Beyond the burning platform: A recipe for continuous quality improvement

The old adage of learning from your mistakes isn't just good advice for people; it applies to healthcare organizations as well. When hospitals make mistakes in the form of a patient error or sentinel event, many will snap into action, using the event as a "burning platform" to spur quality improvement to avoid a similar event in the future.

That was the situation at Saint Francis Hospital and Medical Center in Hartford, Conn. Scott Ellner, DO, the director of quality at the hospital, used a patient harm event that occurred at the hospital as a platform to spur change.

"Our journey in the organization goes back to a single event," he said during a Becker's Healthcare conference in May. A patient suffered from a retained foreign object during a surgery, had to undergo further surgery and eventually died. Dr. Ellner called that event a "burning platform" and said it ignited quality improvement initiatives that helped everyone make a change for the better.

Hospitals across the nation have had similar experiences, and the Institute of Medicine's To Err is Human report, published in 1999, served as a sort of industry-wide burning platform when it revealed that at least 44,000 people die each year as a result of a medical error.

However, it has been several years since To Err is Human sparked change, and if a major patient harm event has not occurred recently in an organization, it can be difficult to keep staff focused on continuous improvement.

Frank Federico, RPh, executive director of strategic partners with the Institute for Healthcare Improvement, says hospitals in that situation can and should look to other organizations where medical errors have occurred. Then, "ask the question, 'could that happen here?'" he says.

But healthcare as an industry should not simply rely on using actual patient harm events to spur improvement. Below are some examples of how hospitals and health systems can keep a spirit of quality improvement alive at all times.

Set a vision

Mr. Federico says the first step for hospital leaders to propel change is to set a vision of what good care looks like at the hospital and what they want to do to achieve that vision. Then it's up to leaders to "align the rest of the hospital with projects that support that 'good care' goal," he says.

Peter Pronovost, MD, PhD, senior vice president for patient safety and quality at Johns Hopkins Medicine in Baltimore and director of Johns Hopkins Armstrong Institute for Patient Safety and Quality, puts it a little differently, saying hospitals should "be absolutely purpose-driven" and that the purpose should be to "partner with patients, loved ones and all others to end preventable harm, continuously improve patient outcomes and experience, and to eliminate waste in health care."

Once the vision is set, the quality improvement work can begin. However, it is important to keep in mind that healthcare workers can suffer from burnout fatigue if too many quality improvement projects are on their plate at once.

"One issue I see is hospitals have so many projects that the people at the frontline say they are under a waterfall and no one has control of what's going on," Mr. Federico says. "They feel overwhelmed by the number of projects."

To combat this issue, hospitals leaders need to make priorities clear. Mr. Federico recommends choosing two or three projects per department or unit that are the most aligned with the hospital's overall goal and getting those done first. "It's nothing more than good project management," he says, "but we don't practice that well in healthcare."

Also, when workers complete a major quality improvement projects and see the results, it can stimulate the staff to want to do more and be even more successful, according to Mr. Federico.

Engage and empower the caregivers

Quality improvement projects won't get completed if they don't have the backing of clinicians, because people on the frontline of care are integral parts of any quality improvement process, according to Dr. Pronovost.

"We need to make sure that we partner with our clinicians and value their voice," he says. "Change progresses at the speed of trust…Things done to professionals, instead of with [them], won't work."

Dr. Pronovost has seen the power of engaging clinicians first-hand at Johns Hopkins Medicine during a project to reduce central line-associated bloodstream infections. The CLABSI reduction project involved implementing a checklist, but that alone wasn't the "magic sauce" to reducing CLABSIs, he says. He attributes the success of the program in large part to the formation of clinical communities. These peer-driven networks of clinicians set priorities for safety and quality, establish goals and strive to achieve results. This approach "encourages innovative solutions that are more likely to be implemented and effective," Johns Hopkins' website states.

In Dr. Pronovost's words, the networks help because clinicians "felt that someone believed in them, that they could reduce infections, and they felt they belonged to a community."

Personalize the data

Another way to keep hospital staff engaged in quality improvement efforts long after a burning platform event seems simple: Tell an engaging, data-driven story.

"You have to keep the story in front of the leaders," James Merlino, MD, former chief patient experience officer at Cleveland Clinic, told Becker's Hospital Review in a previous interview about keeping the spirit of quality improvement alive. "Use data a lot and push it down to different levels of the organization."

Mr. Federico with the Institute for Healthcare Improvement echoes a similar sentiment, urging hospital executives to present data on patient harms —be it infection rates or falls or something else — on a regular basis while connecting it back with an actual patient. "Until you start associating [data] with a patient, it doesn't result in the same passion to make change," he says. "Personalize the data…Create the passion to make change."

So, hospitals do not have to wait for a major adverse event or another report like To Err is Human to spark the passion for quality improvement in their organization. By setting a clear vision, empowering staff and personalizing the data, quality improvement can be kept up year after year.

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