Why Valley Children's posts quality data outside of Starbucks

At Valley Children's Hospital in Madera, Calif., quality metrics are on full display for everyone to see — even in front of the Starbucks within the hospital walls. 

This level of transparency is central to creating a culture of continuous quality improvement and shared accountability, according to David Christensen, MD, senior vice president, chief physician executive and president of Valley Children's Medical Group.

Becker's recently spoke to Dr. Christensen about the efforts behind Valley Children's recognition as one of The Leapfrog Group's top hospitals for quality and safety in 2024, and how the hospital engages its team to sustain and advance its quality goals. 

Question: Valley Children's is one of only eight pediatric hospitals nationwide to earn Leapfrog's Top Hospital Award, achieving this honor five times. Take us inside the foundational work that drives this consistent recognition. What key strategies, initiatives or programs have been instrumental in achieving this level of excellence?

Dr. David Christensen: I think it is about culture change. First, we had to become comfortable with transparency. We post our quality data in very public places, including in front of Starbucks, which is located inside our hospital walls, and on our external website. At first, this was met with concern. Data is not good or bad, it only represents performance at a certain time. We have a commitment to improve. Second, the elimination of hospital-acquired conditions was mandated by our CEO and the board of trustees. This allows us to prioritize quality and safety and obtain the necessary resources. Third, we focus on the harm to the actual patient and make it very real. Finally, we built a learning culture that does not focus on blame but rather seeks to improve.

Q: Leapfrog's criteria span a range of areas, from infection control to surgical safety. Which metrics or areas of improvement were the most challenging to excel in, and what steps did your team take in overcoming those hurdles? 

DC: We started our focus on hand hygiene because this represented our commitment to safety and infection prevention. Over time, it was noted that as our hand hygiene results improved, our HACS went down. This generated confidence in the system. We also encourage reporting on safety concerns. If we don’t know about it, we can’t fix it. We established the Great Catch Award, which provides recognition and a premium parking space for staff who contribute most to our safety culture. Our focus is on the system and how it might have led to harm. We avoid placing blame on individuals.

Q: From your perspective, what is the top barrier hospitals face today in advancing quality and safety? How is Valley Children's positioning itself to overcome this?

DC: Teaching quality and safety to all staff is costly and time-consuming. It must be prioritized. This can be difficult given the competing needs and stresses in healthcare. We believe it is cost effective and a moral imperative to keep our patients safe from harm. The entire team must own quality.

Q: Sustaining a culture of safety and quality requires engagement across team members at every level. What has been most effective in fostering a culture of accountability and continuous improvement among clinicians and staff? What advice would you offer to leaders struggling to sustain momentum or keep their teams focused on the next steps for advancing safety initiatives?

DC: Listen to your front-line staff. Learn from work being done, not imagined. It is amazing what great ideas are generated from our safety rounds. We hear all about the barriers to providing safe care. Most are easily solved. The people at the bedside are your greatest source of solutions. Give them the training and the tools to succeed. Engage them and celebrate them. Also, involve the parents and families. They see the care through a different lens and can provide incredible insight.

Q: How are advancements in technology — such as AI, predictive analytics or EHR improvements — shaping the way Valley Children's approaches quality and safety initiatives? 

DC: I think technology can be used as an adjunct in supporting the clinician. Trigger tools can be used to predict conditions like sepsis and help optimize care. Many of us are looking forward to these advancements but are a bit wary. It will be important to ensure appropriate specificity and sensitivity, and therefore limit alert fatigue.

Q: Looking ahead, what are Valley Children's key quality and safety goals for the coming year? Are there any specific initiatives or focus areas that you believe will drive the next phase of improvement?

DC: We continue our drive to zero harm. While we are focused on the delivery of quality care, we are also committed to maximizing the value of our care. This means driving evidence-based treatments while eliminating interventions which do not add value and may not be supported by medical literature.

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