Method

The commitment to safe patient care by everyone working at a hospital or facility is a necessary first step to improve care. As healthcare workers, we are already committed to this goal, but often there are production pressures, lacking support, and situations that interfere with this. Consistent safe care cannot exist unless this changes. The primary goal at every point in every process at the facility must be safe patient care. These two steps need to take place before anything else can be done. They allow us to establish the standards of care as benchmarks to define every action that should have taken place and every item that should be available and ready and at all points of patient care. Here, call the items and prerequisite actions at each point “preparedness”. Preparedness at points of care in a hospital or facility are evaluated, compared to benchmarks, and graded in this method. One Standard is a tool that can be used in any situation because of the benchmarks it establishes.

Preparedness is a universal requirement for all processes, even those outside of healthcare. Within healthcare, providers need to be prepared to care for patients. To ensure safe care, providers must have what they need when they need it. For critical patient care, like that in the operating theatre and in the post anesthesia care unit (PACU), providers must also have what they may need, ready and available. Evaluation of preparedness is the starting point of One Standard assessments. It is defined by established standards of care, is easy to measure, and iseasy to improve.

Next, we identify points in care where patients are most often harmed. We limit this to three target events in each sector of healthcare. Getting these events to quality and safety standards is now where the attention and resources to improve patient care are focused. Perioperative care is a sector of healthcare. It includes everything from when a patient is scheduled and prepared for surgery until they recover from anesthesia. Airway management is an event that takes place in this sector where patients are often harmed. Then we identify processes that produce these events. They include the induction of anesthesia and nursing care in the recovery room. Since processes are interconnected, assessments that measure preparedness are done in these and related areas.

Here, the assessment tools do more than simply identify problems, they establish minimum requirements, define metrics, outline processes, give specific details about provider’s duties, and more. They help to identify the root cause(s) of the harm that patients experience during the defined events. These, like the advancement tools, can be customized to suit each facility’s needs and modified as conditions and standards change. Reports are automatically generated from the assessments, which show a site’s preparedness, have a percentage score, and a list of items that are needed to get to standards.

Each item on the report represents a problem in a process that needs fixed. When the reason an item is on the list is because providers were unaware that an item or action was needed at the site, this is able to be soon fixed. The omission is identified and advancement tools provide checklists that can be used to keep sites to standards. The One Standard medical education tools have training videos that show preparedness and how the standardized organization of items and checklists make this duty easy.

Some deficiencies can be grouped together and fixed. Items relating to ordering/purchasing processes is one such group. Items might not be at the facility because they were not requested, ordered late, or not ordered at all. There are several tools that help with this. They include a computer program that calculates the amount of each item that will be needed at the facility for a year, which helps to plan for need and prevent ordering omissions. More frequently, items are not at a facility because they are not available. In other tools, communication skills are introduced as an essential duty of everyone at a facility. Communication between departments will not stop shortages, but it can initiate strategies to conserve scarce items. Other deficiencies can be grouped as items relating to the processes involving inventory storage, security, retrieval, and more. Again, simply grouping items with similar root issues together makes correction easier.

Some deficiencies can be grouped as being items that relate to the required actions that were not done, not done completely, not done correctly, or not done on time. The assessment identifies job duties and the details of those duties that are needed to support safe care. The facility can formally assign the duties to provider groups, which also assigns the responsibility of completing those duties and oversite to management.

The One Standard corrective and advancement tools enable healthcare processes to achieve standards and to maintain them. These goals can be reached efficiently and sustainably if there is standardization, preparedness, and quality care. These are the rules that define how tasks should be done. These rules decrease guesswork, human error, and improvised care. They support quality control, productivity, and improve staff morale. As a result, staff know what is expected of them, quickly master and perfect processes, and are not blindsided by other staff who ascribe to a different method of doing things. One Standard has tools that not only standardize processes but make ongoing compliance easy.

In summation, once processes for one event are corrected, that event is replaced by another which becomes the focus of the facility’s attention and resources. The steps are repeated and capacity developes in stages. This greatest impact is early. These successes fuel future improvements. Once care is close to or at standards, a facility can advance care. Failing to achieve foundational safe patient care before advancing care will result in inconsistent and inefficient care.