The cost of harm and savings through safety:  using simulated patients for leadership decision support.
OBJECTIVE
The ultimate objective of this program is to provide an approach to understanding and communicating health-care harm and cost to compel health-care provider leadership teams to vote "yes" to investments in patient safety initiatives, with the confidence that clinical, financial, and operational performance will be improved by such programs.


METHODS
Through a coordinated combination of literature evaluations, careful mapping of high impact scenarios using simulated patients and consensus review of clinical, operational, and financial factors, we confirmed value in such approaches to decision support information for hospital leadership teams to invest in patient safety projects.


RESULTS
The study resulted in the following preliminary findings: ·Communication between hospital quality and finance departments can be much improved by direct collaborative relationships through regular meetings to help both clarify direct costs, indirect costs, and the savings of waste and harm to patients by avoidance of infections. ·Governance leaders and the professional administrative leaders should consider establishing the structures and systems necessary to act on risks and hazards as they evolve to deploy resources to areas of harm and risk. ·Quality and Infection Control Professionals can best wage their war on healthcare waste and harm by keeping abreast of the latest literature regarding the latest measures, standards, and safe practices for healthcare-acquired infections and hospital-acquired conditions. ·Regular reviews of patients with health-careYassociated infections, with direct attention to the attributable cost of treatment and how financial waste and harm to patients may be avoided, may provide hospital leaders with new insights for improvement. ·If hospitals developed their own risk scenarios to determine impact of harm and waste from hospital-acquired conditions in addition to impact scenarios for specific processes through technology and process innovations, they would have more clear guidance for improvement efforts. ·Tools such as impact calculators, performance models, and simulated patient trajectories are no more tied to the reality of running a hospital or treating a patient as jet simulator metrics are to taking a real flight with real weather and real aircraftVthey provide a view to enhance decision making but do NOT provide the answers.


CONCLUSIONS
The final result of this project was to demonstrate a prototype leadership decision-support investment model approach that addresses clinical, operational, and financial performance for typical hospitals.
Texas Medical Institute of Technology, HCC Corporation, Austin, USA. Charles_Denham@tmit1.org
Charles R
CR
Denham
Franck R
FR
Guilloteau
D003661:Decision Support Techniques; D005377:Financial Management, Hospital / Q000458:organization & administration / Q000592:standards; D006801:Humans; D007857:Leadership; D061214:Patient Safety / Q000191:economics* / Q000592:standards; D016544:Patient Simulation; D011785:Quality Assurance, Health Care / Q000191:economics* / Q000592:standards; D017751:Safety Management / Q000191:economics* / Q000458:organization & administration / Q000592:standards