Confident Voices in Healthcare Blog has a solid reputation for honest, interesting, and helpful posts addressing problems and solutions in healthcare. In few weeks, it has made “Top 45” (by Concorde Career Colleges) and “Top 30” (by Best Masters of Science in Nursing) and the “Top 100” (by Best Medical Assistants) lists for Best Nursing Blogs! I love the diversity represented as well as the praise!
One major reason for this success is owed to the high quality posts and perspectives written by guestbloggers like Randy Charpentier. Randy is committed to making healthcare safer for patients and healthcare workers! His early work on the Space Shuttle taught him the importance of being very detailed and thorough in his risk analyses and assessments as it can equate to serious injury, and/or life or death for all involved as we’ve seen in the history of the shuttle program tragedies. Learn more about Randy’s career path and interests in the healthcare sector. (Also please note that in an earlier version of this post, I mistakenly referred to Randy as a Certified Industrial Hygienist. My apologies!)
Posts by Randy!
- Healthcare Workforce & Occupational Injuries-Solutions
- Are Construction/Maintenance Nosocomial Infection Working?-Best Practices
- What is Involved in a TJC Survey of the Environment of Care?-Optimizing Results
Tell us a little bit about yourself: I often get asked, “how on earth did you end up in healthcare safety and risk management”? I actually ended up in it by chance but as I look back, I couldn’t envision doing anything different.
Being the youngest of four siblings, my upbringing in the Northeast U.S. was that of constant change with the four seasons and rising to the challenge of trying to outdo my brother and sisters in everything we did from chores, family outings and recreational activities. One challenge after another! This is one of the most challenging industries to work in.
I began my career working on the Space Shuttle project out of an 85 Bed Hospital on the west coast with CIH’s, Health Physicists and P.E.’s doing environmental management, occupational health, and industrial hygiene among other duties. One thing for sure, the west coast is very different than the east coast. The experience was diverse and challenging.
One of the most appealing parts of what I do is that this profession allows me to positively impact the environment and lives as I’m able to work the entire spectrum of trench work to boardroom environments. From the earliest part of my career, I worked in the field doing a wide variety of tasks ranging from environmental sampling and analyses of water/soil & air, performing occupational safety/risk/industrial hygiene assessments of workers in industrial, manufacturing, construction industries doing ergonomic/body mechanic/air sampling/noise measurements/HVAC operation/emergency response/chemical exposures and spills, doing building surveys, managing complex hazards of businesses that are engaged in high risk activities such as;
- Biomedical research labs dealing with very toxic chemical/biological/radiological agents/hazardous wastes
- Working at heights on the top of the refueling boom of the space shuttle measuring noise levels
- Conducting fuel titrations in a lab
- Analyzing insurance risks to reduce costs and liability, to
- Managing and directing healthcare safety programs to ensure compliance with OSHA/CMS/TJC, etc. requirements.
My experience has allowed me to contribute my entire skill set and expertise to all levels of an organization, from the Facilities end dealing with the Engineers and Tradesman on maintaining a code compliant and safe physical environment while undergoing constant renovations, to training clinical staff on appropriate selection and use of PPE, Fit testing clinical staff on respiratory protection, working hand in hand with Occupational Health & Risk Management on reducing injuries, to developing reports for Quality Improvement.
I have been fortunate enough to work on a variety of diverse projects ranging from the space shuttle, traveling abroad to work for industry leaders in the engineering and insurance profession, to developing/administering best practices in environmental health and safety for the healthcare industries top ten/one hundred biomedical research facility and community based hospitals. Most of my consulting work today revolves around improving the healthcare environment to ensure a safe facility and operation that reduces, minimizes, and eliminates risk to patients, staff and visitors.
What do you think is the most fundamental problem/concern we face in healthcare: From my perspective, one of the most fundamental problem/concern in healthcare is rooted in the “status quo” of the industry. We’ve always done it this way mentality. The changes that are occurring in the industry today may begin to affect change in a positive way suggesting the status quo may finally begin to change. This, in my opinion will require the healthcare professionals to collaborate and communicate more effectively, and mandate a marketing/branding challenge of re-establishing the message that staff safety is as critical as patient safety, the two issues are not distinct and separate but are very much aligned.
This I believe is the Root Cause of why healthcare is one of the most dangerous industries and continues to be even though the hallmark publication “To Err is Human: Building a Safer Health System” published by The Institutes of Medicine in 1999 provided the industry with the guidance necessary to make it safer. With most healthcare organizations relying on TJC Accreditation (The Joint Commission) to qualify for CMS (Centers for Medicare/Meidcaid Services) reimbursement, the question I’ve often asked is;
IF these institutions are TJC Accredited, why aren’t they any safer?
Healthcare is one of the most heavily regulated industries but yet still one of the most dangerous. Even though they comply with TJC requirements, this data suggests that these compliance measures may not be effective at reducing staff/patient & visitor incidents/injuries & illnesses.
CMS has implemented a Value Based Purchasing Programto transform the quality of hospital care by realigning hospitals’ financial incentives to do so. The impact of VBP (Value Based Purchasing) on healthcare institutions is continuing to evolve and according to recent reports, hospitals are being fined at a record rate for high readmission rates so the impact is being felt. But is it enough? Until staff and patient incidents are thoroughly reviewed to determine the interconnectedness per event/incident with a thorough and complete root cause analyses (RCA) performed, it is unlikely we will see substantial improvements.
I have personally seen the impact of a safety driven culture and witnessed the positive affect on staff morale, retention, and clients have realized a significant decrease in patient, and staff incident rates with both frequency and severity of injuries significantly reducing costs and business interruption.
What do we fix and how do we fix it?: Many approaches can be implemented to make a hospital safer aside from CMS/TJC compliance, one very effective approach I’ve witnessed firsthand is that when a healthcare organization commits to a zero incident culture, it starts the process of addressing the events regarding staff/patient injuries, medical errors and preventable Hospital Acquired Infections (HAI’s). The process starts with an organization’s mission and vision statement that includes language regarding the protection and safety of not only patients (We’ve all seen these statements advertised i.e. “Care Centered Around You”, It’s All About The Caring”, Complete Connected Care”, etc. to name just a few), but staff, volunteers, vendors/contractors and visitors.
Once the vision and mission reflects those values, then an organization takes it a step further by addressing staff with a formal commitment letter from the CEO that their goal is to reduce all incidents/injuries by X percent with specific steps on how to achieve. Today’s approach of training staff through a one day orientation, testing annually through a competency evaluation process, or routine in-services should be augmented with an Incident Review Process that analyzes each patient/staff/visitor incident with a thorough and complete Root Cause Analyses and effective Corrective Action Plan that target’s frequency and severity reduction.
Patient and Staff relatedness needs to be highlighted. This data should be communicated frequently and shared throughout the organization citing either reaching reduction goals, or not and detailing next steps. An ideal method to do this may be through an organizations intranet, newsletter, or meeting forums including Quality, Risk, Performance Improvement, Patient Care Assessment and Safety/Environment of Care Committee’s.
Another area of opportunity exists with changing the current structure of Environmental Rounds, or Safety Tours. Conducting physical environment inspections twice a year on patient units/patient care areas, and once a year for non-patient care areas is inadequate at best. It may pass a CMS/TJC audit/inspection but is typically not very effective at eliminating the risks front line staff face minute to minute, hour to hour, day to day. This process should be conducted more frequently by the staff closest to the risk, i.e. Nurses and managed at the Dept./Unit level. With today’s technology, the software can be based on a smartphone/tablet and communicated instantaneously.
These are just a few changes that can be made immediately by any organization to improve results and to reduce injury/incident rates and the probability of CMS fines due to high readmission rates.
Anything else?: While CMS is measuring Quality and Safety, organizations that decide to be proactive in implementing some of the steps outlined above should see immediate results making there facility a safer environment for all. Healthcare staff, patients, visitors, and consumers alike will elect to pick a safer hospital to do their business in as the market shifts to a consumer driven one. Make sure that you are in one of these safe healthcare organizations.