Becker's Clinical Quality & Infection Control

5 electronic medical record freed medical unit sec- retaries from transcribing orders. "Now we have a safer system where the doctor enters the orders directly into the computer," Ms. Liner says. "So medical unit secretaries could take on more of a role of support for the clinical staff." Additionally, the health system implemented pro- cesses such as placing monitors in patients' rooms so nurses could document there. "Rather than having to run around and have hard copy things, they could turn a monitor around and show [the patient] their medications they're going to be going home on," Ms. Liner says. "It became a great tool to engage the patient in dialogue about their care." Novant also had pharmacy techs pull needed medications and place them in patient rooms so that nurses wouldn't have to go looking for them. All of the care process improvements were incor- porated into the system's EMR, Ms. Liner says. "We were really able to accelerate time with the patient by hardwiring activities into the EMR," she says. The system originally put the reforms in motion in 51 of its nursing units and now has the changes implemented in all of its now 15 hospitals. Nov- ant nurses now spend 72 percent of their time in patient rooms, Ms. Liner says. And more direct care time isn't the only posi- tive consequence of the improvement effort. Ms. Liner says Novant has also seen reductions in falls and an increase in patient satisfaction now that nurses are more routinely available. Nurse turn- over rates and infections are also down. Ms. Liner says these developments played a definite part in seven Novant Health hospitals achieving Magnet recognition from the American Nurses Creden- tialing Center in April. To other organizations aspiring to achieve simi- lar results, Ms. Liner advises engaging frontline nurses early on and involving them in the devel- opment of the care model design. "We are proud of the fact that we had our nurses engaged early," she says. "I encourage and offer that as a first step that they take." n Bringing Nurses Back to the Bedside: How Novant Health Tripled Direct Patient Care Time (continued from cover) More than a decade later, it seems the healthcare industry — and accountable care organizations, specifically — are facing the same challenge. A qualitative interview study led by a researcher from New York City-based Weill Cornell Medical College found many people who work in ACOs and public health agencies view the terms population health, public health and community health as the same or similar. "For a few [interviewees] it appeared to be the case that they had not distin- guished between the three phrases before, and reactions during the inter- views varied from intrigue to bemusement," according to the study via BMJ. The findings are based on 39 interviews total, 29 with Medicare ACOs and 10 with public health agencies. The median interview time was 32 minutes. Below are the most common perceptions for each of the three terms. Population health People working for ACOs most commonly defined or referred to "popula- tion health" as a defined group of patients. Sometimes these were directly described as the ACOs' "attributed" patients or those for whom the organiza- tion was at risk for financially, and sometimes as the ACO host organization's patients more generally. The second most common perception of the phrase "population health" was that it referred to all the people living in a geographical area. Researchers found this view to be more common among interviewees from public health agencies. Public health The most common view of "public health" was as something that is deliv- ered by the government, such as a health department at the county or state level, according to the study. The view of public health as communicable disease control, or health promotion and prevention, was also commonly expressed. Community health On a related note, the term "community health" was most commonly viewed as referring to the local or neighborhood level, often implicitly referring to health in the context of small geographical areas. As one ACO executive said: "Community health, I think, is closely allied with both of those [population health and public health] but it's taking it down a level, I think, and it's looking at a particular community or neighborhood or geographic area and looking at ways to improve the health of that community." Conclusions Study authors said that, a decade later, "another warning should be sounded about the use of the phrase 'population health' by ACOs and the healthcare delivery system more widely." Use of the phrase "population health" to refer to a defined group of patients is misleading, though well intentioned, they wrote. The misuse could divert attention from the social determinants of health within geographical areas and to the resources and measures needed to improve the health of a geographical population. "It could be useful if people working in ACOs and other healthcare delivery systems had a more accurate term to refer to what they are trying to do," the study authors concluded. "Perhaps they could use the phrase 'population of attributed patients' when discussing the health of their ACO patients. The phrase 'population health' could be reserved for uses that relate to the health of the population in a geographical area." This would help distinguish the two ideas but let staff know there may be overlap. n Are You Misusing The Term 'Population Health?' (continued from cover) Becker's ASC 21st Annual Meeting - The Business and Operations of ASCs October 23-25, 2014 • Chicago For more information, call (800) 417-2035 30 Great Surgeons, 36 Leading Administrators and 80 Surgery Center Speakers in Total

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