by Staci Porter
May 2019 – The Russian proverb “Trust, but verify” entered the American lexicon in the 1980s when it became a favorite mantra of Ronald Reagan during arms-reduction negotiations with the Soviet Union.
Reagan understood that while trust can provide a strong foundation for a relationship or agreement, verification is also needed to ensure all parties have moved beyond good intentions to take concrete steps toward achieving a mutually agreed-upon goal.
Though today’s healthcare landscape may have little in common with decades-old nuclear weapons treaties, Reagan’s “Trust, but verify” mantra holds particular relevance to one important contemporary question for health system executives: Are clinicians fully taking advantage of technologies that are intended to improve clinical outcomes and enhance financial performance?
Over the last couple of decades, we have seen widespread adoption of solutions designed to transform patient care through the implementation of evidence-based content, including standardized order sets and plans of care. Despite investing millions of dollars in these technologies, few organizations actually monitor whether clinicians are following the evidence-based standards that are proven to improve quality of patient care and safety, reduce the cost of avoidable adverse events, and create more efficient workflows.
As a result of this failure to verify clinician adherence to evidence-based practices, hospitals may miss relatively easy opportunities to boost a number of important quality metrics tied to mortality rates, lengths of stay, readmissions, hospital-acquired infections, and more.
Why evidence-based standards are important
Standardizing common practices on the basis of evidence has enhanced safety in industries outside of healthcare. For example, the number of worldwide aviation fatalities per year has dropped to about 250 today from around 450 two decades ago, despite a doubling of worldwide flight hours during that span, according to a study in the Journal of the Royal Society of Medicine.
Numerous studies have also found that standardization of medical care improves clinical outcomes, patient safety, and possibly costs. One way to create standardization is through the use of evidence-based order sets and plans of care. Evidence-based order sets and care plans guide providers to follow interventions that have been proven to drive the best outcomes and reduce unwarranted care variations that may lead to harm, waste staff time, and even impact the organization financially.
Unfortunately, despite the known benefits of evidence-based care solutions, many hospitals have failed to realize their full potential because of poor adoption by clinicians.
Barriers to adoption of evidence-based standards
Admittedly, establishing standardized order sets and plans of care for a broad variety of conditions requires a significant investment of health systems’ time and resources. This sometimes leads hospital management and clinicians to question whether the benefits of standardization equal the costs, though in many cases the benefits may be obvious: despite the availability of standardized, evidence-based order sets, I’ve seen instances in which a hospital has created hundreds of order sets–many of which may or may not be evidence-based–because of the individual physician’s preference to follow his or her own care routine.
Sometimes clinicians avoid using the hospital’s standardized order sets because the order sets don’t work well with physician workflows. Other times doctors choose not to use order sets because they don’t want to be “told” how to practice medicine. Still others believe these tools add to the many administrative burdens of delivering patient care.
Some organizations are stricter than others in limiting the use of provider-specific order sets and mandating the use of standardized order sets, with possible exceptions based on the individual health and care needs of each patient. Regardless of how stringent a hospital may be in terms of order set adherence, organizations rarely know if clinicians are indeed following plans of care unless they intentionally measure activity, either with analytics or manual patient chart review.
Better adherence, better outcomes
Hospital management may correctly trust that clinicians have patients’ best interests at heart; indeed, most doctors want to provide the best available care to their patients. But hospital leaders need to go a step further and verify that their clinicians are adhering to evidence-based practices included in standardized physician order sets and care plans.
In instances in which clinicians are not following evidence-based standards, leaders have the opportunity to engage providers to understand the gap, change workflows if necessary, and, ultimately, drive behavior change to create adherence. Continuous monitoring is key to assessing whether standardized interventions are producing intended results.
By verifying whether clinicians are putting into practice the evidence-based standards that hospitals have developed, both hospital management and physicians can reap the benefits of the improved patient safety and superior workflows that these protocols produce.
About the Author
Staci Porter, MSN, RN, is a senior clinical strategist at Zynx Health. In this role, she supports the planning, development, and maintenance of clinical decision support across the care continuum. Prior to joining Zynx Health, Porter worked as a clinical informaticist to assist the development, deployment and utilization of an electronic health system transformation.