Journal review modules – a new Osler feature

Staying abreast of the latest literature is traditionally very difficult for most practicing clinicians.

 

There is a seemingly endless array of journals and papers, some of which may or may not be relevant.  For the hardworking clinical staff performing day to day care for patients, it’s almost impossible to detect signal from noise.

 

 

 

 

Busy clinical staff just like you tell us they just don’t have time to review all the relevant literature – what they need is a brief review that highlights the key points, in an engaging, interactive and tailored format.

 

Osler is here to help.  Our recently launched Journal Module series review the most important literature in your specialty’s landscape.  Designed for clinicians with only limited time, the reviews give you the background, a brief overview of the trial, and how it applies in your daily practice.  Break out slides enable you to explore more detail if you wish.

 

And best of all, all the activity you perform can be captured so you can easily update your CPD program with your efforts.

 

So why not join Osler.community today and take advantage of the Osler platform.

Osler’s novel clinical governance platform recognised again

Osler Technology is delighted to be recognised by the industry-leading Learning Technologies Awards in London in November 2016.  LTA is long-established as the peak awards within the online learning and training community, and Osler’s clinical governance platform placed second in the Novel Use of Technology – International category.

Learning Technologies Awards has recognised Osler's clinical governance platform

The award reinforces the sound learning principles upon which the platform is based.  Ensuring learners have access to high quality feedback, in a format they can use to reflect on easily, is critical for busy professionals.  The platform also incorporates an Entrustable Professional Attributes model of assessment, designed to better identify learners who need more assistance.

Work-readiness was a key theme in healthcare clinical governance this year, with the release of a stream of reports and papers identifying healthcare error as a major source of patient morbidity.  Osler is an immediate solution to many common governance issues.

2016 was a big year for Osler, with the completion of our commercialisation phase, the implementation to our first set of customers, successfully applying for grant funding from Federal and State Governments, and recognition in international awards and conferences.  But it’s only the beginning…

We look forward to working with all our supporters and customers in 2017

Hospital Safety Report Provides Opportunity for Innovation

A new report into managing critical safety risks in the hospital system makes important recommendations and highlights the need to prevent patient injury and death in the first place, says a high-tech medical start up.

 

The just-released Duckett review into DHHS management of incidents, such as a spate of perinatal deaths in Victoria in 2013-4, underlines the ongoing national tragedy of 1800 Australians who die each year and another 6800 who are impacted by such adverse events.

 

Osler Technology, the brain child of intensive care and retrieval medicine specialist Dr Todd Fraser, provides real time, meaningful data on patient outcomes within the clinical workspace, and enables clinician leaders to respond rapidly and creatively to prevent future events.

 

By tracking individual training and activity data, it ensures all staff practice within their scope.

 

“The recommendations of the Duckett review create a better environment for patient safety across the wider health system but this is only half the battle. Left unanswered is how health systems prevent patient injury in the first place,” said Dr Fraser.

 

“If meaningful change is to be made, clinical staff will be the ones to make it, and they can only do so with the right tools and information at their disposal. This is where a system like Osler plays a role by taking the high level principles identified in the Duckett review and applying them at individual patient, clinical manager and clinician levels.”

 

Read the full media release here:

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Stephen Duckett’s report highlights need for new thinking on clinical governance

Background

The recently released Duckett Report was commissioned in response to a review of the role of DHHS in detecting and managing critical safety risks and clinical governance across the system following a cluster of perinatal deaths at Djerriwarrh Health Service in 2013-14.

 

The report highlights that while Victorians have a right to assume that healthcare is generally of a high quality across the system, there continue to be significant deficiencies in the system’s defenses against avoidable patient injury.

 

The report cites a 2014-15 review of hospital acquired diagnoses in Victorian Healthcare System, which concluded that “complications of care are far from rare in our hospitals”.  In fact, more than 300,000 patients per year suffer a complication in Victorian hospitals, at least 70,000 of which are potentially preventable such as malnutrition or pressure ulcers. Many of these result in fatalities.

 

This issue, to say the least, is huge.

 

The Duckett report was commissioned to review the role of the DHHS in preventing these events.

 

Essentially, the report calls for the department to better support Victorian Health Services in providing a high level of local clinical governance on safety and quality, to monitor outcome data more closely, and to respond more effectively when things go wrong.

Major Findings

To this end, the report makes several important recommendations, among them :

 

  1. The department must set a clear example to the wider health service that this issue is its number one priority
  2. The system should focus less on “meeting accreditation standards”, and instead greater emphasis placed on outcome monitoring
  3. The department better supports the boards of health services by reviewing the appointment and training processes for board members, to ensure they can effectively oversee hospital governance
  4. Performance of the health service is more effectively monitored, by making better use of available data and filling in gaps as they exist
  5. Improvements are made in the utilization of data, so that the entire system can benefit, and learnings are better shared
  6. All hospitals should be open to periodic external review
  7. That hospitals are held to account in only providing care that falls within its scope of capability
  8. Consumers and front line clinicians must have a louder voice in the quality assurance process.

 

What does this all mean?

Promoting a culture of transparency and accountability, and most importantly trust, are an excellent start, and to this end, the department is to be congratulated for the example it has set.

 

As Dr Duckett himself points out, the department acted immediately to support Djerriwarrh protect its patients, investigate the cluster of deaths and engage in an open disclosure process.  It then sought prompt external review of its own role in the process and made those results public immediately.  It is a high level demonstration of the transparent accountability required at clinician level.

 

The recommendations of the Duckett review create a better environment for patient safety across the wider health system but this is only half the battle. Left unanswered is how health systems prevent patient injury in the first place.  Albeit beyond the scope of the review, here lies the rump of the improvement curve – what are the hospitals and health services, their clinical managers and individual clinicians supposed to do to improve patient care?  The report provides few answers.

 

If meaningful change is to be made, clinical staff will be the ones to make it, and they can only do so with the right tools and information at their disposal.

 

Without appropriate tools, processes and culture in place, no amount of oversight will achieve the department’s lofty goal of zero preventable patient injury.  This is where ready-made systems like Osler plays a role by taking the high level principles identified in the Duckett review and applying them at individual patient, clinical manager and clinician levels.

How can Osler contribute to improved clinical governance?

Osler provides an opportunity for hospitals to be proactive in their patient safety efforts.  As Dr Duckett points out, hospitals should be operating within their defined scope of practice.  The problem is, few clinical managers have sufficient granular visibility of their activity to enable this to occur.  Using Osler to ensure all staff are adequately trained to perform invasive procedures, non-technical skills and basic equipment familiarity helps manage this clear and apparent risk.

 

By providing real time, meaningful and comparative data on clinical proficiency, complication rates and currency or practice, Osler enables hospitals to identify and respond to limitations in service levels and patient care.

 

And by creating a collaborative environment for clinicians, Osler can distribute these essential learnings across the healthcare system so that Victorians, indeed all Australians can be treated in a safer manner.

 

 

“You have to be willing to acknowledge your problems before you can remedy them. If I were to characterise the state of public and private hospital care in the state of Victoria, I’d have to say that this first step is lacking. Both the public and private hospital systems and the government regulators who oversee them are in a state of denial with regard to the level of harm being caused to the public by inadequate attention to quality and safety deficiencies.”

Paul Levy

former president and CEO of Beth Israel Deaconess Medical Centre in Boston, Massachusetts

Deakin University, Thinker in Residence, 2016

Osler Community Survey – Results

Thanks to all the respondents to our first Osler Community Survey!  The response rate we received was highly encouraging, and the feedback quite insightful in relation to professional development, clinical governance, credentialing, logbooks and desirable Osler product features.   We look forward to putting the input and feedback received to good use in the next versions of Osler and we will keep you apprised of the upcoming launch of Osler Community later this year via our newsletter and here on the blog.

 

Congratulations to N Kumta (Australia), M Hoops (Australia) and DP Bowles (UK), our three winners of the free 12 month subscription to Osler!

 

The infographic below provides a summary of your feedback and our findings.

Osler Clinical Performance

 

Or, you can download it from the link below:

Osler Survey (June 16) Results

Development update

workforce 2 copyThe recent expansion of our Melbourne-based development team has allowed for significant progress in the past 6 months, culminating in the release of version 2.0 of our platform this month.

Version 2.0 includes important enhancements to key functionality such as procedure logging and the My Training section.

It also sees the release of our mobile enabled Assessments platform, enabling workplace based evaluation of clinical skills, procedural competence and equipment certification.  Structured assessments ensure that all staff are provided with objective and consistent feedback on their performance, improving skills and knowledge acquisition.

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The Assessment framework supports many our purpose built training plans, such as :

  • Basic and Advance Life Support skills
  • Basic procedures
  • Certification in key equipment
  • Falls risk assessment and prevention

Assessments can also be custom built to suit local needs.

Combined with our mobile procedure supervision & evaluation, Osler Clinical Performance can enable vastly improved clinical governance and provide a real time solution to your credentialing & compliance requirements.

Osler Clinical Performance Version 2 is available for providers and institutions now.  If you’d like to trial Osler for 30 days, you can set up your own demo version AppExchange, or contact us at info@oslertechnology.com

How do you set yourself apart in an increasingly competitive intern market?

There once was a time when medical students could look forward to a guaranteed intern position.

Those days appear over – at least, in many jurisdictions.

Competition for intern places is increasing dramatically, and in some regions a surplus of new graduates is leading to the inability to access a position.

Highlighting the problem is information recently released by Flinders and Adelaide Medical Student Societies, supported by the Australian Medical Students Association, demonstrating that current models suggest a short fall of positions in South Australia of 87 intern positions in just 2 years. Almost half of these are domestic graduates.

Figure from post issued by FMSS / AMSS / AMSA

Figure from post issued by FMSS / AMSS / AMSA

In other areas, intern places are still guaranteed, but competition for more coveted training sites remains intense. So much so in fact, that many medical students are actively encouraged by their tutors and lecturers to be building their curriculum vitae from the day they begin medical school.

As one hospital Chief Medical Officer recently stated, interns are increasingly “vanilla flavoured, and the challenge is to look like boysenberry.”

Of course, there are many ways to do so, including research, community service and other pursuits.

Another is developing a portfolio of skills, better illustrating the credentials that a candidate brings to the table, demonstrating both a willingness to evolve their abilities, and evidence of their “work readiness”.

And with the concept of revalidation increasingly discussed among the world’s regulatory authorities such as the Medical Board of Australia, the routine documentation of activity, outcomes and complications may become an important habit to develop.


If you’d like to trial the Osler platform for individuals, you can register to become part of the Osler Community here

 

Hospitals interested in trialling the Osler platform can do so here

 

The 3rd leading cause of patient death might well be the hospital system itself

Another week, another report illustrating the harm that the healthcare industry inadvertently causes to its patients.

 

This week the British Medical Journal published a report by renowned patient safety champion Marty Makary which examines the role of healthcare error on mortality.

 

Healthcare error take many forms, including :

  • Unintended acts (either commission or omission)
  • Execution errors
  • Interpretation and synthesis errors
  • Planning errors, and
  • Deviations from processes of care

 

The report highlights the lack of visibility surrounding healthcare error. Annual causation mortality data is often compiled from death certificates and coding, based on classifications such as the International Classification of Diseases (ICD) code.   Such systems do not routinely account for healthcare error, and so do not feature on such annual lists.

 

The fact that healthcare error results in patient deaths comes as no surprise to most practicing clinicians, many of whom have either witnessed patient deaths related to management errors, or even been a part of the process themselves. And it’s not a pleasant experience.

 

What should be startling is that the issue has been recognized for so long, yet little progress seems to have been made. It’s now over 15 years since the seminal work of Lucian Leape and colleagues (1) highlighted as many as 98 000 American lives are lost each year related to iatrogenic factors in hospitals, with countless more injured. Many of these deaths are thought to be potentially preventable.

 

Despite the furore that Leape’s To Err is Human report generated, little seems to have changed. Subsequent reviews (2-6) have since estimated that between 200 000 and 400 000 US deaths can be connected to patient error annually.

 

Extrapolating the published literature, Makary and colleagues suggest that, if true, iatrogenic causes of death would rank third on the all-cause mortality table in the US (behind heart disease and cancer).

 

It’s hard to imagine that if healthcare error was viewed as a disease, widespread public awareness campaigns, fundraisers and dedicated research would be inevitable.

 

No one who works in healthcare could possibly suggest that a zero patient death rate due to iatrogenesis is possible. The healthcare system is almost as complex as the humans it cares for. It’s clear that the vast majority of patients who traverse the system are well cared for by highly motivated and caring individuals, and the results are usually positive.

 

That notwithstanding, healthcare needs to re-evaluate its approach to safety. The external perception of the acute care industry is that of a High-Reliability Organization, where safety is prioritised against all other factors. Industries such as oil and gas exploration, aviation, and nuclear power have demonstrated that this approach can reduce injury to almost zero.

 

The serial failure of our industry to embrace standard, risk averse behaviours contributes greatly to the harm it generates :

 

  • Failure of orientation
  • Failure to validate procedural competence
  • Failure to ensure equipment familiarization
  • Failure to embed policy and procedural change
  • Failure to embrace literature and national standards
  • Failure to embrace technology that can improve and enhance safety standards
  • Safe working hours
  • Failure of process documentation and audit
  • Communication failure
  • Failure to measure and report outcomes transparently
  • Failure to ensure critical incident learnings are widely distributed
  • Failure to report and investigate “near miss events”
  • Failure to create a no-blame culture

 

Applying these principles to the healthcare sector will inevitably create tensions and encounter barriers to implementation, but the first step is an acceptance that we can do better.

 

“I think doctors and nurses and other medical professionals are the heroes of the patient safety movement and come up with creative innovations to fix the problems,” he said. “But they need the support from the system to solve these problems and to help us help improve the quality of care.” Marty Makary (source CNN)

 

 

References

  1. Kohn LT, Corrigan JM, Donaldson MS. To err is human: building a safer health system.National Academies Press, 1999.
  2. Leape LL, Lawthers AG, Brennan TA, Johnson WG. Preventing medical injury. Qual Rev Bull1993;19:144-9.pmid:8332330.
  3. HealthGrades quality study: patient safety in American hospitals. 2004. http://www.providersedge.com/ehdocs/ehr_articles/Patient_Safety_in_American_Hospitals-2004.pdf.
  4. Department of Health and Human Services. Adverse events in hospitals: national incidence among Medicare beneficiaries. 2010. http://oig.hhs.gov/oei/reports/oei-06-09-00090.pdf.
  5. Classen D, Resar R, Griffin F, et al. Global “trigger tool” shows that adverse events in hospitals may be ten times greater than previously measured. Health Aff2011;30:581-9doi:10.1377/hlthaff.2011.0190.

American Hospital Association. Fast facts on US hospitals. 2015.http://www.aha.org/research/rc/stat-studies/fast-facts.shtml

 

About the author

Dr Todd Fraser is a passionate campaigner for patient safety through better process.  He is an Intensivist and Retrieval Physician, and co-founder of Osler Technology.

Osler Clinical Performance Platform Available on Salesforce.com AppExchange

Osler Technology has launched our Clinical Performance Platform on Salesforce.com’s AppExchange – the world’s leading enterprise Apps marketplace.

 

 

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This exciting milestone provides Osler Technology with an opportunity to deliver our innovative approach for measuring a hospitals clinical performance globally.

 

Hospitals can click on this link and gain access to our platform using the power of AppCloud and the worldwide reach of the AppExchange.

 

We look forward to engaging with clients from around the world and enhancing our solution further for international hospitals.

 

Please view further details in our Press Release below.

20160404 Osler AppExchange Press Release