Episode 23 - Candace Eden - Preventing Healthcare Violence

Candace Eden urges healthcare organizations to use external peer review and shares some steps hospitals take to prevent violence.

  • 00:00:00 - 21:26:00

    Jerrod Bailey 00:00

    Welcome to Reimagining Healthcare: A New Dialogue with Risk and Patient Safety Leaders presented by Medplace. We're excited to bring you conversations with top risk and patient safety thought leaders from organizations around the country. Please subscribe to get the latest news and content. And if you value this episode, please feel free to share it with your colleagues. We're trying to create meaningful dialogues and other communities around the country. If you're interested in participating as a guest, please send us an email at speakers at Medplace.com. My name is Jared Bailey. I'm the CEO of Medplace I'm going to play host today. And today I'm joined by Candice Eaden. Hi, Candace. Now I want to zoom in on a particular topic that we deal with a lot. And I know this is part of what Joint Commission deals with, but peer review. So Where does Joint Commission see peer review in the overall sort of kaleidoscope of patient safety and quality?


    Candace Eden 00:57

    So typically, we don't serve a to peer review, right, we look at opp II, we look at your FTP, which are two things that are just looking at how do you onboard physicians and make sure they're providing the right care through a peer evaluating them? And how do they continue to provide care and get re credentialed through peers evaluating them. So it is, in a sense, looking at peer review, but not an immediate focus. So peer review is typically for providers anyway thought of as like individual look at care. But here's where we need to not forget. What's critically important is often in those individual peer review cases, we'll find system process issues, and we need someone in the room that can call that out, can pull that out and take it and then help to improve whatever that process issue is. So for example, let's say there's a provider that doesn't hear a critical result. And they don't treat that critical result the patient doesn't do well, they have an adverse medical event because of it. And they're now here in front of peer review. Well, if how did that process work? Did they get that critical result the way it was supposed to happen? Were they called in the time way? Did it go up the chain, if it should have. So those kinds of things need to be looked at too. But what is so important about peer review is to make sure that we're keeping up with the standards of care today. So I think we need to look at who is doing that peer review in our own facility? Do we need to think about other people doing that peer review, maybe we can talk about that a little bit, because I think that's an important area too.


    Jerrod Bailey 02:40

    Yeah, so you know, this concept of independent or external peer review as a tool to use strategically and tactically intermixed with sort of normal day to day, internal staff peer review each other, that's something we talk about a lot, it's something we facilitate on our platform. But I've seen the power of it, I've seen the power of you know, we've talked a lot about system design, and just sort of like flawed system design. And one place where you can create flawed system design is when you have a reviewing component of and this happens in software development, and all sorts of other places, not just healthcare, we have a reviewing component, where you have two collaborators reviewing each other, or two competitors reviewing each other, which often happens in healthcare. And from a system design perspective, you're only ever going to get certain types of data out of a system like that, right? If you have two people that have to show up and have breakfast with each other every morning especially if something difficult happens, right? So when I think about independent peer review, and I think about how relatively few organizations do it, I think most would want to do more of it. It's just historically been very difficult. But the power of it's pretty, pretty self evident. From what I've seen, I don't know if you've had similar experiences with it. I've had


    Candace Eden 04:05

    a lot of work with peer review. And, and I agree with you completely. First of all, if you're in an academic setting, it seems that it's easier to do an internal peer review, just because there's more people that are involved, right. And it's very academically oriented. It's a it's a growth and learning opportunity for residents also in fellows as well. So it's thought of a little bit differently, and it's not a shameful environment, right. But if you're setting or you've got physicians that have been working for a long time well respected and as you said, they might have one or two partners and they socialize with these partners. They eat breakfast with them every day of coffee. So it's it's going to be difficult for either one of them to call each other out on something. But that's where you really need to look at external peer. I think it's critical. It's good to have an independent set of eyes anyway on these cases sometimes it helps us learn and grow. Plus, I think often there are groups of physicians that they've learned from a mentor long ago who was well respected and trusted. And they learned this in med school. And that's the way they did it. And that's the way I do it. And they're not keeping up with what the latest standard of care is. So having that external peer reviewer kind of ups your practice right up to the standard. So that's, that's how I've seen it work. Well.


    Jerrod Bailey 05:27

    Yeah, it's interesting, I think the best policy I've seen, and I'm totally biased when I say this, but it comes from a place that's well, I won't mention their name, but it comes from a hospital system that's sort of regarded as very, very well run, right? They have a great culture of growth, their culture is not punitive at all. It's very much. It's almost like a game. It's like where who can find the next flaw in the system that we can jump on and fix, right? And, and it's very much like, it's a lot of just Hey, I found something I did something yesterday, which this seems if I made this mistake, then I'm sure somebody else is going to make a mistake. How can we, how can we fix this, and they have a policy of there, it's an aspirational policy, try to get to 10% of the other peer reviews get done externally. And they do it programmatically, where it's not a response to something went wrong, or somebody made a mistake. It they also do it for those things. But it's really more of hey, we're just going to take a percentage of what we do, and we're going to even wait it towards the specialties or the practices that we do that are highest risk, right, that end up in lawsuits and things like that, we're probably going to favor those a little bit more to do independent review, just to get more outside, eyeballs on things going on and make sure that we're accounting for our own bias. It's really fascinating from a culture perspective. And I of course, I've seen on the other side of the spectrum, which is, uh, we've never asked anyone outside of our organization, how we're doing anything, right, it's very much the opposite. And I would say the majority of providers tend to fall more towards that, that end of the spectrum, but boy, when you see it done, and you see the collaboration between a highly trained medical specialist and someone they consider a respected peer clear across the country that they don't have to have breakfast together. They're just, they're just talking about the medicine together. It's a really beautiful thing.


    Candace Eden 07:25

    Oh, that is that's the ultimate, isn't it for peer review, I would think. And I think we need to get there, the system you're talking about, obviously, going towards high reliability, which Joint Commission favors they also look for if the Joint Commission just put out a paper recently, this week on using it's called safer DX checklist. And it has to do with diagnostic trigger. So I'm sure that's part of the peer review process that you're familiar with, and use for even your company. And it's just looking at those things ahead of time, like you said, finding those flaws in the process, before something bad happens. Getting those red flags are signals I think almost like gaming gamers play games, and they're always looking for the flaws in the game. So it's the same kind of thing, we should be modifying it to our care. Yeah.


    Jerrod Bailey 08:14

    I love and you've seen, you've seen other industries move in that direction, in healthcare has its own unique idiosyncrasies, and some things other industries do, can apply, and some don't, right? But we know that again, so I come from a human centered design background. And ultimately, humans are the same across industries. And if you sort of understand what, what creates positively reinforced patterns of behavior in humans, technology can facilitate that processes. But ultimately, it's part of that culture that we're trying to create, right. So I want to talk about something do you end up dealing with any of this workplace violence stuff that's going on right now is a small or big part of what you do?


    Candace Eden 09:00

    Huge. I definitely would be remiss if I didn't talk about that. It is a passion for me also being a nurse for many years working in emergency department, I've seen a lot of workplace type violence from patients, and really staff bullying each other. There are certain institutions even within nursing in certain units, where nurses will bully the newer nurse just because you can't meet our expectation. And that has to be ended. So I see a lot of organizations shared across the country are stepping up here and they're putting things in place. For example, I don't know if you saw but Brigham Women's Children's Hospital has just put out a patient Code of Conduct of things they will not tolerate. They will not tolerate patients that are using words or actions that are racist or discriminatory or harassing, and they tell them right up front. Here's what will happen if you should use these words or these behaviors. And it's an All different languages. I love that so much.


    And here's something really interesting. And I'm excited about this, because this is a Florida thing. I'm from Florida, and Tampa General Hospital is cutting edge, the first hospital in Florida put in a weapons detection system, and all of their entrances. And for patients, for visitors and for staff as they come in, I mean, after these Dallas shootings of the social worker nurse that we lost, that should never have happened people were afraid to take patients rights and be looking at their belongings. No, I say you don't come into our facility unless we can look at your belongings and make sure you don't have weapons on you. And Tampa General also has a dog, his name is stone, he's being trained right now. And he is also a weapon detection device. He's got his officer bowl that's working with him right now. And to me, this is forward thinking leadership, these are leaders that have stepped up and said, We're not going to let this happen in our institution. And that's what we all need to be doing. So


    Jerrod Bailey 11:01

    it's amazing. You know, there's so many, there's so much power in that idea, right? So the idea that we need to do something and we're going to take some steps, that the threat isn't any given day that someone's going to come in and shoot for hospital, right, the percentage of that happening is very, very small. The threat is the fear of that happening. Right. And it's in it's the fear that when patients walk in to a facility that they're safe, or we want them to feel safe, right? We want the staff to feel safe. And if they don't, it's an accelerant to the stuff that we've seen the last few years, right, that was sort of catalyzed by by COVID, I think in a lot of ways. Yeah. So you know, when we think about like trends, I'm seeing this trend, the sort of this, it came through COVID. But what I don't know is it continuing? Is it accelerating? Is we seeing a deceleration of the sort of combative nature of patients and their health providers, like what are you seeing? Because you see,


    Candace Eden 12:04

    it's unfortunate, but I'm going to say yes, it is a trend. And it's continuing. And again, you hospitals have got to step up to help keep staff safe. So what Joint Commission has done, they created a workplace environment gap analysis tool, we go specifically and ask if they analyze their workplace issues, what are they doing about them, we talked directly to the leadership about it, they are surveyed to it when the Joint Commission surveyors come. So we're trying to keep it fresh on everyone's mind that something has to be done.


    And some things I'm seeing, there are badges that nurses say, oh, I can push my badge. And people will know if I'm in trouble and people will swarmed to help me. I mean we've seen nurses thrown on the floor in a critical care unit, bash their head, with patients, we've seen all kinds of awful things happening. And nurses were afraid to say anything, they thought it was part of the job, Jared, I thought it was part of the job. I thought, Oh, if I get hit spit upon punched, it's just I'm a nurse, this is you know, I'm just supposed to take it and I'm taking care of them. No, we want to make sure people know to speak up, we're watching this, we're taking care of it. And there are you know, committees all across the country looking at those events and talking to staff and saying let's press charges if you really have a serious issue. You know, we just have to be very cognizant of that and keep our staff and patients safe.


    While plus nurses don't want to go into the profession, if they think see this is happening. And we already have staffing issues, we cannot afford to lose young nurses coming into the profession male or female, if they're afraid


    Jerrod Bailey 13:41

    it's amazing. I've been in the tech world my whole life, right and ever had to be in the clinical setting. And can imagine being afraid to come in or having a you know, when a Migdal is get hijacked. And in you know, in your there's, it's already a tense situation, to have to navigate that and then and then have to pull yourself up by the bootstraps and come in the next morning. And that's a that's a tall order.


    Candace Eden 14:08

    Yeah, I think after that Dallas shooting, I don't know if you got to see the video. But you know, the video just you hear more than see anything. But you know, nurses saying that or people that are thinking about going the professional, they're just not going to it's just too big a risk, right? So we've got to make sure that we can take care of our patients safely.


    Jerrod Bailey 14:27

    Is this is this all because you talk a lot about creating a culture of safety. Is this all under that umbrella? Or like what does that mean to you? It's what's that drum that up?


    Candace Eden 14:38

    Yeah, it truly is. So for me the culture of safety is really where leaders are stepping up and being accountable and everything is about addressing quality and patient safety and staff safety. All three, right? So in everything they do and how they model their own behavior, how they respond to situations that they do encourage that transparency we talked about earlier. We're pleased to report things that are happening. I mean, staff are the ones that know where the next VAT event is going to happen. Because it's happening right there. They see the flood system happening every day. So we want them to tell us that.


    So leadership has to be out there talking to the staff, asking what is the next adverse event that could happen here? What could we do to make things safer for you, and really get that feedback, and then take it to heart. So you know, there is a patient safety culture survey in the state of Florida, it's the only state that has said it's mandatory. Other facilities do it across the country and survey, surveyors and us as consultants from Joint Commission asked about that data. But in Florida, the state has said you must do it. So we're looking for staff to give feedback in the hospitals here in Florida. And then they have to make improvements. And it's published publicly. So the public can pull it up and see what is being said about that hospital by their own staff. So that really puts the culture of safety in the minds of those executives and leaders to make sure that they have,


    Jerrod Bailey 16:03

    yeah, radical transparency. There's, there's carrots and sticks to get us there.


    Candace Eden 16:08

    Radical candor, right.


    Jerrod Bailey 16:11

    Yeah, that's right. Well, Candace, this was great. Is there anything that we missed that you that you'd love to communicate, if we missed anything?


    Candace Eden 16:20

    You know, I just hope I made the point of that culture of safety and how critical it is for transparency, I just want to make sure that's happening. I want to make sure that we are thinking out of the box, working with other industries to see how can we deliver health care in our communities in the best way possible. So maybe everyone can't do heart surgery, right. Even though it's a big moneymaker, maybe we can all do that. Maybe we need to take turns and what we do, and really address the needs of our community by the health care that we deliver, and sharing, like you said, Jared, sharing across the country with others, what are you doing? What can we do don't reinvent the wheel, don't make policies and procedures all different? They can they can all be very similar, just customized to you. And then thinking about that whole financial solvency what are we going to do about that we need to make sure that we can still operate right in a humane and safe way. So


    Jerrod Bailey 17:17

    well, oh, my gosh, rates every day, I'm seeing another bankrupt facility. Right. It's really hard. I know. I know, a lot of the executives that it even very, very large facilities, and it's just been just a taking a beating these last couple of years, they really have it's interesting, the public thinks that the the hospitals are, are making out like bandits or something, it seems to be this perception with the new it's it's very, very difficult situation or just to keep stay solvent and provide beds and provide care.


    Candace Eden 17:51

    To be able to get care, right, we have to be able to get it in a safe and humane manner. Right? Quality. Yeah.


    Jerrod Bailey 17:59

    And we have to keep the lights on while we do it so that we can do it. Well, Candace was great. I plan on following up with you because I like I said, I need your advice on all kinds of things in the industry, what usually triggers a an administrator or hospital to reach out to you what what's usually going on that they pick up the phone and say any cancer. So


    Candace Eden 18:20

    I think it's those in the quality department and patient safety arena, and maybe even risk that are aware that there are things happening in their facility that need a closer look. And also if it's getting close to that survey time they get surveyed usually about every three years of its joint commission that they are utilizing DMV or other agencies that could be every year or so. So it's they know what's coming up, and they want to make sure that they pass or do well. I mean, it's your Medicaid and Medicare dollars. And now we're looking at things like how well are you doing with readmissions? I mean, you saw CMS penalized quite a few facilities that weren't reducing readmission. So they're losing the money, they can't afford to lose it. So those that really care about quality and patient safety, they're the ones that will call and reach out. And I will tell you, I can't honestly say who, but big organizations in this country are the leaders in this, they are the ones that are calling and saying, Come help us we want to do well, we really care about what the care we're delivering. So that gives me some reassurance that things are still happening in a great way for


    Jerrod Bailey 19:25

    I believe in it. I'll talk to administrators and it's very easy in the first conversation I'll know philosophically where they land. They it's I think it starts with the leadership to your point before it goes all the way to the board and there's a philosophy of patient safety and improvement drives our whole operation and then and then you have this just don't have that philosophy, right. And it's definitely more clear that it's, well, it's, it's we want to do good business, we want to grow we want to expand we're going to do this thing but you're not hearing this sort of driving drumbeat of that philosophy. sippy and, and frankly, I'm really astounded how many providers do have that and are marching in that direction and really have a heart and a passion for it. I think it's because it's a lot of folks like yourself who came from the bedside. And they've seen from the human, very human interaction of caring for a person, what that looks like when it can be done well at scale. Right,


    Candace Eden 20:22

    exactly. And you know what else I didn't mention it, but it's the board. So your governing body is the ultimate accountable. They're ultimately accountable for your quality and patient safety in your facility. And many are external members of the community. So Joint Commission is now saying, if the governing body isn't aware of this, or they haven't done this, or you haven't taught them, they're the ones that are getting cited. So governing body is hearing from the consumers in the community. And I think they're taking a much more active role. So I think that really helps guide the leadership and executive leaders of organizations as well.


    Jerrod Bailey 20:57

    I love that. Well, Candace is pleasure. Thanks for spending some time with my pleasure, too. If anybody needs to get a hold of you, obviously, we'll put your LinkedIn any anything specific. You want to tell people to how they find, you.


    Candace Eden 21:10

    Know, I think LinkedIn is the best way, um, email me, I'm happy to give out my Candace eden@yahoo.com. Please feel free to reach out. I always love to talk about my passion for patient safety and staff safety. So


    Jerrod Bailey 21:26

    on LinkedIn, you were the first Candace Eden that I found. So I think, maybe the most popular one on there, too. I'm sure they made more than one of you. But anyway, well, it was a pleasure. Well, for everyone else, thank you for listening to reimagining healthcare and new dialogue in risk and patient safety. Subscribe and Share if you found it valuable. And if you'd like to participate again as a guest, just email us at speakers at Medplace.com And make sure to follow Candace and connect with her on LinkedIn. Candice. Thanks again. And this was great. Thank you. Right Talk soon. Bye bye.

In the second part of her discussion with Medplace, Candace Eden elaborates on how to create a culture of safety using peer review and communication. She then pivots to describe the uptick of healthcare violence facing doctors and nurses and the steps some healthcare organizations are taking to mitigate it. Eden calls on hospitals to enact quality systems, information sharing, and protection for providers to avoid tragic outcomes, expensive verdicts, and poor staffing.


Guest - Candace Eden

Joint Commission Consultant

Candace is a seasoned DNP executive with 40 years of nursing experience and over 28 years of leadership and quality improvement experience. She currently serves as a consultant of the Joint Commission, where she helps organizations across the country interested in evaluating their current processes and workflows to aid in continuous improvement and Joint Commission survey readiness.

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