With more than 25 years of transplant administration experience, Deb Maurer, RN, M.B.A., will tell you that she’s been on both sides of the MPSC table.
Although currently serving as Administrator of Transplant Services for two hospitals at Banner University Medical Division in Arizona, Deb has worked at a number of other OPOs and transplant programs over the years and has represented some of those institutions during MPSC reviews. She’s also been a member of the MPSC and recently completed a term as chair of the MPSC’s Performance Analysis and Improvement Subcommittee (PAIS). In addition, she served on a number of the committee’s work groups.
These experiences have allowed Deb to view the peer review process with a unique lens and witness how the MPSC and UNOS can with members to improve the quality of their care.
The MPSC brings together the community
Deb finds that the MPSC differs from a number of other regulatory review bodies, in that other review processes aren’t as familiar with the practice of donation and transplantation. “I think one of the things that really resonates for me is that the MPSC represents the community – it is your peers. It’s people that do the same thing. Maybe they do it a little differently in their transplant center, but they absolutely appreciate and understand the uniqueness of this business.”
Her involvement with PAIS reviews has brought her to see them as a particular opportunity. “In a way, you’re getting ‘free’ external consultative services. You’ve got your peers, subject matter experts of your transplant type, looking at your program and saying ‘We think you should do this’ or ‘Have you thought about that?’ You’re actually getting great consultative services and you’re not paying for them. In our environment today of fiscal stewardship, I’ve been thinking about that.”
Although Deb has observed the tendency to view MPSC processes as punitive, she views it differently. “I think when I look at it now, the committee – and the community – are absolutely focused on assistance and guidance and process improvement. Because let’s be honest, if something ‘bad’ happens in a transplant program, it usually gets the attention of the press regardless of the ZIP code you are in. It does question the overall credibility of our community when something really unfortunate happens.
Identifying opportunities for improvement
While it’s a natural reaction to be concerned, Deb says members should also look at an MPSC review as an opportunity to make needed improvements, perhaps in ways they could not have been addressed in daily practice. “One of the things that’s beneficial is it helps you get the attention of your executive leadership to say, ‘You know what? We need to invest, we need to recruit, there are things we need to do.’ “
One example of that approach to improvement came in her tenure at the University of Pittsburgh Medical Center. It was under MPSC review and action for issues that resulted in an unintended disease transmission from a living donor to a recipient.
“There were a lot of different ways that UPMC worked to correct that,” Maurer said. “One of the things that we leveraged was the implementation of a new EMR [electronic medical record].” The vendor they selected has a module specific to transplant programs. Based upon the center’s experience, “We were actually asked to present at their annual users meeting how we used the EMR to help with patient safety. That presentation talked about was everything you’re doing to try to minimize human error, because what caused that transmission was human error.”
She added that UPMC also reviewed “the different handoffs in the process and having really good structure in how we presented potential living kidney donors for donation. We revised that entire process to put as many layers of safety net and mitigation of risk in place as we could.”
Sometimes, she notes, improvements in one area of practice can lead to similar improvements with other processes. “You don’t learn that early on sometimes because you’re so in the heat of the moment – you’re very reactionary. And then you get things implemented and give yourself some time and then you can look at how does that have replication possibilities in other aspects of your transplant program.”
“If you get something from the MPSC, don’t freak out,” she says. “Take a deep breath and think through it.” Reflecting on her experiences undergoing reviews, “Were there parts of that process that were uncomfortable? You betcha. But there was never a time when I did not have a hesitancy to pick up the phone and call UNOS and ask questions. Have the conversations and the dialogue you need.
Maurer emphasizes the resources members have at their disposal to maintain a quality atmosphere and either prevent critical issues or better address them when they happen. “Go to the Transplant Management Forum, go to the quality meetings, go to your regional meetings. You need to be actively engaged in your community and know what’s going on ‘outside’ in your community. Then take that information and prepare yourself internally for the what-ifs. We are a community that truly facilitates sharing of information – best practice dissemination. Embrace that transparency. Don’t be afraid to ask questions of your colleagues and your resources.”
“I think we’re unbelievably fortunate to have UNOS,” she adds. “I look at the folks in Member Quality as my colleagues and my peers. Shame on us if we don’t tap into that expertise and embrace what they’re trying to do. At the end of the day, they’re trying to make us a better community for our patients and our donor families.”
Ultimately, she says, public accountability and trust are key to donation and transplantation. “We should all realize that we have a spotlight on us. It’s a privilege to have transplant services in your organization. You go into it with the understanding that you have an obligation to the greater good of this community to do everything you can to mitigate the risks and put a positive spotlight on this.”