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Indian Health Service outlines changes to boost quality care

The federal agency responsible for providing health care to Native Americans unveiled a detailed outline on Wednesday to improve and then sustain the quality of care provided at its hospitals, some of which have faced longstanding deficiencies.

The efforts of the Indian Health Service's quality framework include hiring a deputy director of quality and cultivating an environment in which staff at all levels feel comfortable reporting medical errors and near misses. The outline was developed with input from tribal leaders, national health care experts and the Department of Health and Human Services, which oversees the IHS.

"We recognize there are facilities in some areas that are facing significant challenges, and this framework will help to address those," said IHS's top leader, principal deputy director Mary Smith. "... This quality framework is a living, breathing document, and it will be reviewed and updated annually."

The facilities directly administered by the IHS have faced quality of care challenges for decades, but the agency has been under scrutiny this year after inspectors uncovered severe deficiencies at two facilities in South Dakota. The problems were so severe at the hospital on the Rosebud Indian Reservation that agency had to close its emergency room for seven months.

Inspectors there found that records for a patient with a history of untreated tuberculosis didn't show that infection-control measures were put in place while the person was treated, and a different patient having a heart attack didn't receive treatment until 90 minutes after she arrived. A patient who insisted on walking to the bathroom on two occasions did so without nursing staff and ended up delivering a premature baby there.

Smith, who took over the agency's helm in March, has repeatedly said that the deficiencies are unacceptable. The framework she announced Wednesday includes some of the strategies that she has implemented over the past eight months.

But years of unfulfilled promises of change have left at least one tribal leader wondering if the proposed efforts will lead to meaningful improvements.

"We are always going to be skeptical of anything that they have that evaluates their own program," said Willie Bear Shield, chairman of the Rosebud Sioux Tribal Health Board, citing instances when poorly performing employees were reported, and instead of been reprimanded or terminated by the agency, they were reassigned to another facility. "It might look good on paper, but sticking to it and or enforcing it, that's another issue."

The emergency room that the agency shuttered for months is on Bear Shield's community in South Dakota.

By January, the agency plans to have in place a system-wide process for reporting and managing instances when the safety of patients was put at risk, including medical errors and "near misses." And by the end of next year, the agency intends to have its new office of quality fully operating.

The agency's proposed deputy director of quality is expected to assess the work and staffing of regional offices and hospitals, according to the framework. A report from a government watchdog issued last month criticized the agency for the "minimal efforts" of some of its regional offices to evaluate the quality of the facilities they oversee.

Source: http://www.bhpioneer.com/