Tanya Uden-Holman

Understanding why medication administration errors may not be reported.

Because the identification and reporting of medication administration errors (MAE) is a nonautomated and voluntary process, it is important to understand potential barriers to MAE reporting. This paper describes and analyzes a survey instrument designed to assist in evaluating the relative importance of 15 different potential MAE-reporting barriers. Based on the responses of over 1300 nurses and a confirmatory LISREL analysis, the 15 potential barriers are combined into 4 subscales: Disagreement Over Error, Reporting Effort, Fear, and Administrative Response. The psychometric properties of this instrument and descriptive profiles are presented. Specific suggestions for enhancing MAE reporting are discussed.

Effectiveness of a nationally implemented smoking cessation guideline on provider and patient practices

BACKGROUND The Agency for Health Care Policy and Research (AHCPR) smoking cessation guideline outlines a set of recommendations for physicians to follow in daily practice. However, the effectiveness of this guideline has not been reported. The goal of this project was to evaluate the effect of the AHCPR smoking cessation guideline on provider practices with smokers and on patient smoking rates. METHODS Patient survey and chart review data from 138 Veterans Administration (VA) acute care medical centers with outpatient facilities were examined. Data were available from both sources in 1996, 1997, and 1998. At the midpoint of this period (1997), the VA recommended the AHCPR smoking cessation clinical practice guideline for implementation throughout the VA healthcare system. RESULTS From 1996 to 1998, both the chart audit and the patient survey showed a significant increase in the percentage of patients in the VA who were counseled about smoking and a significant decrease in the percentage of patients who smoke. CONCLUSIONS Because the VA tied the guideline implementation to report cards and other performance-enhancing measures, guideline adherence may have been maximized in this setting. These findings suggest that healthcare systems should take an integrated approach to guideline implementation.

Understanding patient-centered care in the context of total quality management and continuous quality improvement.

BACKGROUND Implementing patient-centered care (PCC) requires a fundamental shift in thinking-from how to best provide a wide variety of independent services to how to effectively combine individual service components into an integrated health care experience that meets patient needs and preferences. DISCUSSION PCC attempts to improve patient care by organizationally and physically moving selected service functions such as basic laboratory, pharmacy, admitting/discharge, medical records, housekeeping, and material support services to patient care areas, thus effecting an organizational restructuring. PCC creates teams composed of multiskilled or cross-trained individuals capable of providing more of the services directly on the patient care unit. Extensive redesign of the basic work processes as proposed by PCC advocates may result in significant changes in employee job scope, task responsibilities, professional autonomy, and reporting relationships. From the employees perspective such changes may be neither warranted nor welcomed. Therefore, critical PCC implementation issues include obtaining employee buy-in and establishing appropriate incentive structures to facilitate the desired changes. How does PCC fit in with the popular improvement philosophies of total quality management (TQM) and continuous quality improvement (CQI)? Inherent within TQM and CQI is the belief that it is wiser to maximize efforts to design a product or process to be right the first time and to minimize resources devoted to inspection and repair caused by poor processes. PCC builds upon previous TQM/CQI health care efforts by focusing on ways to reduce the white space handoff problem by examining what, if any, changes in underlying structures and processes may be required. In the PCC hospital, TQM/CQI can function as intended, as a methodology for examining and improving the process of care and patient-care outcomes, regardless of internal departmental or profession-based organizational boundaries. CONCLUSION For hospitals to remain competitive in todays rapidly changing environment, it is becoming necessary to reevaluate both how they are organized and how their work processes have been designed and controlled. The groundwork already laid by TQM/CQI initiatives will facilitate the more fundamental and long-lasting improvements derived from the redesign of the patient-care unit as prescribed by the goals of PCC.

Using Comparative Clinical and Economic Outcome Information to Profile Physician Performance

This paper presents strategies and empirical examples of comparative physician profiling under conditions of limited patient sample sizes and varying patient severity. A method by which clinical and cost outcomes may be evaluated simultaneously is also presented. Physician economic and clinical performance are compared using data abstracted from nine hospitals into the MedisGroups clinical information management system for inpatients treated from July, 1990 through June, 1992. The main outcome measures are comparative total and ancillary adjusted charges, and morbidity status. Results suggest that objective comparative outcome data provide useful information to assist in evaluating physician performance. A simultaneous comparison of clinical outcomes and adjusted charges identifies physicians who experience favorable outcomes at lower charges, as well as those who have higher charges and/or poorer outcomes. Strategies outlined in this paper may be of value to clinicians, governing boards, and third party payors. These strategies may be used to assist with privileging and other peer review activities when pursued proactively within a Continuous Quality Improvement framework to improve care.

The Role of the Public Health Training Centers in Advancing Public Health Department Accreditation

In the past few years, the drive for public health department accreditation has continued to build momentum. As the Centers for Disease Control and Prevention notes, “Engaging in accreditation catalyzes quality and performance improvement within all public health programs and can help health departments be better prepared to proactively respond to emerging and reemerging health challenges”. Many organizations support accreditation efforts, including the Public Health Training Centers (PHTCs), which have been providing workforce development support since 1999. This article describes how one PHTC, the Midwestern Public Health Training Center, has supported capacity building for accreditation in partnership with other state-based organizations through the development of three major accreditation readiness activities: accreditation workshops, informational videos on Public Health Accreditation Board standards and measures, and competency-based workforce development assessments. Given the current and emerging public health challenges, the need for a well-prepared workforce is more important than ever to strengthen the public health system, and by engaging in activities to meet the accreditation standards, public health departments will be better positioned to respond to these challenges. PHTCs will continue to have a critical role in capacity building for accreditation.

The Role of the U.S. Public Health Learning Network in Strengthening the Current and Future Public Health Workforce

The public health workforce plays a critical role in ensuring the health and well-being of our communities, yet lack of formal training in public health and high turnover impede the ability of the workforce to do its job. The U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA) estimates that only 20% of the nation’s public health workforce has the formal education and training necessary to do their jobs effectively (HRSA, 2004, as cited in Kennedy & Baker, 2005). When surveyed as part of the Association of State and Territorial Health Official’s Public Health Workforce Interests and Needs Survey (PH WINS), 79% of respondents stated they were somewhat or very satisfied with their job, yet 42% were still planning to retire before 2020 or leave their organization within the next year (Sellers et al., 2015). Additionally, the Association of Schools and Programs of Public Health estimates that 250,000 more public health workers will be needed by 2020 to maintain capacity (Association of Schools of Public Health, 2008). Established in 1999, the Public Health Training Centers (PHTC), funded by the HRSA, are partnerships between accredited public health degree programs and schools of public health, related academic institutions, public health agencies, and other community organizations. In 2014, the original PHTC model was updated by HRSA to the current regional model, which is composed of 10 regional PHTCs (one located in each U.S. Department of Health and Human Services region), 40 local performance sites, and the National Coordinating Center for Public Health Training (Bigley, 2016; HRSA, 2014). Collectively, these entities are known as the Public Health Learning Network (PHLN). The PHLN is designed to improve the U.S. public health system by strengthening the technical, scientific, managerial, and leadership competence of current and future public health professionals (Bigley, 2016; HRSA, 2014). Using the competencies developed by the Council on Linkages Between Academia and Public Health Practice, the regional PHTCs assess workforce training needs and provide competency-based education and training programs with an emphasis on improving the infrastructure of the public health system and helping achieve the Healthy People objectives (HRSA, 2014). The 2014 PHTC program also has an emphasis on distance-based programming. Additionally, the regional PHTCs are tasked with establishing and/or strengthening field placements for public health students as well as involving faculty and public health students in collaborative projects that enhance public health services to medically underserved communities and populations (HRSA, 2014). This supplement of Pedagogy in Health Promotion is dedicated to the work of the PHLN. Collectively these 15 articles (3 commentaries, 1 reflective piece, 10 descriptive best practices, and 1 original research piece) describe the work of the regional PHTCs, local performance sites, and National Coordinating Center for Public Health Training, which comprise the PHLN. Specific activities include training needs assessment, workforce development training, technical assistance for the public health workforce, and field placement activities. By reading these articles, readers will understand the importance of the PHLN’s work in strengthening both the current and future public health workforce. The supplement begins with three commentaries that set the context for subsequent articles, which discuss specific activities of the PHLN. The commentary by DeSalvo and Wang (2017) discusses five recommendations for the successful implementation of Public Health 3.0 and suggests that PHTCs have a role in developing trainings that incorporate Public Health 3.0 principles. In the next commentary, Dreyzehner, Williams, and Harkness (2017) talk about the important role that practice-based experiences such as internships and field placements have on public health students. They then describe the Commissioner’s Fellowship in Public Health, 701473 PHPXXX10.1177/2373379917701473Pedagogy in Health PromotionAlperin et al. research-article2017