Quality management in health care
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Qual Manag Health Care · Apr 2011
Handoff communication: using failure modes and effects analysis to improve the transition in care process.
Handoff communication is a high-risk process that causes errors that lead to ineffective care delivery and patient safety breaches. A failure modes and effects analysis was utilized to proactively evaluate handoff through a risk priority scoring process that focused the improvement plan on communication from shift to shift and between units. The electronic medical record was utilized to standardize the handoff tool in SBAR (situation, background, assessment, and recommendation) format for both nurses and patient care technicians. ⋯ Changes to the handoff process were piloted on the telemetry unit then launched on remaining nursing units over time. Data targeting patient satisfaction and nurse-sensitive outcomes were collected pre and post-implementation with notable gains. Sustaining change in light of care-related variables is a challenge leadership, quality, and patient care teams are committed to achieving.
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Concerns about both the cost and quality of health care have led to a growing interest in, and call for "pay for performance." Increasingly, as well, patient satisfaction is being viewed as an essential aspect of care that should be considered in judging performance. At the same time, there are concerns about the validity of patient satisfaction as a relevant quality measure. ⋯ As such, the 2 measures are evaluating different aspects of care that need not--but typically do--coincide. We also suggest that where patient satisfaction is utilized in pay for performance calculations, it constitutes a very small portion of the total money at stake and is unlikely to lead to "gaming" through acquiescence to patients' requests for unnecessary treatments.