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HHS launches major effort to increase organ donation by getting largest hospitals to adopt "best practices".



A comprehensive government study has come up with one of the most ambitious plans ever devised to increase organ donations Organ donation is the removal of the tissues of the human body from a person who has recently died, or from a living donor, for the purpose of transplanting or grafting them into other persons.  in the nation's largest hospitals next year. The study calls for dramatic increases in donations, donor-conversion rates and transplants in the country's 200 largest hospitals.

To achieve such lofty goals, the government panel recommends that others emulate the nation's most successful organ procurement organizations (OPOs) and transplant centers. Those centers employ a common set of "best practices," according to according to
prep.
1. As stated or indicated by; on the authority of: according to historians.

2. In keeping with: according to instructions.

3.
 the newly-released report.

The extraordinarily comprehensive study, dubbed dub 1  
tr.v. dubbed, dub·bing, dubs
1. To tap lightly on the shoulder by way of conferring knighthood.

2. To honor with a new title or description.

3.
 the "Organ Donation Breakthrough Collaborative The Breakthrough Collaborative (formerly Summerbridge National) is a collaboration of programs across the United States and in Hong Kong - all functioning independently from one another - that aims to effect positive change in urban schools. : Best Practices Final Report," was commissioned by Secretary of Health and Human Services Noun 1. Secretary of Health and Human Services - the person who holds the secretaryship of the Department of Health and Human Services; "the first Secretary of Health and Human Services was Patricia Roberts Harris who was appointed by Carter"  (HHS HHS Department of Health and Human Services. ) Tommy Thompson For other people with similar names, see .

Tommy George Thompson (born November 19, 1941), a United States politician, was the 7th U.S. Secretary of Health and Human Services and the 42nd Governor of Wisconsin.
 as the latest, and perhaps last, component in his initiative to increase organ and tissue donation in the US.

The findings of the 70-page report, which was produced by the Lewin Group, were the cornerstone of a 2-day meeting in Washington, DC September 9-10 to launch an intensive push by the secretary to increase organ donation in the nation's largest hospitals in the next year.

"If we can do it in large hospitals in Wisconsin List of hospitals in Wisconsin (U.S. state), sorted by location.
  • Appleton
  • Appleton Medical Center
  • St.
, Houston, Colorado, St. Louis, Tampa, and Boston, we can do it in large hospital's throughout the nation," Thompson told the 404 participants representing 43 OPOs and 103 large hospitals who attended the launch.

HHS unveiled an ambitious set of goals for this phase in the initiative. They include:

*Increase the average conversion rate of eligible donors from the current average of 43% to 75% in the nation's largest 200 hospitals;

*Increase donations by up to 1,900 donors per year;

*Increase transplants by 6,000 per year.

Dennis Wagner, collaborative director of the Health Resources and Services Administration The Health Resources and Services Administration (HRSA) is an agency within the United States Department of Health and Human Services whose goal is to improve access to health care for those without insurance.  (HRSA HRSA Health Resources & Services Administration (US)
HRSA Historical Radio Society of Australia
HRSA Hamilton Rating Scale for Anxiety
HRSA Hotel and Restaurant Suppliers Association (Canada) 
) who heads the project, called the 2-days "one of the most important meetings to occur in organ donation in years, maybe decades."

"Seeing the extraordinary commitment being made to generating an increase in organ donation jointly expressed by OPO staff and representatives from large hospitals is what made it special," Wagner told Transplant News. "We have great expectations for this project and we will do everything possible to achieve the goals. Our goal is going to be all teach, all learn."

Participants at the meeting were schooled in ways to help OPOs and hospitals to quickly "identify, learn, adapt, replicate, and celebrate 'breakthrough' practices that are associated with higher donation rates." HHS noted that the approach is "intended to be consistent with contemporary collaborative models In psycholinguistics, the collaborative model(or conversational model) is a theory for explaining how speaking and understanding work in conversation, specifically how people in conversation coordinate to determine definite references.  of identifying and spreading improvements in health care systems."

"Visits to OPOs and hospitals revealed that there is no single best approach or 'magic bullet' for success," the Lewin Group noted in the report. "Successful donation involves working simultaneously toward optimizing the outcomes during all events in the process: identification and referral of a potential donor, consent, recovery, and transplantation. While no 2 hospitals or OPOs visited conducted the organ donation process in the very same way, the underlying messages of these higher performers were largely consistent."

"This is a very exciting shift from the mom and pop Mom and Pop

An adjective denoting a small-scale and family-like atmosphere, often used to describe these types of businesses and investors.

Notes:
A mom-and-pop business is typically a small family-run business.
 approach to a very touchy process," Clifford Goodman Clifford Everard Goodman (born 20 November, 1869, at College View, St Philip, Barbados, died 1 February 1911 at Belleville, St Michael, Barbados), was a cricketer. A right arm fast bowler, he was educated at The Lodge School, Barbados. , PHD, a senior scientist at the Lewin Group told Transplant News. "This approach is meant to make the extraordinary-asking for organ donation-into a routine business practice. It's based on a systematic approach that identifies best practices that can be shared. It's like seeing what makes a great swimmer and passing it along to others."

Here are the 7 common principles that appear to contribute to the success with some comments by the group.

1.Integrate organ donation fully into routine roles and responsibilities.

Organ donation is integrated into hospital policies and protocols, medical records systems, training, staffing, finances, data collection, and quality improvement in the manner of other services.

2.Set high standards for donation performance to reduce the unacceptable shortage of life-saving organs.

OPOs and hospitals establish clear, often "stretch goals" for their organizations and intensive care units. For OPOs, the goal is to increase the number of organ donors organ donor Transplantation A person/cadaver that donates his/her  organ(s) to a recipient ; for hospitals, the usual goal is to refer all potential organ donor cases to the OPO as soon as possible. Higher performing OPOs and hospitals reassess goals and revise approaches to improve results when donation dips or remains status quo [Latin, The existing state of things at any given date.] Status quo ante bellum means the state of things before the war. The status quo to be preserved by a preliminary injunction is the last actual, peaceable, uncontested status which preceded the pending controversy. .

3. Involve OPO and hospital staff in ongoing standards setting and redesign of means to achieve these standards.

OPO staff become aware of the performance expectations of their positions during the hiring process; for most OPOs, this practice appears to be more recent. While staff expectations are high, leaders and managers provide support and flexible working conditions. Staff are given responsibility, autonomy in decision-making, opportunities to provide feedback to improve the process, and new challenges.

Hospitals perform better with clear guidelines for different aspects of the organ donation process so there is no confusion about roles and responsibilities. OPOs work jointly with hospitals to develop, update, and improve protocols, and ensure that staff are educated in how to follow them.

4.Hold OPOs, hospitals, and their staff accountable for achieving these standards and recognize the staff accordingly.

In addition to being accountable for referring 100% of deaths to their OPOs, hospitals regularly review OPO data on timely referrals, family approaches, consent rates, and donations to determine how well they are following organ donation protocols. Accountability among hospital staff may be driven by hospital administration, other champions for organ donation within the hospital, or OPO staff.

5.Establish, maintain, and revitalize re·vi·tal·ize  
tr.v. re·vi·tal·ized, re·vi·tal·iz·ing, re·vi·tal·iz·es
To impart new life or vigor to: plans to revitalize inner-city neighborhoods; tried to revitalize a flagging economy.
 a network of interpersonal relationships and trust involving OPO and hospital staff, donor families, and other key agents.

The OPOs visited establish, maintain, and revitalize relationships with all levels of hospital staff as well as other individuals or organizations with roles in the organ donation process, including donor families, medical examiners/coroners, EMS staff, and community leaders.

6.Collaborate to meet the range of needs of potential donor families and achieve informed consent to donate.

There is a range of views concerning the assignment of responsibility to approach families regarding donation. While consent rates in many sites have increased in association with the shift in this role from hospital staff to OPO staff specially trained for this purpose, hospital staff are the designated requestors in some instances. Clearly, both approaches can work in their own contexts, which arise from professional, institutional, and community antecedents.

7.Conduct ongoing data collection and feedback to drive decision-making toward performance improvement.

The key measures tracked by all OPOs and used to inform organ donation operations in hospitals include, but are not limited to: donor potential, referrals of deaths, medical suitability, consent rate, conversion rate, organs recovered per donor, and organs transplanted.

Here are the 15 "best practices" identified by the Lewin Group. The complete report contains specific strategies or examples used to achieve or implement each practice. (Information on getting the report is available at the end of this article.)

1.Orient organizational mission and goals toward increasing organ donation.

OPOs and hospitals demonstrate goal-focused leadership and management toward improving organ donation performance, including orienting operations toward measurable outcomes and making organ donation an expected, routine process of the organization.

2.Do not be satisfied with the status quo; innovate and experiment continuously.

None of the OPOs and hospitals reported being satisfied with their current level of performance.

3.Strive to recruit and retain highly motivated and skilled staff.

Given high turnover in the industry, both OPOs and hospitals are highly attentive to staff recruitment and retention.

4.Appoint members to OPO board who can help achieve organ donation goals.

Boards are comprised to promote collaboration and mitigate conflicts via professionally diverse composition and balanced representation of organ donation and transplantation interests.

5.Specialize roles to maximize performance.

At least 3 critical roles are: family support, clinical coordination, and hospital relations.

6.Tailor or adapt the organ donation process to complimentary strengths of OPO and individual hospitals.

7.Be there: integrate OPO staff into the fabric of high potential hospitals.

Among the sample of higher than average OPO and hospital performers, there is a high level of ongoing, routine interaction between OPO and hospital staff.

8.Identify and support organ donation champions at various hospital levels; include leaders who are willing to be called upon to overcome barriers to organ donation in real time.

9.All aboard: secure and maintain buy-in at all levels of hospital staff and across departments/functions that affect organ donation.

OPOs and hospitals articulate the importance of "top-down, bottom-up and sideways buy-in," that is, identification with and commitment to organ donation.

10.Educate constantly; tailor and accommodate to staff needs, requests, and constraints.

Educational interactions address topics such as brain death criteria; donor identification, referral, consent and recovery processes; mechanisms for matching organs to recipients; transplantation processes; recipient care; bereavement Bereavement Definition

Bereavement refers to the period of mourning and grief following the death of a beloved person or animal. The English word bereavement
 care; and criteria for donation after cardiac death.

11.Design, implement, and monitor public education and outreach efforts to achieve informed consent and other donation goals.

OPO and hospital staff expressed differences of opinion on the impact of public education and outreach efforts on organ donation and conversion rates. Hospital respondents tended to give greater weight to the role of public education campaigns; OPO leaders more often found little or no causal relationship between such efforts and organ donation performance.

12.Referral: anticipate, don't hesitate, call early even when in doubt.

Among hospitals visited, there is a common interest and willingness to make early referrals to the OPO and to consult its experts regarding potential donations.

13.Draw on respective OPO and hospital strengths to establish an integrated consent process. One size does not fit all, but getting to an informed "yes" is paramount.

Interacting with a potential donor family to achieve informed consent to donate usually entails a sequence of time-sensitive events and carefully conveyed communications, all within a context of trust.

14.Use data to drive decision-making.

In particular, conducting regular death record reviews in all hospitals helps to determine those with the highest donor potential and ways to increase donations.

15.Follow up in a timely and systematic manner. Don't let any issues fester fester /fes·ter/ (fes´ter) to suppurate superficially.

fes·ter
v.
1. To ulcerate.

2. To form pus; putrefy.

n.
An ulcer.
.

OPO and hospital staff emphasized that when the organ donation process breaks down or when an aspect of the process has been poorly handled, it must be resolved as soon as possible so as not to adversely affect future events.

The study sample consisted in following the following OPOs and hospitals:

*New England New England, name applied to the region comprising six states of the NE United States—Maine, New Hampshire, Vermont, Massachusetts, Rhode Island, and Connecticut. The region is thought to have been so named by Capt.  Organ Bank organ bank Transplant medicine A repository, usually shared by multiple hospitals for long-term storage of certain tissues destined for transplantation–eg, acellular bone fragments, BM, corneas. Cf UNOS. , Newton, MA and: Beth Israel Beth Israel, which means "House of Israel" in Hebrew, could refer for:
  • Beth Israel Deaconess Medical Center
  • Beth Israel Medical Center, New York City, New York
  • Temple Beth Israel
  • Congregation Beth Israel in West Hartford, Connecticut
 Deaconess dea·con·ess  
n.
1. A Protestant woman who assists the minister in various functions.

2. Used as a title prefixed to the surname of such a woman: Deaconess Brown.

Noun 1.
 Hospital, Boston Medical Center Boston Medical Center (BMC) is a non-profit 581-bed medical center in Boston, Massachusetts. It was created by the formal merger of Boston City Hospital (BCH) and Boston University Medical Center Hospital (BUMCH). , Brigham Women's Hospital Women's Hospital of Greensboro (part of Moses Cone Health System)

As the state's first free-standing hospital dedicated to women, the Women's Hospital of Greensboro is a 134-bed hospital is dedicated to providing state-of-the-art, compassionate and personalized care to women
, Massachusetts General Hospital Massachusetts General Hospital Health care The major teaching hospital for Harvard Medical School, widely regarded as one of the best health care centers in the world  (all in Boston).

*LifeLink of Florida, Tampa, FL and: Lakeland Regional Medical Center, Lakeland, and Tampa General Hospital, Tampa.

*University of Wisconsin Hospital & Clinics Organ Procurement Organization, Madison and: Gundersen Lutheran Hospital, Lacrosse lacrosse (ləkrôs`), ball and goal game usually played outdoors by two teams of 10 players each on a field 60 to 70 yd (54.86 to 64.01 m) wide by 110 yd (100.58 m) long. Two goals face each other 80 yd (73. ; Theda Clark Regional Medical Center, Neehah; and University of Wisconsin Hospitals & Clinics, Madison.

*Mid-America Transplant Services, St. Louis, MO and: Barnes-Jewish Hospital
This article is about Barnes Hospital. For other uses, please see Barnes (disambiguation)
Barnes-Jewish Hospital is located in St. Louis, Missouri and is the adult teaching hospital for Washington University School of Medicine.
, and St. John's Mercy Medical Center, both St. Louis.

*LifeGift Organ Donation Center, Houston, TX and: Ben Taub General Hospital Ben Taub General Hospital is a hospital in Houston, Texas.

Ben Taub was opened in May 1963 and is located in the Texas Medical Center. It is owned and operated by the Harris County Hospital District and is staffed by the faculty and students from Baylor College of Medicine.
, and Memorial Herman Hospital, both Houston.

*Donor Alliance, Denver, CO and: Denver Health Medical Center Denver Health Medical Center is a large hospital in Denver, Colorado. Formerly known as Denver General Hospital, Denver Health's primary focus is care for the underprivileged and uninsured.

Denver Health is Colorado's primary “safety net” institution.
, Denver; Memorial Hospital, Colorado Springs Colorado Springs, city (1990 pop. 281,140), seat of El Paso co., central Colo., on Monument and Fountain creeks, at the foot of Pikes Peak; inc. 1886. It is a year-round resort and a booming military, technological, and commercial city. ; and St. Anthony Central Hospital, Denver.

The Organ Donation Breakthrough Collaborative: Best Practices Final Report is available on the HHS organ donor Web site: www.organdonor.gov/bestpractice.htm
COPYRIGHT 2003 Transplant Communications, Inc.
No portion of this article can be reproduced without the express written permission from the copyright holder.
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Comment:HHS launches major effort to increase organ donation by getting largest hospitals to adopt "best practices".
Author:Warren, Jim
Publication:Transplant News
Geographic Code:1USA
Date:Sep 15, 2003
Words:1867
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