Compact Hospitals ? How


How  is the relationship between audit, accreditation and quality efforts? I am trying to enrich that diagram. I positioned the quality pyramid to middle(you are seeing it from top now-it was the subject of previous post)

It is really a challenging question. Because answers are quite diversified.

Every discipline has own followers and own professionals. Usually people like what they do and become enemy to the others. Accreditation is remedy of all sort of diseases for someone, Lean is the last model for some others. Internal auditing is the only essential task for auditing. … and critics: ISO is outdated, Internal audit is costly and useless, lean doesn’t suit hospitals, innovation is something which can only come from Japan or Harvard. 

Again everyone audits in health sector nowadays. CMS audits, accreditation bodies audits(JC, DNV…), other department inspectors inspects, internal auditors audits and so on… In Turkey? Yes, the same. Everyone audits. Duplications, useless documentation… are problems at that point. There are rules, acts, standards, procedures, manuals, policies…

Everyone audits, inspects, controls, evaluates, scores, compares, benchmarks….

Doctors and nurses spends more time and energy for auditing efforts more and more than before.

Then we need to ask:

  1. Are these efforts cost effective? What about “economy of audit” Shouldn’t we try to “do and improve” something besides “auditing and comparing”?
  2. Are these efforts working consistently?
  3. Are these efforts overlaps or duplicates? What do you do to prevent this?
  4. Are these efforts results as burden(additional recording, documenting…) on health professionals and they are complaining about these? (you are working for their convenience. If they don’t appreciate your business but complains, then there might be something wrong with you, your system or them.
  5. Are these efforts helps each other? Is there a task sharing?
  6. Are these efforts using different methods, systems and algorithms for recording

Then we need to be sure about:

  1. Which ones are supposed to assure, which ones are supposed to improve?
  2. Which ones are serving to improvement (if they are supposed to serve) and if they are supposed to assure, do they really accomplish that?
  3. What is your goal for continuing these systems? Are they really efficient? What about improving “auditing, assurance, improvement and accreditation” efforts? They can be audited too isn’t it? They are not from holy books, they are man made.
  4. Which ones are mandatory and which ones are voluntary? Is mandatory one give benefits to you? It must.
  5. Which ones makes doctor, nurses and other professions tired and exhausted? Did you think about their costs and benefits? You need to think. They must be tired by their own issues (and you must work for them to be tired less)
  6. Imagine lacking of any of them. What would you lose? Nothing? Then it’s outdated or you are not doing it in appropriate manner. You can improve your organization without auditing, if audit is not beneficial.

Then let’s go to diagram.

  • Frame: You need a assurance framework. Internal audit is an essential task to assure that your processes works well. If you have an internal control system and internal auditing framework. That would solve so many problems. ISO is and old discipline but it is not old fashioned and outdated. It’s still alive and a good frame for your activities. DNV accreditation with its ISO for pre-requisite framework competes with Joint Commission in USA.
  • Folder: Internal control and documentation with health IT is essential if you need a robust processed hospital. It’s quite challenging to do this in million-tasked hospitals but not impossible. If you didn’t document effectively you are in danger financially and for safety issues. If you didn’t document by Health IT your process improvement efforts may be very hard.
  • Pyramid: And quality pyramid; Accreditation Improvement Innovation (as written in yesterday’s post)

What must be our goal?

Your system must:

  1. Walk to same mission, vision and values.
  2. Be aligned professionally to not to overlap, not to duplicate.
  3. Speak with each other with same jargon
  4. Use different parts of same records for their own needs. Different recording system for different roles makes doctors tired. (We don’t want this)
  5. Use these for evaluation and benchmarking
  6. Use these for pay for performance system

I named this as “Compact Hospital” Is there a hospital accomplished these? I didn’t see or read.

  • If you know, comment.
  • If you say some other qualifications we need, comment.
  • If you think differently, comment
  • If you say I can do it in my hospital then we must applaud.

Thanks to Mr.Scott Chapman of Providence Hospital, SC Columbia for the ideas. 


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