6 Steps to Encourage Patient Safety Innovation at Hospitals

Following evidence-based practices is critical for preventing harm in a healthcare setting. However, what happens when there are no evidence-based practices? Hospitals are being called upon to innovate and create patient safety protocols to fill gaps in the literature and adapt existing practices to different environments.

Detroit-based Henry Ford Health System has been recognized nationally for its commitment to patient safety and its innovative solutions to challenges. It was awarded the 2011 Malcolm Baldrige National Quality Award and the John M. Eisenberg Patient Safety and Quality Award in 2011 for reducing system-wide harm events by 34 percent and system-wide mortality by 12 percent from 2008 to 2011. 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, share six steps hospitals can take to drive innovation in patient safety.

1. Create a robust patient safety program. To encourage patient safety innovation, hospitals have to first create a structured program of patient safety and an infrastructure that enables people to test and share ideas. HFHS started the "No Harm Campaign" in 2008 with a goal of reducing harm events by 50 percent by 2013. The campaign has a clear structure, including committees dedicated to different kinds of harm and monthly reporting requirements.

2. Develop a culture of safety. Fostering innovation also depends on a strong culture of safety in the organization. Ms. Hawkins says HFHS develops this culture through educational offerings and training. The system also assesses leaders' and staff members' perceptions of the culture through surveys.

The employee engagement surveys also include questions related to safety assessment, from how leaders promote a culture of safety to how employees address safety concerns that arise. As part of the curriculum, each employee receives a tool kit and individual coaching on communication about safety as necessary. Leaders are expected to improve culture in their areas based on feedback from the survey. All HFHS leaders are also trained in managing a just culture when errors do occur.

3. Hold people accountable. Holding people accountable for patient safety in the organization motivates them to find ways of overcoming challenges to meet goals. In the No Harm Campaign, HFHS' definition of harm includes all types of harm, whether preventable or not. "When you're holding the team accountable for improvement, they have to come up with innovations because if something appears to not be preventable, it's forcing you to fix it, to come up with new approaches," Dr. Conway says.

For example, following standard best practices to reduce catheter-related blood stream infections in hemodialysis patients resulted in only modest improvements at HFHS, which motivated the team to develop new best practices. HFHS established an antibiotic lock protocol, in which a solution of gentamicin and trisodium citrate is instilled into the catheter lumen after each patient's dialysis session. This practice has led to a 34 percent decrease in dialysis mortality since its implementation in 2008.

In addition, HFHS was innovative in its approach to managing anticoagulants, which is one of the highest risk medications. The team developed the Pharmacist-Directed Anticoagulation Service in 2008, a practice in which pharmacists direct the dosing of anticoagulants and follow certain protocols to manage the medications.

4. Pilot programs.
Specific patient safety protocols don't have to be an all-or-nothing venture. In fact, piloting new projects provides an opportunity for leaders, physicians and staff to innovate, test new ideas and refine practices that can then be shared system-wide. Ms. Hawkins says results of pilots are shared with a steering committee all the way up to senior leadership and the board quality committee to evaluate their success.

5. Partner with researchers. Researchers can support innovation by testing new theories and providing data to support new practices. HFHS has a significant focus on research. "We're a big research organization, so we have lots of physicians and scientists who love to dive into data. If we see blips we don't understand, we take a harder look at what's happening, brainstorm ideas and test them," Ms. Hawkins says.

6. Participate in outside patient safety programs.
Participating in regional or national patient safety programs can spur innovation by enabling different organizations to share their successes and failures. For example, HFHS participates in the Institute of Health Improvement programs, which inspired the system to create its own method of measuring patient safety metrics, according to Ms. Hawkins.

Click here to access a free webinar by the American Society for Quality on HFHS' No Harm Campaign.

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