Quality operatives from Strategic Radiology member practices gathered at the March Quality Forum recently, held in Phoenix at the Wild Horse Pass Resort, to share best practices and provide input on future quality initiatives. Lisa Mead, Strategic Radiology PSO and Quality Director, kicked things off with a review of the regulations governing Patient Safety Organizations (PSOs) listed by the Agency for Healthcare Research and Quality for the new participants in the room.

“Unless your hospital is in a PSO, they don’t get it, so here are the basics,” Mead said. PSOs were birthed under the Patient Safety and Quality Improvement Act of 2005 with the express purpose of creating safe and protected learning environments where patient safety and health care quality could be improved. Because everything is discoverable in Florida courts, most Florida hospitals participate in a  PSO to protect the data gathered in quality-improvement efforts, but the concept of the PSO may not be as well understood by hospitals and health systems in other states.

The impetus for the act was to provide federal protection for health care providers that participated in peer review programs, as state-based peer review protections are varied in scope and not the same for all health care workers.

A PSO provides the following protections:

• Equal consistent enforcement. All licensed providers receive equal protection.
• Nationwide and uniform. Offers the ability to share data across state lines without legal ramifications.
• Early recognition. Supports risk mitigation by creating awareness of errors.
• Meaningful comparison. The tendency is to think, “We are very good.” Benchmarking promotes learning and provides meaningful comparison, and all boats rise.
• Patient Safety Work Product. To be protected under the Patient Safety and Quality Improvement Act, data must be created in a Patient Safety Evaluation System (PSES) and assembled by the provider for analysis and deliberation.

The PSES is the system by which data is collected, managed, and analyzed for deliberation and possible reporting to or by the PSO and is an important determinant of what can and cannot be done within the PSO. Within the Strategic Radiology PSO environment, data is uploaded to one hub, with a distinct, hyper-encrypted location for each member practice, ideally with all personal health information and physician names removed.

The foundation of the PSO concept is the creation of a protected learning environment in which the focus is performance improvement versus disciplinary or legal implications of findings. A PSO allows organizations to maintain a just and fair culture in which organizations can examine their shortcomings.

Peer review is a great example of the potential of the safe PSO environment to positively impact quality improvement in radiology. “If we are still walking into rooms and hearing, ‘You won’t believe what Joe missed’ or ‘Who did that!’ then something is wrong’,” Mead says. “That’s not what we are doing here. We should be hearing, ‘Hey, this is a great learning case.’ Our objective is to create a fair and just environment that provides the opportunity to learn and teach.”

In addressing the Strategic Radiology Board of Managers following the two-day Quality Forum, Mead surveyed the room and said: “I’m excited, because I look around, and I see groups that did not have quality operatives that now have quality professionals,” she said. “Our Patient Safety Organization has raised the bar across our practices. We’ve seen how that blame-free culture is working, and that is a testament to your groups.”