Creating and updating school emergency management plans

They can measure that; they can measure the number of patients who are on Coumadin, for example, whose blood anticoagulation level is out of the therapeutic range.And then they can put in a program to improve that pattern and show that the number of people out of range has been remarkably diminished. Fairview Southdale Hospital in Edina, Minnesota, USA, has done the same sort of thing, and there are a number of other hospitals in the IHI Collaboratives that have demonstrated this type of improvement.This is of course what Don Berwick [former President and CEO, Institute for Healthcare Improvement] has been saying in another way for ten years: Health care has a number of features about it that are really unhealthy.For example, there’s been a lot of study of institutional behavior, and institutions can be characterized as learning organizations or progressive organizations — and by other buzzwords — but hospitals tend to be on the dysfunctional side.Despite a great deal of resistance because of the associated expense, it looks as if a large number of hospitals are making plans to implement it over the next year or so.That is a very important development because it is a high-leverage change.

It’s important for the front office and the board of trustees to understand that in punitive environments most errors are not being reported.What we’re finding is that more and more hospitals are having success at doing this: Luther Midelfort — Mayo Health System in Eau Claire, Wisconsin, USA, is a very good example.The reporting of events goes up by orders of magnitude of 10, 20, 30, or 40 once people know that it’s safe to report and that there is some interest in it.The continuing ratcheting down of reimbursement and ratcheting up of belt-tightening in hospitals has created an environment that puts people in a defensive mode and makes it harder for them to take on additional responsibilities or do something different.The nursing shortage is real — a crisis that is already here — and it is sometimes difficult to talk about quality of care or safety when you’re concerned with survival.The hospitals that have succeeded in doing this have succeeded because the CEO understood and supported this principle and made it part of the mission of the hospital.Q: When I hear people talk about things like establishing a culture of safety, teams, full disclosure, patient empowerment, etc., they all sound like such obviously good ideas. A: The fact that we’re talking about things that sound so obvious is a measure of the dysfunctionality of the modern health care system.When people, particularly nurses, make a medication error they are disciplined, but what we’re saying now is that’s not appropriate.Nor is it effective in terms of reducing the odds of a next mistake.And physicians have long been told by the lawyers on the hospital staff that they should never admit to the patient they’ve made a mistake, because that information can be used against them in court.Well, that makes it pretty hard for them to admit to a patient that they’ve made a mistake.

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