Partnering with a Patient Safety Organization provides an important way to improve patient safety and drive down liability exposure. Thomas Piotrowski, executive director of Clarity PSO, looks back over the evolution of PSOs and gives his view of their future role.
Clarity Group, Inc is a healthcare services company that specializes in the management of professional liability risk exposure through integrated risk-quality-safety (RQS) processes and tools. The principals at Clarity have worked in the medical malpractice environment for more than 35 years, and have consistently operated on the fundamental premise that to best protect against allegations of medical negligence, healthcare providers must focus attention on quality and safety. No harm, no claim, period.
Clarity was formed 12 years ago, and with that philosophy we have worked diligently with our healthcare clients to adopt integrated RQS systems to modify behaviors and mitigate risk exposures across the entire system of care.
In 2005, the Patient Safety and Quality Improvement Act (PSQIA) was signed into being. Clarity watched the development of this act eagerly because we felt that our clients could benefit greatly by the principles described there. Among other provisions, the act outlined a system for the creation of Patient Safety Organizations (PSOs), whereby the open and transparent sharing of patient safety data would be used in order to help build a picture of national patient safety trends and awareness, and in exchange any data shared would offer certain protections for participating providers—both as privileged from use in legal trials as well as confidential from certain disclosures.
After the ruling was published, Clarity immediately filed our listing for Clarity PSO. As a component PSO and independent operating division of Clarity Group, Inc, we officially became listed as P0015 with the Department of Health and Human Services, Agency for Healthcare Research and Quality, on November 18, 2008, relisted for our second three-year term in November 2011, and recently relisted for a third three-year term.
We are proud to be a founding PSO in the patient safety movement as well as serving the healthcare providers who contract with us for our insight and services that support their patient safety efforts.
PSO successes: realizing the potential of the PSQIA
The types of patient safety activities that are afforded by the PSQIA and performed by Clarity PSO have yielded strong and positive insights and results for our client organizations. The table overleaf demonstrates some of those patient safety activities, followed by some of the changes that have been made as a result of these activities.
Some of the changes noted among our clients through their participation with Clarity PSO include:
• The beginning trend of decreasing events associated with harm to patients in the hospital setting, while encouraging greater overall reporting of safety concerns and events.
• A concentrated focus on raising awareness in ambulatory/outpatient settings of events that can lead to harm and capturing those events in real-time for accelerated interventions and more coordinated RQS management across the continuum of care.
• New practice guidelines being designed and implemented to address potential system issues that became clear through PSO data analysis and investigation such as hand-offs, risk screening, and development of specialty national practice guidelines.
Impact of the PPACA
The Patient Protection and Affordable Care Act (PPACA) created a sea-change in the configuration of healthcare delivery systems. A fundamental principle of the PPACA is access to affordable healthcare and the creation of an insurance marketplace.
Part of the PPACA legislation highlights what will be required of hospital providers who desire to work with the Health Insurance Exchanges (HIX) in the insurance marketplace, ie, a phased-in approach (through 2017) that will require all hospitals with more than 50 beds to work with a PSO if intending to contract through the HIX. To date, hospitals have been somewhat reluctant to participate with a PSO, but this provision will encourage/require that participation.
The way forward for PSOs
The benefits of contracting with a PSO are becoming much clearer.
• Maximize existing resources by focusing attention on the areas where the data suggest it is needed most in terms of harm reduction and system changes.
• Increase knowledge sharing and awareness-building in a safe place protected from discovery.
• Take a system-wide view of events that may be happening, accelerate decision-making in terms of needed interventions, and support sustainable change over the long term.
• Enhance your culture of safety and watch it spread throughout your organization.
Ultimately, AHRQ (and HHS) have a goal to create a national repository of data that can be used by all providers to create positive change in their organization(s). The Network of Patient Safety Databases is coming together to accept data from listed PSOs nationally. Once operational this can become a rich source of information for healthcare providers nationally to reduce harm and enhance healthcare quality.
Healthcare providers working with a PSO have the power to move from experiencing repeatable (and arguably preventable) errors that eventually cause harm to a more predictive modelling process that can determine where the potential for harm exists and where it can be proactively mitigated. One way that PSOs will help to do this is to transform Common Format reporting from its current state (which is a retrospective analysis of an event) into a surveillance type of analysis.
The future of PSOs must focus on what can be possible with a different look at safety. Yes, we must continue in-depth analysis and research and identification of best practices. But we must also consider how we can infuse safety into every aspect of care delivery from the very beginning of formal education and training as well as those not-so-obvious areas.
Clarity PSO embraces our role as a part of this exciting movement, partnering with providers across the country to continuously foster excellence in patient care and safety in all healthcare delivery settings.
What the PSQIA means for healthcare providers
• Aims to improve safety by addressing:
• Fear of malpractice litigation;
• Inadequate and varying protections by state laws; and
• Inability to aggregate data on a large scale.
• Creates PSOs to assist healthcare providers in their patient safety activities.
• Provides Federal legal privilege, as Patient Safety Work Product, and confidentiality protections to information collected for patient safety and healthcare quality enhancement purposes and assembled and reported by the healthcare providers to a PSO or developed by a PSO to conduct patient safety activities.
• Limits the use of patient safety information in criminal, civil and administrative proceedings and imposes monetary penalties for violations of confidentiality or privilege protections.
Patient Safety Organization, Thomas Piotrowski, PSOs, Clarity Group, Clarity PSOs, RQS, PSQIA