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Hospital Staff

MonitoringDr Milan Choksey

2009 HO 003Dr Nitiraj Gandhi

2009 HO 021Dr Sandeep

Moolchandani 2009 HO

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What is Medical StaffMonitoringThe JCAHO standards clearly call

for regular review of quality andappropriateness of care by the

hospital's medical staff.Medical staff monitoring includes

routine collection of information

about aspects of patient careprovided and about clinicalperformance of members

It encompasses routine

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Why monitor staff ?

Check the quality of customerservice

Review staff skills and

competencies used in their jobAssess training requirements for

staff

Ensure staff safety

Observe the application of health

and safety rules

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Deciding whether ornot to monitor

It has to be both appropriate andproportionate

Undertake an impact assessment that:

- Clearly identifies the purpose(s)behind monitoring and the benefits ofmonitoring

- Assesses the benefits of monitoringagainst any adverse impact on staff

- Considers how to be fair to workers

- Considers how to ensure that anyintrusion is ke t minimum and

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Medical StaffMonitoring CommitteeIt should comprise of the

following members

- CEO / Hospital Administrator

- Medical Superintendent

- Head of Nursing Staff

- Head of Human Resources Dept- Staff Representative

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Types of monitoring

General Monitoring

Punctuality, Work hours,Absenteeism, Adherence to

behavioural norms

Stratified MonitoringMonitoring the aspects

specific to their jobs eg Prescription

errors in doctors

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General Monitoring

Recruitment and CredentialingCheck in and Check out times

Monitoring Use of ElectronicCommunication

Monitoring Use of Business

VehiclesMonitoring of Professional

Behaviour

Monitorin of Workload

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Recruitment andCredentialing

The first step in monitoring is to

ensure that the right person isbrought in the organization

The HR department is responsible for

this activityThe JCAHO recommends that

hospitals collect such information

from an applicant as the following :

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Monitoring The Use OfElectronic Communication

A policy on electronic communicationsshould cover use of email, internetaccess, telephone, mobile phone andfax.

The policy should:

- set out the standards expected forbusiness use

- cover confidentiality ofcommunications and the purpose andmethods of monitoring the use ofequipment

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Monitoring The Use OfHospital Vehicles

Technology increasingly allows forvehicles to be monitored. Forexample, satellite trackingsystems can record vehicle location,distances covered and relatedinformation about users' driving habits

The policy should state what private

use can be made of vehicles and theconditions for the same

RFIDs are being increasingly used todetect stretchers, wheelchairs, trolleysand ambulances especially in

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Stratified Monitoring

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Stratified Monitoring

This involves division of staffby their nature of work andassessing their performance

with the help of indicatorscustomized for that particular

job

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Methods of Monitoring

Peer Review360 review

Recording of ErrorsPeriodic and Surprise InternalAudits

Mock Drills and Evaluation

P R

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Peer Rev ew as aMethod of Medical

Staff MonitoringIt started with American College

of Surgeons to improve the

standard of care in hospitals byimposing minimum requirementson recordkeeping, the

performance of autopsies, andvarious aspects of medical stafforganization

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Rationale for MedicalStaff Peer Review1. Asymmetry of information

between buyers and sellers ofmedical care leads to errors

going undetected2. A second justification for peer

review is based on the concept

of moral hazard due to thepresence of nearly completeinsurance as there is noincentive for medical staff to not

rovide this care

Ri k f P R i b

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Risks of Peer Review bythe Hospital Medical

StaffMedical staff peer reviewers have

an ongoing relationship. As such,

there is no incentive for anindividual medical staff peerreviewer to challenge the

conduct of a colleague because,one day, the peer-review shoemay be on the other foot

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Audits and ErrorsMonitoring

Certain indicators may bedeveloped customized to theparticular job to conductaudits

Error Reporting and disclosureis also a very important partof Quality Management and

Patient Safety Monitoring

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Examples of

Indicators

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Physicians/ Surgeons

Number of OPD consultations /month

Number of Surgeries performed /

monthPatient Attrition ( chronic

diseases) rate

Patients preferring other doctors

Number of wrong prescriptions

Number of Readmissions and

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Monitoring Quality ofPhysician Care

Judgement as to the quality ofindividual physicians may bemade on the basis of current

licensure, relevant training,experience, current competence,and health status.

The JCAH recommends thathospitals collect all suchinformation from a physicianapplicant

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Nurses

Medication errors per month

Response time in emergenciesNumber of sentinel events

Number of near misses

Number of patient falls

Pre and post training evaluation

Errors in disposal of biomedical

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Technicians

Number of procedures per dayErrors per 50 procedures

Work hoursProcedural time

Breaks between procedures

Use of PPE

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Housekeeping Staff

Number of times floors aremopped per day

Work schedule and timeadherence

Time required to assemble a bedBiomedical waste disposal errors

Usage of PPE

The correct ways to

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The correct ways tomonitor your staff

Make sure that any monitoring is justified

Ensure that monitoring is proportionate

Inform staff that they are being monitoredand what data you are collecting

Inform staff why you are monitoring them

Strictly target and limit covert monitoring to

cases where you suspect criminal or otherserious malpractice and where telling theindividuals about the monitoring would belikely to prejudice its prevention or detection

Manage data protection by complying with

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Donts in Monitoring

Use information for any purposeother than that for which it was

collectRoutinely check workers' phone

messages, emails, etc. You

should only check suchcommunications if you havemade all reasonable efforts to

inform potential users that you

e onsequences e

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e onsequences eImproper Monitoring OfWorkers

Claims for constructivedismissal if - through impropermonitoring - you have

substantially breached theimplied term of trust andconfidence

You may have topay damages to any individualwho suffers damage or distressbecause of a breach of data

rotection law, or to the sender

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Monitoring for StaffSafety and SecurityMonitoring and support to lone

workers

Helpline for Emergencies

Fire Safety Audits and Drills

Assessing the potentialrisks facing employees whoneed to travel abroad / insusceptible areas

Security Audits

U i B ld i C it i t

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Using Baldrige Criteria toAchieve Excellence at the

R W J Hospital HamiltonRWJ Hamilton adopted the

Baldrige criteria, focusing its

organizational improvementefforts in the seven categories: 1)leadership;

2) strategic planning; 3) focus onpatients; 4) measurement andanalysis

5) staff focus; 6) process

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Tools for Change

PDCAIdentifying long run and short

term changes necessary

Benchmarking

Continuous Feedback

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Reports Received byTrusteesService Standards and Employee

Commitment Five Pillars ofExcellence

Patient Safety Five PillarCommunications Plan

Improving Clinical Outcomes -

participation of interdisciplinary,disease-specific task forces

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PILLARS OFEXCELLENCE

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PILLARS OFCOMMUNICATION

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References

http://www.businesslink.gov.uk/

www.who.int/patientsafety/en/

www.e-healthwire.com/Detailed/49.html

http://www.commonwealthfund.org/Content/Innovations/

http://www.businesslink.gov.uk/http://www.who.int/patientsafety/en/http://www.e-healthwire.com/Detailed/49.htmlhttp://www.commonwealthfund.org/Content/Innovations/Case-Studies/2005/Mar/Case-Study--Using-Baldrige-Criteria-to-Achieve-Performance-Excellence-at-the-Robert-Wood-Johnson-Uni.aspxhttp://www.commonwealthfund.org/Content/Innovations/Case-Studies/2005/Mar/Case-Study--Using-Baldrige-Criteria-to-Achieve-Performance-Excellence-at-the-Robert-Wood-Johnson-Uni.aspxhttp://www.e-healthwire.com/Detailed/49.htmlhttp://www.who.int/patientsafety/en/http://www.businesslink.gov.uk/