Clinical governance assessment

Mobile Evaluations are Here

Mobile Evaluations – Osler Version 2

One of the features of Version 2 of Osler Clinical Performance that we are most excited about is mobile enabled assessments – an important component of a complete clinical governance system.

Evaluate your team and provide immediate feedback with evaluation for compliance and clinical areas such as:

  • Basic Life Support
  • Advanced Life Support (ALS)
  • Falls Prevention
  • Direct Observation of Procedural Skills (DOPS)

all from your handheld Android or iOS device!  Evaluate on the go so you can claim more of your precious time, and aren’t spending it filling out evaluations.

You can design Assessment Forms to support pass/fail, multiple choice and rating scales (level of mastery or competence) questions, and file uploads to incorporate evaluations into any Osler Learning training plans.

 

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.  30 day trials can be accessed on the AppExchange.

 

Clinical governance assessment

Everyday heroes. Saving lives, one at a time…

I’m the COO here at Osler Technology.  I’ve had decades of experiences building businesses, developing software and helping clients achieve benefits through the use of that software.   But until I got involved at Osler, I was a complete novice in the inner workings of our health care system (still am!).  A recent event reminded me about why we are building Osler.

 

Earlier this week, one of our content editors (and a practicing nurse) witnessed a woman collapse on the steps to a supermarket across the road from our HQ in Noosa Heads, Queensland.  She immediately swung into action and commenced CPR and basic life support activities and called Todd, our founder (and a practicing intensivist), who was up the road having a coffee.   Between the two of them,  they kept this woman alive until transported to Noosa Hospital. 48 hours later, with a new stent in place, she was sitting up in bed, calling Jo & Todd her guardian angels.   Without the lucky coincidence of the timing and location, this woman probably would not have survived.

 

As our CEO remarked,  “Truly amazing to be involved in a software company where our team members actually go on to the street and resuscitate people who have had a heart attack.”

 

We’re building tools to help clinicians acquire new clinical skills and improve their clinical performance,   and to help providers be more efficient in developing and maintaining those skills among their workforce.  We know that these everyday heroes get it right 99% of the time.   But if Osler can help improve clinical governance, patient safety, and help those heroes get it right 99.1% of the time,  then it will be a huge win for public health,  patient safety,  and of course, our amazing team.

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

 

Osler Community Survey – Give us your views

We’re interested in your opinions about professional and clinical skills development, clinical governance and transparency in healthcare, and your feedback on our product ideas. Osler is developing a revolutionary new approach to professional development.

This survey shouldn’t take more than 8 minutes to complete & your feedback is incredibly valuable. We will distribute a summary of the aggregated results to all respondents at the conclusion of the research.

The best 3 answers to a question in the survey will also receive a free one-year subscription to Osler Community when it launches later this year.

LAUNCH SURVEY

 

Clinical Skills Development

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.

Free Trial – Osler’s Clinical Governance application

Osler’s Clinical Performance Platform (CPP) is now available to trial on the AppExchange.

If you want to see how Osler CPP can:

 

  • improve your hospital’s approach to clinical governance
  • reduce costs of delivering mandatory training
  • help your staff improve their procedural skills by recording and measuring their procedural activity
  • provide immersive e-learning for a range of clinical procedures
  • give you at-a-glance views of your team’s clinical skills and procedural competence
  • improve patient safety

then go to the AppExchange Listing to sign up for a free 30 day trial with a fully configured application, including sample data.    Download the Osler TrialForce User Guide under the Details tab to help you get started,  and then click the [Get It Now] button.   You’ll be up and running in about 15 minutes!

 

osler-appexchange-banner-learning1

 

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

Why I record all my outcomes, good and bad

Recently I led a crisis team that was required to intubate a patient with severe pneumonitis.

 

Ultimately the process went well enough – the patient was established on mechanical ventilation and we set about implementing the strategies required to treat his underlying condition.

 

Later that day, I took the time to record the procedures I’d performed in my logbook on Osler.  Intubation, induction of anaesthesia, arterial line, central line, bronchoscopy, transportation of a ventilated patient.  It’s what happened then that is the reason I’m telling this story.

 

I was forced to acknowledge that things hadn’t gone as smoothly as I would have liked.  The patient had desaturated below a level I was comfortable with.  An IV was accidentally dislodged as we moved the patient onto the CT scanner.  There was nothing catastrophic, but to me, it was a trigger to examine what had occurred.

 

Importantly, it gave me the opportunity to review all my intubations and see if there was a signal – was this a once off event?  Or do I have a bigger problem?

 

But it left me wondering whether this was just me or does everyone have these issues?  In reality, I have no way of knowing because I can’t benchmark myself against anyone else.  Perhaps I’m great at this, perhaps I suck.  Or perhaps I’m doing as well as anyone.  But it would be nice to know, because it changes how I see my performance.

 

Recording my complications doesn’t mean I’ve failed or am negligent.  It might not even by my fault.  But it did happen, and that’s the point.  If there is a way of stopping it happening again, then I need to find it.

 

With this in mind, I can now set my attention to figuring out why things had not gone as well as they could.  I found a few issues, both personal and team based, and have set about fixing them so I can reduce the chances of this happening next time.

 

And while I would love for things to have gone better the last time, it’s the next time I can do something about – and I feel good about that.

 

About the Author

Dr Todd Fraser is an intensive care and retrieval medicine specialist, podcast editor of the Society of Critical Care Medicine, and founder of Osler Technology, a clinical performance management platform for acute healthcare providers.

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