Sandborg Christy I, Hartman Gary E, Su Felice, Williams Glyn, Teufe Beate, Wixson Nina, Larson David B, Donnelly Lane F
Department of Pediatrics, Stanford University, School of Medicine, Palo Alto, Calif.
Department of Surgery, Stanford University, School of Medicine, Palo Alto, Calif.
Pediatr Qual Saf. 2020 Dec 28;6(1):e375. doi: 10.1097/pq9.0000000000000375. eCollection 2021 Jan-Feb.
Healthcare organizations are focused on 2 different and sometimes conflicting tasks; (1) accelerate the improvement of clinical care delivery and (2) collect provider-specific data to determine the competency of providers. We describe creating a process to meet both of these aims while maintaining a culture that fosters improvement and teamwork.
We created a new process to sequester activities related to learning and improvement from those focused on individual provider performance. We describe this process, including data on the number and type of cases reviewed and survey results of the participant's perception of the new process.
In the new model, professional practice evaluation committees evaluate events purely to identify system issues and human factors related to medical decision-making, resulting in actional improvements. There are separate and sequestered processes that evaluate concerns around an individual provider's clinical competence or behavior. During the first 5 years of this process, 207 of 217 activities (99.5%) related to system issues rather than issues concerning individual provider competence or behavior. Participants perceived the new process as focused on identifying system errors (4.3/5), nonpunitive (4.2/5), an improvement (4.0/5), and helped with engagement in our system and contributed to wellness (4.0/5).
We believe this sequestered approach has enabled us to achieve both the oversight mandates to ensure provider competence while enabling a learning health systems approach to build the cultural aspects of trust and teamwork that are essential to driving continuous improvement in our system of care.
医疗保健机构专注于两项不同且有时相互冲突的任务：（1）加速临床护理服务的改进；（2）收集特定提供者的数据以确定提供者的能力。我们描述了创建一个流程来实现这两个目标，同时保持一种促进改进和团队合作的文化。
我们创建了一个新流程，将与学习和改进相关的活动与那些专注于单个提供者绩效的活动隔离开来。我们描述了这个流程，包括审查的病例数量和类型的数据以及参与者对新流程看法的调查结果。
在新模型中，专业实践评估委员会纯粹为了识别与医疗决策相关的系统问题和人为因素而评估事件，从而带来实际改进。有单独且隔离的流程来评估对单个提供者临床能力或行为的担忧。在这个流程的前5年中，217项活动中的207项（99.5%）与系统问题相关，而非与单个提供者的能力或行为问题相关。参与者认为新流程专注于识别系统错误（4.3/5）、非惩罚性（4.2/5）、是一种改进（4.0/5），并且有助于参与我们的系统并促进健康（4.0/5）。
我们相信这种隔离的方法使我们能够既实现监督要求以确保提供者的能力，又能采用学习型健康系统方法来构建信任和团队合作的文化方面，而这些对于推动我们的护理系统持续改进至关重要。
