February 2024 Healthcare Hygiene magazine February 2024 | Page 20

data , staff and patient feedback , and best practice to strengthen internal processes and promote safety .”
Part of a total systems approach is the hazard vulnerability assessment ( HVA ), which “ proactively helps provider organizations identify a range of potential hazards that may lead to emergencies ,” according to ECRI ’ s recent whitepaper , Total Systems Safety Approach to Hazard Vulnerability Assessment ( Madrigale and Rose , 2023 ). The whitepaper acknowledges that “ Emergencies disrupt continuity of care and service delivery by shifting normal day-to-day activities from routine to non-routine , and in the worst cases , pose very real danger and threaten the lives of patients , residents , and staff .”
Madrigale and Rose ( 2023 ) explain that the quality of an HVA can determine outcomes of an emergency because “ it serves as a framework for overall emergency preparedness and response . After identifying potential hazards , organizations should use a participatory and structured approach to assign value to these hazards before they occur , thus prioritizing potential hazards by considering likelihood , frequency , and severity to better inform emergency planning . This process provides information critical to an organization ’ s mission of protecting residents from harm by having tested policies , procedures , and processes that guide decision-making and action for the duration of an emergency .”
Victor Lane Rose , MBA , NHA , CPASRM , FCPP , executive director of Aging and Ambulatory Care for ECRI , and Cailin Madrigale , risk management analyst for ECRI , share their perspectives in the following Q & A :
Victor Lane Rose
Cailin Madrigale
Q : Do you have a feel for whether U . S . healthcare systems are currently conducting an HVA as part of their risk assessment and mitigation strategies ? If they aren ’ t and this is new to them , how important is it for them to do so considering the recent pandemic and likely other public health emergencies to come ?
A : Conducting an annual HVA is required for organizations that participate in reimbursement programs from the Centers for Medicare and Medicaid Services ( CMS ), meaning most organizations should be familiar with the concept and process . However , that does not mean that most organizations have optimized their HVAs to get the most out of the effort , such as an all-hazards approach aligned with total systems safety . It is extremely important to undertake this effort . HVAs are key to ensuring an organization ’ s emergency preparedness and response programs are comprehensive and equipped to effectively manage emergencies as they occur to mitigate potential harm and ensure continuity of care and services . The pandemic showed just how ill-prepared organizations can be when emergencies occur on such a large scale and for long durations when certain contingencies are not in place or certain variables are not considered during the HVA process .
Q : Is an HVA appropriate for helping to manage a smaller-scale emergency as well ?
A : Any emergency that disrupts continuity of care , large or small , poses a risk for potential harm . Consider what happens during a search for a missing resident , where staff from all areas of the operation must be deployed to help search a building and grounds , pulling them away from their routine duties . It can create an environment where adverse events are more likely to occur , in addition to the potential harm that might befall the missing resident or patient . An HVA would still outline the organization ’ s current capability to manage that emergency and reveal improvements that may be necessary to minimize operational / care delivery impact .
Q : Can an HVA get healthcare facilities thinking about new hazards , especially in an age of evolving complexities of care processes and technology , coming together as the perfect storm ?
A : Using a total systems safety approach can help identify emerging issues by revealing biases inherent to any process . Past experiences with emergencies , for example , tend to shape where we look for potential hazards , which opens the possibility of either missing certain hazards altogether or missing important elements associated with a potential hazard and resulting emergency . Undoubtedly , many provider organizations identified infectious outbreaks as a potential hazard , but our experiences showed us that few providers were truly prepared for such a pandemic that reached the scope and duration experienced during COVID . Having a multidisciplinary team to collaborate on the HVA process can help overcome such inherent biases as they can identify key evolutions in care processes and technology that may not be familiar to individual departments or medical specialists .
Q : How can an HVA address infection prevention risk and strategies as part of its scope ?
A : An infection prevention HVA would outline specific infections that the facility or community is at risk for outbreak , such as routine influenza , healthcare-associated infections ( HAIs ), or emergent infections like novel coronaviruses . The HVA would then identify infection risk based on probability rate , severity ranges , and mitigation strategies . The scope of HVAs is inherently targeted and comprehensive to best inform improvement , planning , and prioritization efforts .
Q : Is a total systems safety approach compatible with efforts to be high-reliability organizations , and other quality improvement models ? How so ?
A : Total systems safety is indeed compatible as it ensures that all improvement efforts address core healthcare safety fundamentals . In the context of an HVA , a total systems safety approach provides multiple lenses from which to identify potential threats and shapes an organization ’ s response to that threat to better prepare and reduce the potential for preventable harm . As mentioned earlier , the COVID-19 pandemic emphasized the care-critical importance of including staff safety and well-being in our emergency preparedness and response activities . Continuity and quality of care is almost impossible without continuity of staffing and scheduling . All hazards that pose a threat to key processes or parts of the care and service continuum should be considered . Additionally , any quality improvement model can incorporate total systems safety by considering how the subject requires improvements from culture and governance , patient and family engagement , worker safety , and learning system perspectives . Doing so helps organizations on their high-reliability journey as well .
Q : Post-pandemic , do you think organizations and healthcare personnel are more receptive to an HVA and its goals ? Or might there be some challenges in implementing this due to ongoing staffing deficits , resource shortfalls , etc .? And what are some ways to counteract those ?
A : HVAs are fundamentally important to understanding basic risks to healthcare organizations and pave the way for emergency readiness , which is always beneficial . Although ongoing industry struggles indeed present challenges in routine maintenance for emergency programs , such programs should remain a top priority given the devastating impact that emergencies present . Conducting HVAs does not need to be a time or resource-heavy endeavor as all HVAs are scalable to fit the needs of the organization . From a risk management and safety perspective , organizations cannot afford to allow HVAs and emergency preparedness to fall to the wayside .
References :
Madrigale C and Rose VL . Total Systems Safety Approach to Hazard Vulnerability Assessment . ECRI . 2023 .
National Steering Committee for Patient Safety . Declaration to Advance Patient Safety . Boston : Institute for Healthcare Improvement ; May 2022 . ( Available at www . ihi . org )
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