Nothing new doesn't mean nothing important

Do not be complacent about NPSGs

The 2013 National Patient Safety Goals (NPSG) came out last month and did not really include any big surprises. Indeed, there was nothing new in them. But that doesn't mean you do not have to pay attention to them.

According to Bill Metzcar, the CEO of Ohio-based ISO Consultants for Healthcare, "this is the year that hospitals should seek to improve performance in the areas of the patient safety goals, as well as core measures and HCAHPS." Because so much is happening in health care, a break from worrying about something new in the patient safety goals can give quality professionals a chance to take a breath and perhaps look a little deeper, he says.

"Hospitals should be prioritizing their focus on the NPSGs by evaluating current performance, understanding problem-prone processes, high-risk areas and activities, and then determining through their annual planning where to devote their time for improvement," Metzcar says.

There are some process-focused building blocks within some of the NPSG's chapters, he says. "This makes TJC's [The Joint Commission's] desire to bring hospitals to a level of process management evident, but the overall approach must be considered as in-progress."

Metzcar did notice a couple of things in goal 7, which is related to infection control, specifically in NPSG.07.03.01, related to healthcare-acquired infections with multi-drug resistant organisms, and NPSG.07.04.01, related to central line-associated bloodstream infections. Both chapters include some initial steps toward process management within the elements of performance, he says. "First, within the elements of performance there are two levels of criteria. The first is specific criteria that apply to the activity, and the second level is criteria that focus on process thinking. Many years ago as I worked with experts in quality management and process improvement, there was a common statement: 'Design quality into the process rather that inspect quality in later.' When I first heard this statement, I did not understand the intention, but through maturity in process improvement and quality management, this statement is at the core of how healthcare must change in order to improve."

For example, look at some of the criteria that is process-specific in chapter NPSG.07.04.01. In the elements of performance, it states under points seven through 10 specific steps for the process. He calls them quality control points. These include hand hygiene, not inserting catheters into femoral veins in adult patients unless other sites are not available, using standardized supply cart or kit, and standardized protocols for sterile barriers. "These are all great points and should be followed and used as education throughout healthcare," Metzcar notes. "However if these points were what was needed to be successful, then once hospitals implemented the elements as standard practice, our process should perform well and we would not need this chapter included in the NPSGs."

The Joint Commission has included what he deems the most important aspects of this chapter in the first six elements. They include education, policies and practices, periodic assessment, and risk evaluation. Says Metzcar: "These are not all inclusive of the process foundation, but it is a start, and they represent a powerful tool when implemented properly and completely."

Often he says he will see hospitals implement TJC's requirements chapter by chapter in a silo model throughout the hospital. But this leads to process variation that will have to be managed by hospitals, since multiple policies and methods will have been developed independent of the overall hospital system.

Metzcar says that despite the lack of change in the goals, "there is ample opportunity for hospitals and healthcare facilities across the country to re-evaluate their processes and interactive systems to continue driving improvement and changing the culture of an organization and ultimately yielding safer care for the patient."

The complete list of goals can be found at Metzcar warns that what's in the report isn't the most important thing. What counts is what yields the results, and that should be front of mind all the time, not just when the next year's goals come out. "You shouldn't need the goals or TJC to tell you what your weaknesses are. If you are looking at the data you generate all the time, you will know how your hospital relates to these goals. You should already have a strategy in place for figuring out what to do next. Do not wait for TJC to tell you."

For more information on this topic, contact Bill Metzcar, CEO, ISO Consultants for Healthcare, New Madison, OH. Email: