Our hospitals need integrated tools for communicating to staff at all levels that reporting error... more Our hospitals need integrated tools for communicating to staff at all levels that reporting errors or near-misses is not only the right thing to do, it contributes to system improvements. In response to this need, the Health Research and Educational Trust, Partners HealthCare System ...
Originally published in Contemporary Psychology: APA Review of Books, 1996, Vol 41(3), 287. Autho... more Originally published in Contemporary Psychology: APA Review of Books, 1996, Vol 41(3), 287. Authored by scholars and practitioners in the field of bereavement and care, this text (see record 1995-98196-000) focuses on the care of terminally ill patients and the issues that confront their caregivers
Events such as the 30th anniversary of Health Services Research in 1995 typically inspire reflect... more Events such as the 30th anniversary of Health Services Research in 1995 typically inspire reflection on past activities and consideration of future directions. Such reflection and assessment are particularly relevant for those of us with AHA's Hospital Research and Educational Trust, since the Trust just celebrated its 50th anniversary in 1994. Looking back to the first issue of HSR, William S. Specter, who was edi
We have an innovation that is showing tremendous gains in improving health, especially among vuln... more We have an innovation that is showing tremendous gains in improving health, especially among vulnerable populations. It has produced a return on investment of 4:1 when applied to children with asthma and a return on investment of 3:1 for Medicaid enrollees with unmet longterm care needs . Among participating patients with HIV, 60 percent achieve undetectable viral loads . In fact, examples keep emerging from around the country about its effectiveness in improving health outcomes and reducing emergency room visits and hospitalizations ICER, 2013). If these were the results of a clinical trial for a drug, we would likely see pressure for fast tracking through the FDA; if it was a medical device or a new technology, there would be intense jockeying from a range of start-ups to bring it to market. Instead, despite the promise this innovation has shown for years-and recognition from the Institute of Medicine (IOM, 2010), the Affordable Care Act, and the Department of Laborit still has not been widely replicated or brought into the mainstream of U.S. health care delivery. It is still not supported by most health care financing mechanisms, which causes some organizations that successfully deploy the innovation-and show better health outcomes-to actually lose money . The innovation is the use of community health workers (CHWs), and, more specifically, their integration into team-based primary care. Scaling up the use of CHWs presents a unique set of obstacles, but it is also possible to chart a roadmap forward. The potential to improve care for vulnerable populations, help achieve the Triple Aim of better care, better health and lower costs, and advance population health is too promising to be deterred.
The healthy communities movement can provide insight into population health efforts in the United... more The healthy communities movement can provide insight into population health efforts in the United States, particularly in the context of recent health care reform. The movement has evolved from multisector partnerships that focused on improving the health, well-being, and quality of life for people and the social determinants of health to partnerships that focus more on chronic disease prevention, health equity, and environmental change. Evaluating the effects of community programs on population health has been challenging for a number of reasons. More metrics need to be developed for population health that will address inequities and focus policies on long-term health effects.
Over the last twenty-five years, the Healthy Communities Movement has played a prominent role in ... more Over the last twenty-five years, the Healthy Communities Movement has played a prominent role in reframing how health is perceived in the United States
Part One of this article describes the principles and origins of the Healthy Communities movement... more Part One of this article describes the principles and origins of the Healthy Communities movement. Part Two describes the Coalition for Healthier Cities and Communities, a national network of partnerships and organizations. The authors argue (a) that to sustain community initiatives, practitioners must move from projects that address symptoms of social problems to changing the underlying community cultures, incentives, and settings that give rise to these symptoms, and (b) that the Coalition's continued relevance depends on its ability to help leaders make that transition.
... We thank you for sharing our vision and the ardors and delights involved in its develop-ment.... more ... We thank you for sharing our vision and the ardors and delights involved in its develop-ment. Inge B. Corless Mary Pittman-Lindeman Page 29. ... DC: and ARV, AIDS-related virus, by Jay Levy and his associates at the University of California, San Francisco. ...
The healthy communities movement can provide insight into population health efforts in the United... more The healthy communities movement can provide insight into population health efforts in the United States, particularly in the context of recent health care reform. The movement has evolved from multisector partnerships that focused on improving the health, well-being, and quality of life for people and the social determinants of health to partnerships that focus more on chronic disease prevention, health equity, and environmental change. Evaluating the effects of community programs on population health has been challenging for a number of reasons. More metrics need to be developed for population health that will address inequities and focus policies on long-term health effects.
The Pathways for Patient Safety™ modules, Working as a Team and Assessing Where You Stand, covere... more The Pathways for Patient Safety™ modules, Working as a Team and Assessing Where You Stand, covered the importance of team building and assessing current safe practices and the safety climate in physician practice settings. This module, Creating Medication Safety, presents materials to facilitate safe medication management and includes specific recommendations for: • obtaining and sharing a current list of the patient's medications, and • safeguarding your patients from errors involving high alert medications. Additional readings and tools are provided as examples to be used by your designated Patient Safety Officer to lead improvement, inform discussion, and assist your team in helping patients be more aware of their role in medication safety. Medication management plays an essential role in protecting patients from harm. Over-use, under-use, and misuse of medications are all important health care concerns. 1, 2 Although all health care practitioners have a role in preventing adverse drug events (ADEs), the majority of medication treatment begins in the physician practice setting. Complete medication management is a multidisciplinary, team-based process that includes physicians, pharmacists, nurses, and other health care professionals as well as patients and lay caregivers working to achieve optimum and safe use of medication. Medication safety should be a standing item in the regular patient safety staff meetings and be a key part of your practice's patient safety plan. Module Three is designed to assist office-based physician practices safeguard their patients from ADEs by using medication reconciliation and building staff awareness of high alert medications. Here is what you will learn in each area: Medication Reconciliation • understand the importance of medication reconciliation • define the current process in place • initiate and/or improve the process of medication management in your office • measure success Medication safety should be a standing item in the regular patient safety staff meetings and be a key part of your practice's patient safety plan.
Thirteen years ago in Public Health Reports, Tyler Norris and Mary Pittman (2000) drew on the his... more Thirteen years ago in Public Health Reports, Tyler Norris and Mary Pittman (2000) drew on the history of the Healthy Communities Movement to set forth an agenda for the emerging Coalition for Healthier Cities & Communities. The agenda included the recommendation to “align the incentives of health care providers with the public health and Healthy Communities emphasis on improving population health status and quality of life.”
Objective. To evaluate the impact of rigorous WalkRounds on frontline caregiver assessments of sa... more Objective. To evaluate the impact of rigorous WalkRounds on frontline caregiver assessments of safety climate, and to clarify the steps and implementation of rigorous WalkRounds. Data Sources/Study Setting. Primary outcome variables were baseline and post WalkRounds safety climate scores from the Safety Attitudes Questionnaire (SAQ). Secondary outcomes were safety issues elicited through WalkRounds. Study period was August 2002 to April 2005; seven hospitals in Massachusetts agreed to participate; and the project was implemented in all patient care areas. Study Design. Prospective study of the impact of rigorously applied WalkRounds on frontline caregivers assessments of safety climate in their patient care area. WalkRounds were conducted weekly and according to the seven-step WalkRounds Guide. The SAQ was administered at baseline and approximately 18 months post-WalkRounds implementation to all caregivers in patient care areas. Results. Two of seven hospitals complied with the rigorous WalkRounds approach; hospital A was an academic teaching center and hospital B a community teaching hospital. Of 21 patient care areas, SAQ surveys were received from 62 percent of respondents at baseline and 60 percent post WalkRounds. At baseline, 10 of 21 care areas (48 percent) had safety climate scores below 60 percent, whereas post-WalkRounds three care areas (14 percent) had safety climate scores below 60 percent without improving by 10 points or more. Safety climate scale scores in hospital A were 62 percent at baseline and 77 percent post-WalkRounds (t 5 2.67, p 5 .03), and in hospital B were 46 percent at baseline and 56 percent post WalkRounds (t 5 2.06, p 5 .06). Main safety issues by category were equipment/facility
World hospitals and health services: the official journal of the International Hospital Federation
This paper provides a brief overview of the supply of healthcare professionals and some of the fa... more This paper provides a brief overview of the supply of healthcare professionals and some of the factors impacting supply. The demand for healthcare professionals and some of the factors impacting demand are then addressed. Finally, a brief overview of the health reform law recently passed, the Patient Protection and Affordable Care Act, is provided as it pertains to the supply of and demand for health professionals.
Collaboration among a community's institu... more Collaboration among a community's institutions and its residents can help increase the use of appropriate screening, preventive, and primary care services. To improve the health of the community, institutions must reach out to their colleagues and other stakeholders. They must not only deal with the structure of the healthcare delivery system but also be responsive to the characteristics of the local population groups they are trying to serve. Over the last several years, a group of 25 community-based partnerships across the country have used a multifaceted model to guide their work in making their communities healthier. Through a wide variety of initiatives tailored to local needs, they have not only improved people's health but also provided a series of benefits to the partnering organizations and the community as a whole.
Outbreaks of highly pathogenic avian influenza (HPAI) (2000-2003) resulted in 50 million EU birds... more Outbreaks of highly pathogenic avian influenza (HPAI) (2000-2003) resulted in 50 million EU birds culled or dead. The circulation of H5N1 in Asia could represent the origin of a human pandemic. Questions have been raised to combat the ongoing AI crisis. HPAI H5N1 has spilled over to resident and migratory wild bird populations which could represent a means of the virus reaching the EU, but lack of data make any forecast imprudent. Poultry holdings located close to migratory bird breeding and resting sites are considered at greater risk of exposure and methods to prevent exposure should be implemented. Legal safeguards for importation of poultry commodities currently only apply to HPAI and rely on detection of clinical signs that may not be observable during incubation period. Illegal imports represent an additional risk. Insufficient data on the effectiveness of commodity processing are available and few indications can be deducted. Biosecurity is the primary tool to prevent AI introduction and secondary spread. Massive spread was observed in densely populated poultry areas resulting in vaccination programs. Vaccination should be used to support eradication together with enhanced biosecurity and restriction measures, which shall also be implemented in case of prophylactic vaccination. Animal welfare aspects of AI include use of appropriate culling methods, correct vaccine application, and availability of trained staff. EFSA has recently set up a new scientific work group to further assess the risk of HPAI introduction and spread posed in particular by wild, migratory birds, as well as further follow-up of recent AI developments.
A critical barrier to eliminating disparities and improving the quality of patient care is the fr... more A critical barrier to eliminating disparities and improving the quality of patient care is the frequent lack of basic data on race, ethnicity, and primary language of patients within health care organizations. According to the authors' survey of 1,000 hospitals nationwide and results of the 2003 American Hospital Association annual survey, the majority of hospitals (78% in both surveys) reported collecting race and ethnicity data about patients. Only 50 percent of respondents from the 22 states that have a mandate to collect such data were actually aware of the mandate. The primary determiner of race/ethnicity is the patient or an admitting clerk. Among hospitals that collect data on race/ethnicity, 70 percent did not see any drawbacks to collecting the data. During site visits to six leading hospitals and health systems, the authors found that despite a commitment to collecting this information, there are no consistent policies and practices in place.
Our hospitals need integrated tools for communicating to staff at all levels that reporting error... more Our hospitals need integrated tools for communicating to staff at all levels that reporting errors or near-misses is not only the right thing to do, it contributes to system improvements. In response to this need, the Health Research and Educational Trust, Partners HealthCare System ...
Originally published in Contemporary Psychology: APA Review of Books, 1996, Vol 41(3), 287. Autho... more Originally published in Contemporary Psychology: APA Review of Books, 1996, Vol 41(3), 287. Authored by scholars and practitioners in the field of bereavement and care, this text (see record 1995-98196-000) focuses on the care of terminally ill patients and the issues that confront their caregivers
Events such as the 30th anniversary of Health Services Research in 1995 typically inspire reflect... more Events such as the 30th anniversary of Health Services Research in 1995 typically inspire reflection on past activities and consideration of future directions. Such reflection and assessment are particularly relevant for those of us with AHA's Hospital Research and Educational Trust, since the Trust just celebrated its 50th anniversary in 1994. Looking back to the first issue of HSR, William S. Specter, who was edi
We have an innovation that is showing tremendous gains in improving health, especially among vuln... more We have an innovation that is showing tremendous gains in improving health, especially among vulnerable populations. It has produced a return on investment of 4:1 when applied to children with asthma and a return on investment of 3:1 for Medicaid enrollees with unmet longterm care needs . Among participating patients with HIV, 60 percent achieve undetectable viral loads . In fact, examples keep emerging from around the country about its effectiveness in improving health outcomes and reducing emergency room visits and hospitalizations ICER, 2013). If these were the results of a clinical trial for a drug, we would likely see pressure for fast tracking through the FDA; if it was a medical device or a new technology, there would be intense jockeying from a range of start-ups to bring it to market. Instead, despite the promise this innovation has shown for years-and recognition from the Institute of Medicine (IOM, 2010), the Affordable Care Act, and the Department of Laborit still has not been widely replicated or brought into the mainstream of U.S. health care delivery. It is still not supported by most health care financing mechanisms, which causes some organizations that successfully deploy the innovation-and show better health outcomes-to actually lose money . The innovation is the use of community health workers (CHWs), and, more specifically, their integration into team-based primary care. Scaling up the use of CHWs presents a unique set of obstacles, but it is also possible to chart a roadmap forward. The potential to improve care for vulnerable populations, help achieve the Triple Aim of better care, better health and lower costs, and advance population health is too promising to be deterred.
The healthy communities movement can provide insight into population health efforts in the United... more The healthy communities movement can provide insight into population health efforts in the United States, particularly in the context of recent health care reform. The movement has evolved from multisector partnerships that focused on improving the health, well-being, and quality of life for people and the social determinants of health to partnerships that focus more on chronic disease prevention, health equity, and environmental change. Evaluating the effects of community programs on population health has been challenging for a number of reasons. More metrics need to be developed for population health that will address inequities and focus policies on long-term health effects.
Over the last twenty-five years, the Healthy Communities Movement has played a prominent role in ... more Over the last twenty-five years, the Healthy Communities Movement has played a prominent role in reframing how health is perceived in the United States
Part One of this article describes the principles and origins of the Healthy Communities movement... more Part One of this article describes the principles and origins of the Healthy Communities movement. Part Two describes the Coalition for Healthier Cities and Communities, a national network of partnerships and organizations. The authors argue (a) that to sustain community initiatives, practitioners must move from projects that address symptoms of social problems to changing the underlying community cultures, incentives, and settings that give rise to these symptoms, and (b) that the Coalition's continued relevance depends on its ability to help leaders make that transition.
... We thank you for sharing our vision and the ardors and delights involved in its develop-ment.... more ... We thank you for sharing our vision and the ardors and delights involved in its develop-ment. Inge B. Corless Mary Pittman-Lindeman Page 29. ... DC: and ARV, AIDS-related virus, by Jay Levy and his associates at the University of California, San Francisco. ...
The healthy communities movement can provide insight into population health efforts in the United... more The healthy communities movement can provide insight into population health efforts in the United States, particularly in the context of recent health care reform. The movement has evolved from multisector partnerships that focused on improving the health, well-being, and quality of life for people and the social determinants of health to partnerships that focus more on chronic disease prevention, health equity, and environmental change. Evaluating the effects of community programs on population health has been challenging for a number of reasons. More metrics need to be developed for population health that will address inequities and focus policies on long-term health effects.
The Pathways for Patient Safety™ modules, Working as a Team and Assessing Where You Stand, covere... more The Pathways for Patient Safety™ modules, Working as a Team and Assessing Where You Stand, covered the importance of team building and assessing current safe practices and the safety climate in physician practice settings. This module, Creating Medication Safety, presents materials to facilitate safe medication management and includes specific recommendations for: • obtaining and sharing a current list of the patient's medications, and • safeguarding your patients from errors involving high alert medications. Additional readings and tools are provided as examples to be used by your designated Patient Safety Officer to lead improvement, inform discussion, and assist your team in helping patients be more aware of their role in medication safety. Medication management plays an essential role in protecting patients from harm. Over-use, under-use, and misuse of medications are all important health care concerns. 1, 2 Although all health care practitioners have a role in preventing adverse drug events (ADEs), the majority of medication treatment begins in the physician practice setting. Complete medication management is a multidisciplinary, team-based process that includes physicians, pharmacists, nurses, and other health care professionals as well as patients and lay caregivers working to achieve optimum and safe use of medication. Medication safety should be a standing item in the regular patient safety staff meetings and be a key part of your practice's patient safety plan. Module Three is designed to assist office-based physician practices safeguard their patients from ADEs by using medication reconciliation and building staff awareness of high alert medications. Here is what you will learn in each area: Medication Reconciliation • understand the importance of medication reconciliation • define the current process in place • initiate and/or improve the process of medication management in your office • measure success Medication safety should be a standing item in the regular patient safety staff meetings and be a key part of your practice's patient safety plan.
Thirteen years ago in Public Health Reports, Tyler Norris and Mary Pittman (2000) drew on the his... more Thirteen years ago in Public Health Reports, Tyler Norris and Mary Pittman (2000) drew on the history of the Healthy Communities Movement to set forth an agenda for the emerging Coalition for Healthier Cities & Communities. The agenda included the recommendation to “align the incentives of health care providers with the public health and Healthy Communities emphasis on improving population health status and quality of life.”
Objective. To evaluate the impact of rigorous WalkRounds on frontline caregiver assessments of sa... more Objective. To evaluate the impact of rigorous WalkRounds on frontline caregiver assessments of safety climate, and to clarify the steps and implementation of rigorous WalkRounds. Data Sources/Study Setting. Primary outcome variables were baseline and post WalkRounds safety climate scores from the Safety Attitudes Questionnaire (SAQ). Secondary outcomes were safety issues elicited through WalkRounds. Study period was August 2002 to April 2005; seven hospitals in Massachusetts agreed to participate; and the project was implemented in all patient care areas. Study Design. Prospective study of the impact of rigorously applied WalkRounds on frontline caregivers assessments of safety climate in their patient care area. WalkRounds were conducted weekly and according to the seven-step WalkRounds Guide. The SAQ was administered at baseline and approximately 18 months post-WalkRounds implementation to all caregivers in patient care areas. Results. Two of seven hospitals complied with the rigorous WalkRounds approach; hospital A was an academic teaching center and hospital B a community teaching hospital. Of 21 patient care areas, SAQ surveys were received from 62 percent of respondents at baseline and 60 percent post WalkRounds. At baseline, 10 of 21 care areas (48 percent) had safety climate scores below 60 percent, whereas post-WalkRounds three care areas (14 percent) had safety climate scores below 60 percent without improving by 10 points or more. Safety climate scale scores in hospital A were 62 percent at baseline and 77 percent post-WalkRounds (t 5 2.67, p 5 .03), and in hospital B were 46 percent at baseline and 56 percent post WalkRounds (t 5 2.06, p 5 .06). Main safety issues by category were equipment/facility
World hospitals and health services: the official journal of the International Hospital Federation
This paper provides a brief overview of the supply of healthcare professionals and some of the fa... more This paper provides a brief overview of the supply of healthcare professionals and some of the factors impacting supply. The demand for healthcare professionals and some of the factors impacting demand are then addressed. Finally, a brief overview of the health reform law recently passed, the Patient Protection and Affordable Care Act, is provided as it pertains to the supply of and demand for health professionals.
Collaboration among a community's institu... more Collaboration among a community's institutions and its residents can help increase the use of appropriate screening, preventive, and primary care services. To improve the health of the community, institutions must reach out to their colleagues and other stakeholders. They must not only deal with the structure of the healthcare delivery system but also be responsive to the characteristics of the local population groups they are trying to serve. Over the last several years, a group of 25 community-based partnerships across the country have used a multifaceted model to guide their work in making their communities healthier. Through a wide variety of initiatives tailored to local needs, they have not only improved people's health but also provided a series of benefits to the partnering organizations and the community as a whole.
Outbreaks of highly pathogenic avian influenza (HPAI) (2000-2003) resulted in 50 million EU birds... more Outbreaks of highly pathogenic avian influenza (HPAI) (2000-2003) resulted in 50 million EU birds culled or dead. The circulation of H5N1 in Asia could represent the origin of a human pandemic. Questions have been raised to combat the ongoing AI crisis. HPAI H5N1 has spilled over to resident and migratory wild bird populations which could represent a means of the virus reaching the EU, but lack of data make any forecast imprudent. Poultry holdings located close to migratory bird breeding and resting sites are considered at greater risk of exposure and methods to prevent exposure should be implemented. Legal safeguards for importation of poultry commodities currently only apply to HPAI and rely on detection of clinical signs that may not be observable during incubation period. Illegal imports represent an additional risk. Insufficient data on the effectiveness of commodity processing are available and few indications can be deducted. Biosecurity is the primary tool to prevent AI introduction and secondary spread. Massive spread was observed in densely populated poultry areas resulting in vaccination programs. Vaccination should be used to support eradication together with enhanced biosecurity and restriction measures, which shall also be implemented in case of prophylactic vaccination. Animal welfare aspects of AI include use of appropriate culling methods, correct vaccine application, and availability of trained staff. EFSA has recently set up a new scientific work group to further assess the risk of HPAI introduction and spread posed in particular by wild, migratory birds, as well as further follow-up of recent AI developments.
A critical barrier to eliminating disparities and improving the quality of patient care is the fr... more A critical barrier to eliminating disparities and improving the quality of patient care is the frequent lack of basic data on race, ethnicity, and primary language of patients within health care organizations. According to the authors' survey of 1,000 hospitals nationwide and results of the 2003 American Hospital Association annual survey, the majority of hospitals (78% in both surveys) reported collecting race and ethnicity data about patients. Only 50 percent of respondents from the 22 states that have a mandate to collect such data were actually aware of the mandate. The primary determiner of race/ethnicity is the patient or an admitting clerk. Among hospitals that collect data on race/ethnicity, 70 percent did not see any drawbacks to collecting the data. During site visits to six leading hospitals and health systems, the authors found that despite a commitment to collecting this information, there are no consistent policies and practices in place.
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Papers by Mary Pittman