I came across this item earlier today. What do you think about ranking hospitals by quality scores ? (note this is different from ISO registration - the hospitals are actually graded on what they do or don't do.)Quality gap grows between hospitals
By Editorial Board (ComplianceOnline.com)
Publication Date: 10/18/06
The gap between the non-federal hospitals with the best and worst quality of performance is growing larger, according to a survey by HealthGrades, an independent healthcare ratings organization.

The organization, which can be found online at www.healthgrades.com (http://www.healthgrades.com), surveyed 5,000 US hospitals and gave them a rating between one and five stars. The survey, which reviewed 41 million Medicare hospitalization records from 2003 to 2005, show that a patient has a 69 percent lower chance of dying in a five-star hospital than in a one-star hospital.

The survey also showed that a patient who has a typical coronary artery bypass surgery has a 73 percent lower chance of dying if his or her surgery was performed at a five-star hospital. According to HealthGrades, if all coronary artery bypass surgeries were done at five-star hospitals between 2003 and 2005, 5,308 lives could have been saved. Likewise, the study showed that if all hospitals performed at a five-star level, 300,000 lives could have been saved.

The overall mortality rate of hospitals went down by almost 8 percent, but the gap between high- and low-quality hospitals grew by approximately 5 percent. The degree of improvement also varied greatly between hospitals. Half of the deaths that HealthGrades said were preventable were associated with heart failure, community-acquired pneumonia, uncontrolled infections and respiratory failure.

With people living longer, this growing gap is alarming. Those who may not be able to afford the five-star hospitals should not be in greater danger than those who can just because of financial constraints.

If you wish to see the ratings of a specific hospital in a certain area of the country, visit www.healthgrades.com (http://www.healthgrades.com). The Web site also has rating reports on several physicians in their specific areas of expertise.

Wes, thanks for the link. I really think all of us should know/research our hospital systems before something happens. I never really thought much about it until I became an EMT. I'm sorry to say that our area hospital ranked poor on everything. But, that came as no surprise. I have told everyone who spends any amount of time with me that if something happens to me they should make sure that I am sent to another (I will not name names) hospital system in Va. (really not that different in mileage)

I'm a child of the Canadian healthcare system. We've been told that other countries strive to emmulate what we have. I suppose it's not bad...I've had long waits in emergency wards and short waits...bad nurses and doctors, excellent ones...but service varies from place to place, be it a hospital or a manufacturing environment or the local ice cream shoppe.

I will share with you some experience I've had with a local hospital in regards to "customer" service. Some of you are aware that my father's health is not the best. He has good days, he has bad days...and he has really terrible days.

One of these terrible days led to the following:

Drive to the emergency ward and park outside the doors.
Ask nurses for help and am informed "Not our job."
Ask for a gurney because my father could not walk due to the pain.
"He'll have to take a chair like everyone else."
No chairs available.
Get him to walk in...barely...and without assistance.
Sign him in...wait for hours despite the room being nearly deserted.
Get an examination room...wait for hours.
Doctor comes in and prescribes some pain killers.
Doctor disappears. Nurses forget to administer pain kilers.
Find doctor who reminds nurses.
Doctor disappears. Nurses forget to adminsiter pain killers.
Doctor reappears...confused. My father was supposed to have been admitted into the actual hospital. Administers pain killers himself.
Administered.
Nurse taking notes has computer die in the middle and starts to swear.
Can't find notes from doctor.
Can't find doctor.
Finally get everything settled.
Nurses won't bathe patients and will not permit my father to take a shower.
Mom has to come in and force them to allow her to accompany him and help him clean up.
Nurses tip over vases of flowers - breaking vases, etc. - no apologies.
Wrong food - missed meals.
Knocking meals on to floor and then trying to return to him saying "The floor's clean."
Nurses unsure how to read morphine pump and start to play with it.
Nurses screw up dosage.
Doctor doesn't check up on the conflictions between his medications.
Kidneys start to deteriorate.
Goes through withdrawl as medication is removed.
Father is now deemed 'clinically depressed' - just add it on to the physical problems.


Yeah, let's just say I have a very tarnished view of the health care system right now.

Well, I can definitely feel your pain about the waiting, and having staff not follow through. But the thing that scares me the most is the fact that our hospital system (which is run through a large network in conjunction with the university health system) has the highest rate of MRSA infections in the state. Not to mention botched surgeries (knicking arteries and such) and just plain misdiagnosis (patient brought in from car accident and left in the waiting room, staff finds patient dead from internal injuries half an hour later). No thanks, people go there to die, not to recover. I'll take my chances elsewhere. This is the same hospital that nearly killed me by pumping morphine for pain when they knew I had an active bleed in my brain. Morphine is known to cause a sudden and often fatal drop of blood pressure when administered in too large or too many doses. I asked to be transferred, luckily I got to the "good" hospital system before I crashed (medical slang term for bottoming out of blood pressure or death)

I think ranking hospitals by quality scores is nice for people who have a choice in hospitals.
But it seems to me that in this very large country only people in metro areas and suburbs really have a choice - especially for emergency care.
I've always lived in an area where you could choose from at least two.
But in college there was really only one hospital in emergency distance.

You may initially only have a choice of one for emergency care, but you can and should ask to be transferred to the hospital of your choice once stabilized. This is why it is so important to make your wishes known ahead of time to someone you explicitely trust to follow through and not be cowed by medical practitioners.

This story (http://query.nytimes.com/gst/fullpage.html?res=9A06E6D91739F93AA25756C0A96E958260) (from 1998) of amazing stupidity comes to mind. This happened in the hospital in Chicago where both of my children were born:

A 15-year-old boy who was shot on Saturday just steps from Ravenswood Hospital died after emergency room workers refused to treat him, saying it was against policy to go outside.
Hospital officials rescinded the policy late today.
Ravenswood is not a trauma center and staff members do not leave their duties to treat anyone outside, said a hospital spokeswoman, Milli Striegl. She said they did call 911.
Many standard hospital emergency rooms do not have a trauma center -- a costly and specially equipped unit that treats the most seriously injured.
Friends of the boy, Christopher Sercye, tried to walk him through an alley to Ravenswood's emergency room. One ran inside, and a neighborhood resident said hospital workers would not go outside.
Two police officers in the hospital rushed out and repeatedly called for an ambulance, said a police spokesman, Kevin Morison. After waiting nearly 20 minutes, the officers got a wheelchair and took the teen-ager into the hospital themselves, Officer Morison said.

My question is, why did the officers and friends of the boy wait for an ambulance twenty minutes, when they could have grabbed the wheelchair right away?

My question is, why did the officers and friends of the boy wait for an ambulance twenty minutes, when they could have grabbed the wheelchair right away?

Twenty minutes elapsed from the time the kid was dropped outside the ER until the police put him in a chair and took him inside; I'm not sure that the police were there for that whole period of time. What the linked story also doesn't tell is that the ER personnel refused to give anyone a gurney, and the police wound up grabbing the nearest available wheelchair on their own.

I have a hunch many of our Cove quality practitioners will empathize with the frustration the members of the Institute for Healthcare Improvement (http://www.ihi.org/ihi) experience when we meet with blank stares from healthcare practitioners as we try to discuss mistakeproofing, control plans, root cause investigation, management involvement, employee training, and evaluation of the effectiveness of the training.

Here in Illinois, State officials are trying to deliver a dope slap to one powerful "nonprofit" hospital by taking away its real estate tax exemption because it fails to deliver "charity" service to the poor patients in direct contradiction of its claim for such exemption - i.e. that it "provides free service to the poor and needy in the community."

I have a hunch many of our Cove quality practitioners will empathize with the frustration the members of the Institute for Healthcare Improvement (http://www.ihi.org/ihi) experience when we meet with blank stares from healthcare practitioners as we try to discuss mistakeproofing, control plans, root cause investigation, management involvement, employee training, and evaluation of the effectiveness of the training.

Here in Illinois, State officials are trying to deliver a dope slap to one powerful "nonprofit" hospital by taking away its real estate tax exemption because it fails to deliver "charity" service to the poor patients in direct contradiction of its claim for such exemption - i.e. that it "provides free service to the poor and needy in the community."

I'm far from being knowledgeable in this area, but it sure seems to me that some sort of different approach is needed, and trying to transfer manufacturing quality principles will just keep causing the aforementioned blank stares. I think that when you walk through the front door of a hospital (or a physician's office), you're just not in Kansas anymore.

I'm far from being knowledgeable in this area, but it sure seems to me that some sort of different approach is needed, and trying to transfer manufacturing quality principles will just keep causing the aforementioned blank stares. I think that when you walk through the front door of a hospital (or a physician's office), you're just not in Kansas anymore.Roxane writes One of these terrible days led to the following:

Drive to the emergency ward and park outside the doors.
Ask nurses for help and am informed "Not our job."
Ask for a gurney because my father could not walk due to the pain.
"He'll have to take a chair like everyone else."
No chairs available.
Get him to walk in...barely...and without assistance.
Sign him in...wait for hours despite the room being nearly deserted.
Get an examination room...wait for hours.
Doctor comes in and prescribes some pain killers.
Doctor disappears. Nurses forget to administer pain kilers.
Find doctor who reminds nurses.
Doctor disappears. Nurses forget to adminsiter pain killers.
Doctor reappears...confused. My father was supposed to have been admitted into the actual hospital. Administers pain killers himself.
Administered.
Nurse taking notes has computer die in the middle and starts to swear.
Can't find notes from doctor.
Can't find doctor.
Finally get everything settled.
Nurses won't bathe patients and will not permit my father to take a shower.
Mom has to come in and force them to allow her to accompany him and help him clean up.
Nurses tip over vases of flowers - breaking vases, etc. - no apologies.
Wrong food - missed meals.
Knocking meals on to floor and then trying to return to him saying "The floor's clean."
Nurses unsure how to read morphine pump and start to play with it.
Nurses screw up dosage.
Doctor doesn't check up on the conflictions between his medications.
Kidneys start to deteriorate.
Goes through withdrawl as medication is removed.
Father is now deemed 'clinically depressed' - just add it on to the physical problems.
Help me understand how the situations Roxane describes are

DIFFERENT (nurses don't follow prescription order)from an industrial situation where a foreman gives instructions to a worker who ignores instruction, resulting in damaged product; foreman gives second (repeat) instruction which is ignored again; finally, foreman does work himself.
DIFFERENT (morphine pump) from a worker put at a machine without having a competency rating to run the machine and allowed to run the machine, endangering life, health, and safety of customers.
DIFFERENT (medication conflict) from an operations manager who authorizes use of obsolete drawings because he didn't have an infrastructure of configuration management, resulting in products which endanger life, health, safety of end users

Roxane writes Help me understand how the situations Roxane describes are

DIFFERENT (nurses don't follow prescription order)from an industrial situation where a foreman gives instructions to a worker who ignores instruction, resulting in damaged product; foreman gives second (repeat) instruction which is ignored again; finally, foreman does work himself.
DIFFERENT (morphine pump) from a worker put at a machine without having a competency rating to run the machine and allowed to run the machine, endangering life, health, and safety of customers.
DIFFERENT (medication conflict) from an operations manager who authorizes use of obsolete drawings because he didn't have an infrastructure of configuration management, resulting in products which endanger life, health, safety of end users

I'm not saying that the situations are different, and I didn't suggest that the solutions in cases of defect prevention would be substantially different. I said that the approach doesn't seem to be working. That's the exasperating part of it. But if you only speak English and your target audience doesn't understand English, it doesn't matter if your English entreaties are rationally sound.

The reason the quality approach doesn't seem to be working is exacty the same reason it doesn't work in some industrial or service organizations - top management Refuses to listen, effectively putting fingers in their ears and yelling, "LA LA LA LA! I can't hear you!"

Here we have some certified ISO 9001 parts of Hospitals. However what you told about using mistake proofing techniques in this kind of services is still not tried.
I think that the health sector should be the one where these ideas must be applied in a most efficient way – we are talking about direct human lives.
Anyway, now I’m working as an ISO 9001 trainer in an Hospital, is there any information in the Cove about applying the standard in this field?
Thanks!:rolleyes:

António

You better shop around. We are in a small town and there are two within about 10 miles of each other. There is a BIG difference.

Here we have some certified ISO 9001 parts of Hospitals. However what you told about using mistake proofing techniques in this kind of services is still not tried.
I think that the health sector should be the one where these ideas must be applied in a most efficient way – we are talking about direct human lives.
Anyway, now I’m working as an ISO 9001 trainer in an Hospital, is there any information in the Cove about applying the standard in this field?
Thanks!:rolleyes:

AntónioI'm not aware of any substantive threads here in the Cove regarding health care and ISO Standards in the last three years.

If you are not aware of Grout's Poke Yoke page (mistake proofing) on his college's website (http://csob.berry.edu/faculty/jgrout/pokayoke.shtml), you might be interested in joining a prgram specifically for health care - see http://www.mistakeproofing.com/medical/ for further info.

Do you have this ISO Standard?IWA 1:2005 http://www.iso.org/images/transparent.gifhttp://www.iso.org/images/transparent.gifhttp://www.iso.org/images/transparent.gif
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Quality management systems -- Guidelines for process improvements in health service organizations

(available in English only)
Edition: 2 (Monolingual)
Number of pages: 84
Technical committee / subcommittee: TMB (http://www.iso.org/iso/en/stdsdevelopment/tc/otherbodies/TechnicalCommitteeDetailPage.TechnicalCommitteeDetail?COMMID=4675&scopelist=); ISO Standards (http://www.iso.org/iso/en/CatalogueListPage.CatalogueList?COMMID=4675&scopelist=)
ICS: 11.020 (http://www.iso.org/iso/en/CatalogueListPage.CatalogueList?ICS1=11&ICS2=20&ICS3=&scopelist=); 03.120.10 (http://www.iso.org/iso/en/CatalogueListPage.CatalogueList?ICS1=3&ICS2=120&ICS3=10&scopelist=)
Status: http://www.iso.org/images/statusPublished.gif Published standard
Current stage: 60.60 (http://www.iso.org/iso/en/widepages/stagetable.html#60)
Stage date: 2005-10-03
Revision information: (Show (http://www.iso.org/iso/en/CatalogueDetailPage.CatalogueDetail?CSNUMBER=41768&ICS1=11&ICS2=20&ICS3=&showrevision=y)) Add to shopping basket
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Abstract:
IWA 1:2005 provides additional guidance for any health service organization involved in the management, delivery, or administration of health service products or services, including training and/or research, in the life continuum process for human beings, regardless of type, size and the product or service provided.

Corrigenda, Amendments and other partshttp://www.iso.org/images/statusPublished.gif ISO 1:2002 (http://www.iso.org/iso/en/CatalogueDetailPage.CatalogueDetail?CSNUMBER=28086)http://www.iso.org/images/statusPublished.gif ISO/TTA 1:1994 (http://www.iso.org/iso/en/CatalogueDetailPage.CatalogueDetail?CSNUMBER=23062)http://www.iso.org/images/transparent.gif
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My goodness I wouldn't send a dead person to the hospital in my town. We were there a couple weeks ago and all we heard about was the contract the nurses had that was about to expire and what thier holiday plans were. Hey, here's an idea do some work. The Doctor ordered a test a 6:00 as of 8:00 it still had not been done. There were plenty of other issues but far to many to list here. If it had been me that was their for treatment I would have walked out.

I've never heard about the standard IWA 1:2005 "Quality management systems - Guidelines for process improvements in health service organizations", I never worked in the health field.
Thanks Wes, very interesting information!
:)

I am working on a project I ahve mentioned previously, but the progress slowed down a bit. I am working with some Healthcare professionals to develop ISO training for the Healthcare industry using healthcare language. As discussed in this thread, a key necessity is to speak to them in language they understand.

Industry has solved many of the same quality and productivity problems that hospitals face. But we have to speak their terms.

I feel that healthcare will embrace ISO 9001 in a big way if they can see examples where it has been done correctly.

I am working on a project I ahve mentioned previously, but the progress slowed down a bit. I am working with some Healthcare professionals to develop ISO training for the Healthcare industry using healthcare language. As discussed in this thread, a key necessity is to speak to them in language they understand.

Industry has solved many of the same quality and productivity problems that hospitals face. But we have to speak their terms.

I feel that healthcare will embrace ISO 9001 in a big way if they can see examples where it has been done correctly.From your lips to a Deity's ear!