Reference
1. Zimmerman E. “Start-ups for the end of life,” New York Times, Nov. 22, 2016.
Quality Improvement: How to create a high-value culture
Hospitalists today are overseeing the health system’s movement toward an emphasis on value over volume.
“As leaders begin to strategize the best ways to spur transformation, our team realized that checklists and algorithms alone would likely not be enough to create sustained change in divisions and practices across the country,” said Reshma Gupta, MD, MSHPM, of the Robert Wood Johnson Clinical Scholars Program in the department of medicine at the University of California, Los Angeles. She’s the lead author of the recent study, “Development of a High-Value Care Culture Survey: A Modified Delphi Process and Psychometric Evaluation.”“Patient safety culture surveys have previously been used to drive care improvements, but no comparable survey of high-value care culture currently exists,” the authors wrote. “We aimed to develop a High-Value Care Culture Survey (HVCCS) for use by health care leaders and training programs to target future improvements in value-based care.”
Researchers conducted a two-phase, national modified Delphi process among 28 physicians and nurse experts with diverse backgrounds. They then administered a cross-sectional survey at two large academic medical centers among 162 internal medicine residents and 91 hospitalists for psychometric evaluation.
Four factors emerged with strong reliability:
• Leadership and health system messaging.
• Data transparency and access.
• Comfort with cost conversations.
• Blame-free environment.
The HVCCS can assist hospitalists and administrators in identifying tangible areas to target, Dr. Gupta said. The instrument was found to have good reliability and appears to correlate with an important patient outcome metric: the Centers for Medicare & Medicaid Services value-based purchasing score that has determined hospital reimbursement in recent years.
Now that this instrument has been created, the next step is for hospitals to begin using it. Dr. Gupta recognizes hospital medicine already has been a national leader in efforts to promote value-based care.
“With hospitalists leading many operational or research efforts in this area,” she says, “it will be vital to measure and address culture change. We believe this tool can aid them in their efforts to shape the story of value promotion at their institutions.”
Reference
Gupta R, Moriates C, Harrison JD, et al. Development of a high-value care culture survey: a modified Delphi process and psychometric evaluation [published online ahead of print Oct. 26, 2016]. BMJ Qual Saf. doi: 10.1136/bmjqs-2016-005612.
Quick Byte: Cleaning robotic surgical instruments
Robotic surgical instruments can retain some contamination even after cleaning, a new study suggests. Over 21 months, the researchers assessed protein residue on robotic and standard surgical instruments that were cleaned according to manufacturers’ instructions. The cleanings were 99.1% effective on the standard instruments but 97.6% effective on the robotic instruments, suggesting complete eradication of surface contaminants from robotic surgical instruments may not be possible with the current cleaning procedures.
Reference
1. Preidt R. “Robotic surgical tools tough to keep clean,” HealthDay News, Nov. 1, 2016.
Suzanne Bopp is a freelance writer in New Jersey.