How Health Systems Can Create a Robust, Enterprise-Wide Patient Safety Program
William Conway, MD, senior vice president and chief quality officer of HFHS and CMO of Henry Ford Hospital in Detroit, and Sue Hawkins, senior vice president of performance excellence at HFHS, describe how HFHS created a patient safety program that spans five hospitals and numerous other sites of care.
The program's structureTo be sustainable in different environments, whether by type of provider or geographic location, an enterprise-wide patient safety program needs to have a clear, robust structure that enables frequent communication across facilities.
The No Harm Campaign's structure has three areas of focus:
1. Process: Understanding what the high-risk areas are and what processes can improve the harm rate.
2. Culture: Creating a safety culture through education and training.
3. Safe practices: Following evidence-based safety protocols, such as hand hygiene.
All three areas support the campaign's goal of reducing harm.
The campaign's goals are executed through several subteams that report to a larger, multidisciplinary committee that meets monthly for two hours. The subteams work towards reducing specific types of harm. The campaign looks at all harm, whether currently preventable or not, and separates them into six categories: infection-related harm, medication-related harm, procedural harm, care delivery harm, employee harm and other, which includes hospital-acquired renal failure, pulmonary embolisms and deep vein thrombosis.
Embedding patient safety practices in the cultureImplementing a multi-year patient safety program across different hospitals and care sites depends on a strong safety culture. Making patient safety part of the organization's culture was one of the biggest challenges but also one of the biggest keys to success of the No Harm Campaign. Ms. Hawkins says HFHS tried to make patient safety practices part of people's "daily work and culture so it doesn't feel like an extra activity."
Embedding these practices in one's workflow is important not only for physicians and staff members, but also for the system's leaders. "We're concentrated on aligning the existing leadership to adopt [eliminating] harm as part of their daily work," Dr. Conway says. For example, the CMO of HFHS is responsible for insulin protocols, and nursing officers are responsible for falls and pressure ulcer protocols. The leaders report their progress on a regular basis, and their performance review takes this progress into account.
Leadership and accountability
Managing a system-wide patient safety program also requires accountability to and by leaders — leaders need to hold others accountable for their efforts, and the leaders need to be held accountable for their role in the initiative. In addition to performance reviews, HFHS leaders' progress on meeting patient safety goals also affects their compensation.
HFHS drives accountability from the top of the organization down to ensure improvement in meeting the No Harm Campaign's goals. The board evaluates patient safety data and the system's performance. Patient safety leaders at HFHS encourage the board to hold them accountable to their improvement goals to continue to challenge them on patient safety efforts. "We actually insist to our board that they ask us hard questions and keep asking us how it's going on these initiatives," Ms. Hawkins says. "We do the same thing at the next level, which is our quality and safety team, and at the next level, the senior leaders of the organization — they are required to report on what's going on and what's not working. We're very transparent about what's not working."
Transparency of results
Transparency is a critical component of a system-wide patient safety program, as it promotes communication among different stakeholders. At HFHS, transparency keeps everyone informed on progress toward the common goal of reducing harm by 50 percent by 2013. For example, the system posts each unit's progress on the harm they're responsible for. Transparency of data can motivate physicians and staff to improve their performance. "We don't blind any of the results because it drives healthy internal competition," Dr. Conway says.
One of the challenges of a system-wide patient safety initiative is maintaining energy and performance. For HFHS, taking on the formidable task of reducing harm events by half over six years presented the challenge of maintaining enthusiasm for patient safety efforts and maintaining improvements. "It takes constant vigilance to make sure improvements are sticking," Dr. Conway says. "Many times there's a period of relapse after introducing change. It's very hard to achieve consistent [improvement]."
To ensure patient safety advances are long-lasting, it is essential health systems constantly measure patient safety metrics. "Never stop measuring data," Ms. Hawkins says. By not measuring data, organizations are susceptible to not recognizing patient safety issues right away, which makes improvement more difficult. "There's a constant dynamic between [infections] and people," Dr. Conway says. "When we see a spike in infections, we figure out why it happened and get on top of it right away."
While a health system may have multiple hospitals across several regions or states, it is possible to implement a single approach to patient safety. Some key components of engaging all providers in the patient safety effort include a robust structure, a culture of safety, accountable leadership, transparency and continued monitoring of data.
Click here to access a free webinar by the American Society for Quality on HFHS' No Harm Campaign.
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