The quality and economic impact of disruptive behaviors on clinical outcomes of patient care.

Disruptive behaviors have been shown to have a negative impact on work relationships, team collaboration, communication efficiency, and process flow, all of which can adversely affect patient safety and quality of care. Despite the growing recognition of the damage that can be done, there are still pockets of resistance to taking action to address the issue head-on. Given the new call to action from the Joint Commission accreditation standard and the growing public accountability for patient safety, organizations need to recognize the full impact of disruptive behaviors and implement appropriate policies, procedures, and educational programs to raise levels of awareness regarding the seriousness of the issue, hold individuals accountable for their behavior, and provide training and support not only to reduce the incidence and consequences of disruptive events but also to improve efficiency of communication and team collaboration in an effort to improve outcomes of care.

Measuring and managing the economic impact of disruptive behaviors in the hospital.

Disruptive behaviors have been shown to have a significant negative impact on staff relationships, team collaboration, communication flow, and patient outcomes of care. They can be a major factor in contributing to the occurrence of adverse events that compromise quality care and patient safety and can put the patient and organization at increased risk. Whereas organizations generally are not reticent to make system enhancements designed to improve patient safety, they are more reluctant to address human factor issues such as disruptive behaviors for a variety of reasons. This article presents a 10-step process for addressing both the economic and quality impact of disruptive behaviors in an attempt to stimulate a call to action.

Medicare's value-based payment initiatives: impact on and implications for improving physician documentation and coding.

Medicare has introduced a number of new payment initiatives that will have a profound effect on hospital reimbursement and quality and safety ratings. The new medical severity diagnosis-related group (MS-DRG) payment system adds a number of new DRG categories to more adequately account for patient severity. The new present-on-admission (POA) initiative is designed to withhold additional reimbursement for selected complications that were not recorded as being POA but that occurred during the course of the hospitalization. The recovery audit contract requires hospitals to repay Medicare for services deemed not clinically necessary based on retrospective chart review. Reimbursement and quality rankings for each of these initiatives are based on the extent and thoroughness of physician chart documentation. Physicians must understand the importance of their role and responsibilities in this process and embrace what needs to be done through appropriate education, coaching, and guidance, which leads to more effective chart documentation.

CFOs and quality managers: bridging the disconnect.

A survey of hospitals to assess the impact of selected organizational factors on achieving optimal patient outcomes found several barriers. To improve clinical and financial outcomes healthcare organizations should: Perform a self-assessment and discuss different perspectives and perceptions among stakeholders. Redesign structures and processes that support multidisciplinary input and involvement. Realign roles and responsibilities. Address problem personalities. Ensure open lines of communication among stakeholders.

New technology planning and approval: critical factors for success.

The steady evolution of technology, with the associated increased costs, is a major factor affecting health care delivery. In the face of limited capital resources, it is important for hospitals to integrate technology management with the strategic plan, mission, and resource availability of the organization. Experiences in technology management have shown that having a well-organized, consistent approach to technology planning, assessment, committee membership, approval, evaluation, implementation, and monitoring are key factors necessary to ensure a successful program. We examined the results of a survey that assessed the structure, processes, and cultural support behind hospital committees for new technology planning and approval.

Assessing new technology: how are other hospitals facing the challenge?

A VHA West Coast survey of 19 hospitals shows several key components aid successful new technology assessment programs, including: A multidisciplinary committee structure that includes substantial clinical representation Set criteria and protocols for technology evaluation Strong integration with the hospital's strategic plan.