Rulon Stacey is so excited about Web conferencing that you'd wonder if he doesn't get out much, which isn't the case.
Another U.S.-Israeli friendship
Patient-safety collaboration seeks broader Middle East participation
He's president and CEO of Poudre Valley Health System, which has two hospitals in northern Colorado and serves communities scattered into neighboring Wyoming and Nebraska, and he has friends far from the Rocky Mountains. Stacey and two friends and colleagues in Israel have enlisted a handful of their peers to work together across huge distances toward improving healthcare in what they've named the International Patient Safety Collaborative.
“We're learning things from each other from across continents,” Stacey says, recalling a recent Web conference on hospital-acquired infections conducted with healthcare professionals stretching from the West Coast of the U.S. to Jerusalem.
“Just listening to them, I thought: ‘Holy mackerel! I think we've got something here,' ” Stacey says. “This was just a dream a year ago or so.”
Anything resembling results remains many months removed, but the collaboration's progress has been substantial. Two years ago Stacey, along with Shmuel Reznikovich, administrator of Netanya (Israel) Geriatric Medical Center, and Zvi Stern, director of the Mount Scopus campus of Hadassah University Hospital in Jerusalem, spotted an opportunity to receive grant funding through the Binational Science Foundation, which supports collaboration between U.S. and Israeli researchers.
They didn't get the grant but decided to push ahead without funding with the groundwork they laid, and an inaugural face-to-face meeting was held September 2008 in Jerusalem.
The initial inspiration was to include Palestinian hospitals in the effort. Reznikovich says there were three underpinnings. The first two are practical: Improve patient safety and do it without reinventing the wheel by sharing knowledge. The third is hopeful: “Maybe we'll be able to warm up the frozen peace process.”
So far appeals made to the medical directors of four Palestinian hospitals in the West Bank have been declined or unanswered, Reznikovich says.
“No matter what is our personal opinion in our home, walking in the hospital we think about the best for our patients, regardless if they are Arabs, Jews, Christians,” Reznikovich says. “As you can see in any Israeli hospital, there are patients from every belief. When they are patients, they are patients.”
Although he is ambitious in his belief that a shared healthcare mission might budge an intractable political impasse, he's also realistic about how the political climate could determine whether such collaboration can happen.
“It's 100 miles above your head and your capacity,” Reznikovich says. He adds, though, that the invitations will continue to be made, and he hopes that the Palestinian hospitals will be represented at a meeting in June to be held in Jerusalem.
Under the umbrella of the collaborative, two networks have been established. One targets hospital-acquired infections and the other is focused on medication errors, both using a model derived from the approach of the Institute for Healthcare Improvement in the U.S. Each participant in a network has written an aims statement, identified things that affect those drivers and selected interventions.
Each network also has a shared set of goals. For drug events, they include implementing electronic error-reporting and improving use of automatic medication dispensers. For infections, they include improving handwashing compliance and cutting the incidence of infections caused by particular strains of bacteria by 30% in one year.
Now they're measuring and sharing, working toward drawing some conclusions to share when they convene again in person in Jerusalem in June 2010. After the current networks conclude, Poudre Valley Health System intends to administer a new one on ventilator-associated pneumonia.
In the meantime, collaboration is happening remotely across many time zones. The networks meet virtually each month in formats that have been evolving through trial and error, taking place early in the morning in the western U.S. and at 5 p.m. in Israel. The first meetings were via teleconferencing with spotty call quality and a disruptive moderator, which proved particularly challenging as members struggled with one another's accents (the meetings are conducted entirely in English).
The discussions have evolved to combine the phone hookup with a Web-based meeting place, allowing presenters to use visual materials, and a test session with video conferencing is planned for February.
Marly Christenson, system director of clinical transformation for Seattle-based Providence Health & Services, agreed to administer the network on hospital-acquired infections, in effect absorbing four of the Israeli hospitals into a project that was previously planned for the system, which owns or sponsors 24 hospitals in Alaska, California, Montana, Oregon and Washington state.
“There's an additional experience in this international collaboration that adds one more level of incentive and motivation—this sense of really contributing globally to patient safety,” Christenson says. One realization from the experience, she says, is that clinicians in Israel lack accreditation standards shared by clinicians in the U.S., which provide a framework for improving patient safety. A central-line checklist, for example, isn't a universally regarded standard of practice, she says.
Such differences have encouraged her Providence teams to think in new ways in order to help their Israeli counterparts motivate their clinicians' behavior, and also engendered new respect for U.S. standards that at times seem like headaches. “It's helped us realize it can be a benefit to have that framework,” Christenson says.
The Joint Commission International, meanwhile, is administering the network on drug errors. Deborah Nadzam, JCI's practice leader for patient safety, says the project has required significant flexibility recognizing all of the participants are volunteering their time and resources to be a part of it.
One consequence of such flexibility is that there's no standard method of measuring and no central database to which the hospitals are contributing data.
However, adds Nadzam's JCI colleague Jeannell Mansur, practice leader for medication safety, there is a real benefit in the simple act of sharing. “One of the objectives is just to create a new venue where we can talk to each other and learn from each other,” Mansur says. “There's a real hunger.”
Stacey says he believes the reach of the collaborative could become much broader than he and the other founders conceived. Some recent meetings have been joined by Krishnan Sankaranarayanan, the senior patient-safety officer at Tawam Hospital, in Abu Dhabi, United Arab Emirates, and by the hospital's medication safety officer.
In an e-mail, Sankaranarayanan says he hopes Tawam Hospital, which is managed by Johns Hopkins Medicine, Baltimore, will become an official member of the effort in 2010. He also is thinking of ways the organizers might reach an audience in Middle Eastern and North African countries, such as holding a conference in Jordan or the U.A.E. or attending the Patient Safety Exhibition & Congress in Abu Dhabi in October 2010.
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