the secret to reaching all the hospital personnel who need to be educated on ORYX is persistence. "I drilled everyone. I talked daily to various administrators. I went down and talked with the CEO repeatedly and explained what we needed to do and what this was going to cost. It was important to impress upon everyone that we can’t just say we’ve made this improvement and therefore it’s finished. We improve by increments, and we need to demonstrate what we’ve done. In fact, we compared quite well with other hospitals. That made everyone sit up and notice. When we looked at data that showed how well we compared with other facilities and how well we were practicing medicine, it validated our work."
Banahasky also needed to show where improvements were needed and how they could be accomplished. "I explained, for instance, that with myocardial infarction admissions, we could improve the door-to-drug time from 60 minutes to 30. When they looked at the plan, they saw that we indeed could do it."
Technology investment saves time
She also persuaded the hospital to invest in technology that would help simplify the measurement process. "We pay a system that handles all our computer matters, and now we have a program that assists with ORYX and runs databases in areas where we need them. We can’t do it all by computer. We still gather a lot of data by hand. But automation has been a big plus. It makes it all less time-consuming.
"Some hospitals are reluctant to have their data evaluated in case the Joint Commission takes issue with them," Banahasky notes. "And in this day of balanced budgets and cost containment, CEOs are worried about the bottom line. But the CEOs I know also are concerned with good care and health. And this is what you need to address when working for their support of ORYX."
Banahasky cautions that hospitals should look carefully at the indicators they select and not just monitor the areas where they know they do well. "If it isn’t a problem," she says, "then tackle something where you can make a difference."
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