QTracer: A New Approach to Accountability and Quality and Safety Improvement in Healthcare

In the healthcare industry, accountability is incredibly important. I will explain how an internal dialogue and feedback mechanism based on a tracing approach comes together in one technological Tracer System to implement tracers with impact and help, encourage healthcare professionals accountability to act and improve processes and compliance with standards, and to support the journey to become a high reliability organization.

Keywords: accountability, tracing, dialogue and suggestion, feedback, encouragement, continuous improvement

A lack of accountability in healthcare can cause significant damage to the organization and can put patients lives at risk. Many studies show that worldwide hundreds of thousands of patients die every year and millions of injuries are caused by hospital-related infections or medical mistakes. Hospitals can minimize those that are avoidable if staff followed proper rules, policies and procedures.

A culture of accountability in healthcare can help prevent such mistakes. Rules are nothing without accountability. In fact, without employee ownership – about taking initiative and responsibility – and accountability, your quality and safety of care is dying. Accountability should therefore be an integral part of your organization.

Put simply, “accountability” is about taking responsibility for your actions, always ensuring you are competent to do the activity you’ve been asked to perform, and always putting patient/client interest and safety first. Accountability also means complying with the quality and safety standards and regulations. This means words and actions are in alignment. The power lies in people choosing to hold themselves accountable while also finding value in the help of others who can support their journey to achieve chosen compliance goals.

As a founder of QTracer I was triggered by the challenging question how tracers can play a substantial role in helping people take responsibility and build a culture of accountability. I truly believe that a Dedicated Tracer System can easily enable staff to obtain the right insights about what goes well and what needs to be improved and encourage them to proactive take actions on provided feedback. But let me first explain what I think tracing in healthcare is about.

Tracing Healthcare Processes and Systems

Yet, today’s organizations struggle to keep pace and meet the highest standards of patient care. There is extensive evidence demonstrating that there is a gap between the health care that patients receive and the practice that is recommended. In both primary and secondary care there are unwarranted variations in practice and processes, and in resulting outcomes that cannot be explained by the characteristics of patients 

Working in a healthcare setting, particularly in hospitals, experience you quickly that the environment is composed of hundreds of thousands of processes, or systems– like cleaning patient rooms – which call for protocols and procedures in order to greatly reduce all types of risks to patients. When a process, like a catheter placement, is deconstructed into many smaller process steps or activities, to be performed in a particular sequence or method, it allows care teams to look back and retrace their steps to see where a process might have broken down.

There is a further need for organizations to develop knowledge in real-time and to extract that knowledge from the people and their working environment, and from the repositories in which it’s stored when needed. This is due to the fact that most underperformance is caused by a lack of understanding and awareness, process deficits, and motivational issues – and formal training can’t solve these factors. 

Most underperformance is caused by a lack of understanding and awareness, process deficits, and motivational issues – and formal training can’t solve these factors.  

A way of identifying “broken” processes is through implementation of tracers– an internal audit and feedback mechanism based on the tracing approach as recommended by world-class healthcare accreditation bodies like Joint Commission International (JCI) and Accreditation Canada International (ACI). Tracers are designed to “trace” the care experiences that a patient had while at an organization or trace a system like medication management or infection control.

A tracer always takes place where value for the patient is created, wherever there is patient interaction, where the real work is taking place. And certainly not in the conference room, while the real knowledge and real experts were at the bedside, delivering care.

A health care provider may conduct tracers toreflect on their own practices and processes and evaluate performance in order to identify learning needs and areas for improvement whilst at the same time demonstrate compliance to standards and regulations. By tracing care this way providers monitor their patient safety and quality rule-based system in the life world and get insights into its performance. In the following sections I try to explain QTracer clients approach to measure and improve accountability with the aim of increasing the quality and safety of care.

Encouraging accountability

Having to implement a rule-based safety management system does not automatically determine the way in which the rules of such a system are implemented, even if people are motivated. The process of becoming compliance and achieving and maintaining safe and high-quality care can be difficult and confusing. An important question that comes to mind is how you keep professionals and teams inspired and taking action to improve performance despite the rising operational pressure. 

I think people often confuse accountability with coercion. If you’ve been in business, you’ve probably figured out that you can’t coerce or motivate other people into doing something they don’t want to do. There is a myth about motivation that has been going around for years. It says that people can motivate other people. That myth is popular, but it’s not true. People motivate them selves. Their fire comes from within. The good news is that you don’t have to motivate the people. All people have a fire within and are therefore motivated. They all work hard at something. That includes healthcare workers. All of them work hard at something.

After doing some research I was very surprised when I found out that accountability has more to do with encouraging professionals and teams to want to take action and improve performance than money, time off and competition combined. While some may attach a negative air to the word accountability, research indicates that holding people accountable for their results has very positive effects.If hospitals want to build a motivating culture that breeds success, they should invest in learning how to create a culture of accountability; read the tips of C.J. Goulding

Holding people accountable is a real dilemma for today’s leaders. Holding people accountable is not something that happens overnight. You don’t flick a switch and turn on accountability. Accountability is a framework, a system, a way of operating.

Study shows that, even in the case of obligatory rules, different approaches to rule-implementation can be used: coercive (based on monitoring and threats or punishment) and catalic (based on dialogue and suggestion). It is indicated that a catalytic approach is related to higher levels of motivation, whereas a coercive approach is not. 

A catalytic enforcement style is based on the assumption that individuals are motivated to comply with rules, but that they are not able to do so because they do not have the capacity to be compliant or they do not understand what can be done to be compliant. Compliance is encouraged through technical and financial support, education and other inducements. 

Acting on Feedback – A lack of tools, knowledge, or ideas can be a barrier to action 

Healthcare institutions are looking at their front-line staff to act effectively as their first line of defense when it comes to ensuring that the organization is acting in a compliant way with accreditation and regulatory standards and discovering potential risk and areas of improvement. Our experience is that front-line staff generally act on the feedback they’ve been given, they are intrinsically motivated to ‘improve their lot’ – but a lack of tools, knowledge, or ideas can be a barrier to action. 

Accountability Feedback Loops

One of the most important, but often overlooked, components of on-going quality and patient safety improvement efforts is establishing the appropriate mechanisms for collecting and sharing information between key individuals and groups, and ensuring that there are feedback loops in place for incorporating the information collected into on-going improvement initiatives.

We redesigned a compliance improvement strategy where compliance and learning is encouraged trough an tablet-based internal audit and feedback mechanism – based on the tracing approach of world class accreditation bodies like JCI and ACI – as the catalyst that drives continuous improvement. Whereas the main focus of the JCI and ACI audits is on controlling and judging, the Dedicated Tracer System of the healthcare organization is focused on supporting the wards and their professionals in their improvement. The collected data is used for learning rather than judging.

The tracer-based accountability feedback loop is an interpersonal process of influencing, empowering and giving suggestions where the data feedback strategy is continual. The aim is to enable people to realize their continuous improvement potential and maximize their contribution to the organization’s processes to ensure safe and effective patient care delivery. 

We all need people who will give us feedback. That’s how we improve. –  Bill Gates

Feedback is about giving information in a way that encourages the department and professionals to accept it, reflect on it, learn from it, and hopefully make changes for the better.

A dedicated tracer solution supports a bottom-up leadership approach to allow all employees to easily measure, learn and evaluate performance in a collaborative way by utilizing one central system. Bottom-up leadership approach can be further explained as allowing every person, at every level of the organization become a part of the process for guiding continuous improvement that will help make everyone feel a large part of the goal: achieving and maintaining the highest client/patient quality and safety standards. The system can help employees to find the right focus, and build morale to engage and work on quality improvement. All employees will come to an understanding and may have insights on where and how to improve the performance of processes. The system supports them to reflect on their practice and experiences to demonstrate compliance, get a change to express their views and ideas and share their suggestions to pass them on to colleagues from other departments through a central dashboard. This kind of technology supported collaborative measuring and learning in the workplace can improve processes in new ways. 

Unfortunately there is no magic piece of software that can keep a person accountable. What the QTracer technology can do is:

  • Helping to make compliance and performance monitoring easier – Encouraging accountability.
  • Helping people take responsibility. When people accept a responsibility, they give you the right to hold them accountable for their performance.
  • Helping to provide access to ideas and thoughts and making suggestions that others acting on similar focuses found success with.
  • Helping initiate action on feedback: make focusing on a targeted action simpler.
  • Helping to encourage staff into sharing their positive experiences about what works.
  • Helping to make the process of taking action more transparent.

I hope you enjoy my post and feel inspired to reflect on your current internal audit system. Does your system encourage employees to hold each other accountable for quality performance and for making accreditation an on-going improvement process? If not, it can be a tough road and very labor intensive to reach your compliance goals.

To know more about how a Dedicated Tracer System can help you to get the most out of your tracers and save time, get a demo.

William Sommer +32 4732 655 96 William.sommer@qtracer.com

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