How hospitals can stop communication breakdowns before they start
Breakdowns in communication, which account for approximately $12 billion in waste annually in U.S. hospitals, can trigger a series of negative consequences that may ultimately lead to patient harm.
Brent Lang, president and CEO of Vocera, a healthcare communication solutions company, said failed communication contributes to clinicians' inability to respond to urgent issues in a timely manner, increased rates of infections and falls, increased lengths of stay and higher rates of medication errors, among other concerns. Communication failures contribute to between 210,000 and 400,000 deaths annually, according to the Journal of Patient Safety.
Now, several external and internal forces are driving hospitals to prioritize communication and the systems that support it, according to Mr. Lang.
1. Healthcare reform. Population health management, bundled payments and other value-based payment models are forcing hospitals to improve operations. "They must wring out inefficiency," says Mr. Lang. "A big source of inefficiency is communication breakdowns." Poor communication impedes real-time care coordination and patient handoffs, which can lead to readmission to the hospital. Higher readmissions put hospitals at risk under value-based payment models and can result in financial penalties under CMS' Readmission Reduction Program.
2. Consolidation. As health systems merge and become larger, the network of clinicians and administrators who need to communicate with one another becomes more expansive. "Clinicians need to communicate between different care settings because the [merged] health system is responsible for all costs and activities in disparate locations," says Mr. Lang. "Previous in-person conversations between doctors and nurses may not occur now because they are distributed across different environments."
3. Consumerism. Consumers are playing a more active role in determining where they will receive their care. They now have more resources available to them to inform their decision making, such as patient satisfaction scores and patient reviews. Hospitals that provide the best patient experience will ultimately be the most competitive.
Communication has a direct impact on patient satisfaction, according to Mr. Lang. For instance, when looking at patient experience data, it is clear that patients want to leave the hospital as soon as possible. However, poor communication impedes care coordination, which can ultimately extend the length of stay.
4. Technology. Efficient, easy-to-use technology that enables productivity is central to strong communication. Furthermore, clinicians' use of intuitive technology in their personal lives has raised their expectations for technology in their professional lives.
Obstacles to communication
Despite growing awareness of the need to improve communication, certain limitations make doing so a challenging goal.
Virtually all (97 percent) of hospital clinicians interviewed by Spyglass Consulting Group in 2014 said nurses lack appropriate tools to determine the availability and status of other members on the care team, and 90 percent said their hospitals have made no or only limited departmental investments in mobile communication.
As a result, many clinicians opt to use their personal smartphone devices to communicate with one another. But "bring your own device" is problematic; nearly all (96 percent) of physicians with smartphones use unsecure SMS to communicate about patient care. This carries the risk of HIPAA violations, data breaches and system hacking, which can each incur fines of up to $1.5 million per incident, according to Spyglass.
Mr. Lang says "it's only a matter of time" before a data breech occurs as a result of physicians using their personal unsecure devices. BYOD systems raise other concerns, including those of durability, sterility and usability.
Another major obstacle to efficient communication is the inability of clinicians to easily connect with the most appropriate person at the right time, and furthermore, to know who to escalate an issue to if someone cannot be reached. During time-sensitive situations, this type of communication breakdown can have serious consequences.
"Clinicians don't necessarily have access to know who is doing what across the system of care, where they are and what their role is. There is no master directory," says Mr. Lang. "It's hard to identify the right person to reach, let alone get a hold of [him or her]."
Getting to the core of the problem — and applying a solution
The solution to these pain points may lie in a software platform that connects clinicians and administrators across the health system and that contains all relevant information about the individual users, their roles and functions. "Intelligence software allows us to deliver the right information to the right person at the right time," says Mr. Lang.
Vocera's Enterprise-Grade Communications Platform provides the "master directory" that most care teams lack. This information empowers the team to contact the right person as quickly and efficiently as possible. Each user in the system has a profile that includes a range of information, such as what groups they are a member of, their current location and which patients they are treating. All of this information is updated in real time — both automatically and manually — and is then presented back to other users. If a clinician is unavailable, he or she has the ability to turn on a "do not disturb" setting. If a call is made to someone with that setting turned on, it will automatically be rerouted to another appropriate clinician.
"You never want someone to go to voicemail," said Mr. Lang. "The system always escalates an urgent issue to someone live."
The platform is not a standalone communications offering; rather, it extends beyond the hospital to include physician clinics, ambulatory surgery centers and post-acute care facilities. It gets fully integrated into each component of the end-to-end clinical workflow engine, such as the nurse call system, the EHR, patient monitors, real-time location systems, radio frequency identification devices and bed management systems.
The platform can automatically deliver notifications for urgent items, such as stat orders, critical test results, high-risk admissions, patient discharges and housekeeping, dietary and transport requests. As a result of employing such a platform, hospitals will see improved patient care and safety, reduced rates of sentinel events, improved team coordination and efficiency, and physician and staff satisfaction.
Comprehensive communication not only alleviates difficulties experienced by clinicians, it also helps patients feel more connected to their care team, something that is known to positively impact the patient experience. Patients can easily engage in communication with their nurses through the push of a button.
Now that most health systems have already rolled out EHRs and have met meaningful use stages 1 and 2, many health systems are looking for what's next, according to Mr. Lang.
"The opportunity for communication to rise to the top of hospital leaders' strategic priorities is important," he says. "There is a great deal of dissatisfaction with the impact EHRs have had on workflow." He says communication solutions can have an equally powerful impact — but in a positive direction.
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