(upbeat music)
- Hello, I'm Kelly Proctor,
the president of D&D Healthcare USA Incorporated.
Thank you for joining us for this episode
of our podcast, Rx for Hospital Quality.
It's my privilege to introduce podcast host, Simile Miller.
- Good morning, healthcare world.
Welcome to this edition of Rx for Hospital Quality.
I am your host, Simile Miller.
Today I'm solo, Jeremy is out on assignment.
So I thought today maybe we would talk about,
we've had a couple of requests for this podcast
and it is regarding process auditing
compared to tracer auditing.
Many of you over the years
are familiar with tracer auditing.
Our competitor still does what we call tracer auditing.
This is where you basically a clinician
will take a patient from admissions
and trace that patient all the way through to discharge.
And we approach this a little different.
So I thought this would be a good opportunity
to kind of discuss with you those differences
to get you familiar with our approach
if you're new to us or if you have employees
who are new to us and you want them to understand
how we do process auditing,
all of the disciplines do process auditing.
I thought this would be good episode
that you could have them listen to.
We are glad that you are listening to the podcast
and I hope everyone is having a good June.
The weather is a little rocky in parts of the country.
So I hope everyone is doing well.
So let's jump into our approach first
and then we'll do some of the comparisons.
For us, it's important to look at an entire process
and the people who can speak to us about the process
are the frontline workers,
the people who are actually doing those activities,
that process, that patient care process
or process in their department.
Maybe it's not directly related to patient care.
And the best way to really describe how we approach this
is the same way that we teach it in our courses.
And that is you look at the inputs,
what is needed for a process,
then you ultimately want to look at
then are you achieving your output,
the objective for that process?
Where we kind of dig in deeper is we look at everything
then that is part of that process.
So for example, we will go up to a department,
let's say maybe we go up to a PACU.
I'll just randomly pick that one.
And we may say to PACU,
okay, tell me what it is that you do here
and walk me through your process.
When do you receive the patient?
Do you do anything pre receiving the patient?
How do you ensure that you have all of the equipment,
supplies, all of the things that you need
to take care of that patient once you receive them?
Then walk me through your process
of taking care of the patient.
And then we'll sample,
we'll often sample medical records.
We might ask for the policy or procedure for some things.
Then we take that all the way to the ultimate output
which would be you transitioning them
either to another level of care or discharge
or whatever the scenario is.
So that is how we audit on each unit
as opposed to following a patient
from admissions all the way through to discharge.
Tracer methodology we found with the research that we did
is not, it doesn't get really deep into the patient care
in that it's, you're sampling a couple of patients
which we all know doesn't always give you the best picture
but there's not enough time.
There's not enough time for any accrediting organization
to really dig in too deep.
We're only there for a few days.
So with the tracer methodology, you take a few patients
and you trace them through from when they're admitted
or when they come into the ED all the way through discharge
you're really only surface checking
when they touch each department.
So if a patient were to come in, let's say the ED
and they're in the ED for a few hours before they're admitted
a surveyor typically would, you know, sample
and talk to some people who may have touched that patient
or looked at some of the process
that was done with that patient in the ED
and then they go on to the next, into admissions
and then they'd go up to the unit where they were
and there's just that process only allows you
to kind of touch the surface in each area.
Whereas process auditing that DNV does,
we are able to look in depth at each process.
We go to each department, we spend time,
we focus more on that service line or department
depending on how you prefer it to be described.
The generalists go into radiology.
So if radiology was part of that patient
that you were tracing, the clinician would only be able
to pop into radiology really quickly
and have a quick conversation because they've got to get
through all of the stages for tracing that patient
where with us, the generalist goes in
and they speak to radiology about their processes.
They talk to them about the areas
where they might have pain points.
They look at what are their goals?
What are they trying to achieve?
And then we have them walk us through the process,
walk us through the process for a patient who's coming in
for a CT, whether it's an inpatient or outpatient.
And then we'll sample records and documents.
So we found by really understanding
and spending that time with those departments
and sampling from those departments,
we get a more thorough look
'cause we do survey to red flags.
So in talking, our surveyors are very, very skilled
at interviewing.
We pride ourselves on that.
We spend a lot of time working with them.
We want them to be able to get people to open up,
but not in a negative way,
not in a way in which they're going to spill all the beans.
So our approach is not to be feared, if you will.
The reason our surveyors are trained very well
to interview people is because we need them
to tell us truly what's going on
and how they do their process in a real-time way
so that we can see if there's any issues
and you can see if there's any issues.
Remember, I've said it many, many times,
but our ultimate goal here is that you,
by implementing ISO, have the ability
to identify your issues, non-conformances, pain points,
whatever you want to call them, opportunities,
whatever suits you.
You are able to identify those before we come in.
And then when we come in every year,
we then are able to confirm what you've found,
verify, yes, look, we also found it.
You guys are on the right track and/or go deeper
and see if there's something else with a fresh set of eyes.
And that gives an organization a double layer of safety
to prevent an issue with the patient
or prevent an issue with the department,
with their processes.
So our commitment is to improve healthcare in this nation
and to make sure that we're supporting hospitals
and being able to provide quality, safe patient care.
We are collaborative.
We are 100% collaborative.
We need to come in and we need to approach your staff
with the ability to ask questions and to educate
or our approach is very educational
and make them feel comfortable to know that it's okay
to have a culture of transparency.
We need to see, we need to be able to ask questions
and that's for the benefit of your organization
and your, and the patient and your patients.
We do not believe in a punitive approach to accreditation.
So, and that can be hospitals who are new to us.
That can be a little bit of a switch.
Some hospitals still very much have a punitive approach
to accreditation.
I would just remember my experience back
when I was in the hospital and it's been 16 years ago,
I think since I was in a hospital in a full-time job.
I remember that we were so nervous
when our accrediting organization,
before we switched to DMV,
when our accrediting organization would come in
because people actually got fired
if there was non-conformances identified.
And it was a really scary time
and it did not make you feel like you should be transparent
if there were issues or there was things
that we were dealing with in the department.
It really promoted that duck and hide.
You remember how surveyors would come up on a unit
and clear the floor because nobody wanted to talk
to the surveyor because they were afraid
that if they answered or said or did the wrong thing,
they would potentially lose their job.
And that you will find, I think,
if you talk to a lot of our clients
who have been with us at DMV,
that culture has just completely turned around.
We do not have a punitive approach to our way of surveying
because we don't care if you have 100 non-conformances,
what we care, don't get me wrong,
but we do not have a tipping point.
There is nothing that would tip the scales
when it comes to the number of non-conformances
that you have.
What we care about is what you do
with those non-conformances once they've been identified,
that you have corrective action in place
and that you're measuring and monitoring
that corrective action for effectiveness.
That's what we are most concerned about and focused on.
And we come every year.
So we're there to see how it's going
with your corrective action.
So our process approach is really driven
to promote a culture of transparency.
We have to be honest.
We are human beings working on human beings.
And there is a lot of room for human error in that scenario.
And many of you have heard me say
you can have 10 patients come through the door,
perform the exact same procedure the exact same way
10 times on each patient
and end up with 10 different outcomes
because one patient might have a co-obidity
that affects the results.
One patient may have an allergic reaction.
There's just so many things
when we're dealing with human beings.
So to create a culture of transparency
in healthcare is key.
We really want to empower staff
to say, hey, something went wrong.
There was a mistake made
or this did not happen the way it was supposed to happen.
We need to give people that transparency
and report those incidents
so that we can investigate to see, okay,
what do we need to do different?
Was that a one-off scenario?
So we are really engaging at the level
of the frontline staff level
to get people to open up and answer our questions
so that we can clearly see what it is that they do
so that you're able to start to work
on that transparent culture.
And the key to that for us is definitely process auditing.
It is very ingrained in the way that DNV does things.
It does allow us every year
to go a little deeper into processes.
And because we surveyed to red flags and talking to staff,
it's not uncommon for, in fact, it's very, very common
for hospitals who have been with us
for many, many years to, for frontline staff
or even leadership to say, okay, here are the areas.
Here are the processes where we're struggling.
We wanna make sure that it's on your agenda.
We need another set of eyes.
We need you to see and look,
are we not compliant in some areas
or something there that we're not doing correctly
so that we can fix it because we've tried
and we can't quite identify what the issue is.
And so we ensure that it's on the agenda
and we go down and survey.
Now, there have been cases where we've had quality people
saying this one area is really struggling
to comply with our processes and we think
and we wanna know if you will please audit that area.
And we're like, sure, we'll add it,
but we're not gonna write up a non-conformance
unless we have objective evidence
to support that non-conformance.
So even though we are very collaborative and educational,
we are 100% committed to maintaining the integrity
of the requirements and the integrity of your requirements,
your policies and procedures.
If there's not where we're not prescriptive
and you've really outlined how something should be done,
we honor and make sure that we support the integrity
of your policies and procedures as well.
And if we go down there and we talk to staff
and we survey and we sample and at the end of the day,
there's no objective evidence to demonstrate a non-conformance
that we can't write it up.
And sometimes quality people are like,
no, I don't think they're doing it right.
Well, maybe it's not comfortable to you
the way they're doing it, but they are compliant
and there's no evidence of any failures going on
or any issues going on or any non-compliance.
There you go, that's the word I'm trying to get to.
There's no evidence of non-compliance.
So sometimes that can be a little disappointing
to a quality person who is really hoping
that we would support sometimes their agenda
of how they want it done.
And then sometimes it may not be the ideal process,
but it's compliant and working.
And there's been no harm to a patient.
There's been no failures.
So it's compliant.
So sometimes it doesn't always look pretty.
Who are we to say?
Who are we to tell you?
Just because that doesn't look the way
that we think it should look
the way we're used to looking.
Because it's not what we're used to seeing
doesn't mean that there's a problem there.
What works best for you may have not worked
in our previous positions at our hospitals.
Sometimes, you know, that's an important distinction
for people to understand that we are just there
to see if you're compliant, to see if it's working for you
and how that looks is typically up to you.
But that's why process auditing works better
for identifying those non-conformances,
for being able to dig in deep enough
to help promote quality safe patient care.
So I really wanted to spend this podcast
giving you that information.
So I hope all of that made sense.
And I hope that you can see the benefit
with process auditing compared to tracer auditing.
It really does cut through that low hanging fruit
because you guys have fixed that generally
after a year or two.
It allows us to really spend time
with the people who do that processes.
So that's why all three of our surveyors
hit those key areas.
You know, the clinicians spend time
in the clinical departments,
the clinical areas and units.
The generalist spends time in the ancillary service areas.
And then of course the physical environment,
the surveyor spends time
in all of those physical environment areas.
And we come together and we have a conversation
and we look to see where there's overlap if we are.
It's not uncommon for us to come together
and say, hey, I'm noticing this
and the clinicians say, yeah,
I'm noticing that on the clinical side too.
And we come together to be able to identify more
of a systemic issue, a true process issue.
That's why when we write our non-conformances
we do require three things of our surveyors.
When they write it, they have to have the requirement.
You know, is there a NIO requirement?
Is the policy and procedure for the hospital?
What is the requirement
that says that they must do X, Y and Z?
And then what is the failure to that requirement?
So the second thing is the failure.
They have to identify that that requirement is failing.
And then the third thing, the most important thing is
what is the objective evidence to support that failure?
What did you see?
Who did you talk to?
What did you observe or what documents did you review
that supports that you came to the conclusion
of a process failure?
Sometimes you have a one-off scenario
and it doesn't necessarily mean you have a process failure.
That's why we really push our surveyors to look to see
do you have objective evidence
that supports that process failure
or was that a one-off scenario?
Of course, risk plays a role.
You could have a one-off scenario that's high risk
that could still lead to a nonconformance.
The truth of the matter is
that most of the time with process auditing,
we need to see that that process is,
there's issues with that process.
It's either a broken process
or there's enough objective evidence to demonstrate
that there's inconsistencies
and some systemic issues with that process.
That is process auditing, guys.
So I hope that along with transparency,
the culture of your organizations,
it's really, really important across the country,
across the world that we really shift to
the ability to allow our staff to be transparent.
We are, again, can't say it enough,
human beings working on human beings
and that alone is high risk
with a lot of variables that could go wrong.
I hope that was helpful.
We've been receiving a lot of submissions
for topics on the podcast.
Please continue to submit any requests
or any ideas that you have for podcast topics.
You can submit those to our education email box,
which is
[email protected].
You can also, don't forget to visit our website,
dnvhealthcare.com,
where you can find a plethora of information
on our advanced certifications.
If you're new and considering switching over
to DMV for your accrediting organization needs,
you can get information again on our website
on how to do that.
There's also a little button,
if you have questions that you can click on.
Our symposium information is on there.
DMV Healthcare University is happening in two weeks
and the information for that event is on there,
though I think by the time we post this,
that registration will be closed,
but we will have another one next year.
So if you have any questions or want to see
what that looks like,
we also have a bunch of public courses that we are posting.
So there are two currently on our website.
Our public courses are for anybody to attend.
Most of the time our courses are private.
We go to a hospital and we teach whatever course
you need us to teach at a hospital,
but we do offer some public courses.
Some of them are virtual even.
Some courses we found that we can still teach virtually.
Some courses do not translate well virtually.
Please check that out.
We do plan to put more courses, virtual courses,
and public courses on the website for Q3 and Q4 this year.
If you have any other educational needs,
just let us know
'cause we can customize something for you as well.
I hope everyone continues to have a good month.
Be safe out there.
And as always, please, please, please take care of yourselves.
Until next time.
- Thank you for listening.
Rx for Hospital Quality is a podcast
produced by D&B Healthcare USA Incorporated.
To learn more about subjects covered here
or to download any of our standards or requirements,
please visit our website at www.dnbhealthcare.com.
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