From appetizer to main course: How HonorHealth is taking HAI reduction to a new level

Scottsdale, Ariz.-based HonorHealth has a lot to be proud of on the quality improvement front, achieving a nearly 40 percent drop in patient harm events in just four years.

As part of this effort, the health system has been laser-focused on reducing hospital-acquired infections, according to Stephanie Jackson, MD, senior vice president and chief quality and clinical value officer at HonorHealth.

"I like to say infections are no longer a side dish; they're the main course," she said, alluding to HonorHealth's comprehensive infection control plan that's allowed the system to cut Clostridium difficile cases by three-fourths.

Here, Dr. Jackson discusses HonorHealth's continued efforts to reduce harm, highlights how the system is turning to technology to support quality initiatives, and shares the one patient safety issue she'd solve overnight.

Editor's note: Responses have been lightly edited for length and clarity.

Question: What safety or quality initiative are you most excited about right now?

Dr. Stephanie Jackson: This is a difficult question because we have so many great initiatives going on. In broad terms, I'm most excited about our Communication and Optimal Resolution program, which outlines a process for providers to respond to any harm events in real time in a patient-centered way. We started working on the CANDOR program in 2017 and implemented it in fall 2018. 

We've already done a lot of work on reducing patient harm. Over a four-year period, we had a 39 percent reduction in patient harm per 1,000 days. We're doing this initiative to further improve our safety culture. The program encourages people to speak up and identify harm events, and work rapidly with patients and families toward a resolution.

Q: What is the No. 1 challenge you are facing in your role, and how are you tackling it?

SJ: Improving quality in the ambulatory environment is challenging because it's spread over so many locations. We've gained experience over the years with improvement methodology in the inpatient environment, and now we need to translate that to all of our outpatient settings to create a truly integrated care model. We've started on this journey but have a long way to go.

Q: What has been your proudest moment as HonorHealth's chief quality officer?

SJ: I have to quote our overall reduction in harm. To achieve a 39 percent reduction over a four-year period is very impressive. I'm also very proud of the work we've done to reduce readmissions. We are reaching top-quartile performance in several of our facilities, and that's exciting.

One of the reasons we've been so successful with harm reduction is because we've made some strategic investments to prevent issues using technology. For instance, we've put in 29 xenon UV disinfection robots to reduce the bacterial burden in patient rooms as part of a comprehensive infection control approach. We've seen a more than 75 percent decrease in C. difficile cases, which we attribute to our hand hygiene work, the robots, testing and antibiotic stewardship efforts. In our surgical area, we also invested in a sponge counting technology, and we haven't had a retained sponge all year. 

Q: If you could fix one patient safety issue overnight, what would it be? 

SJ: There are so many. If I had to pick one, it would be medication reconciliation. It's been a problem my whole career. Nationwide, about one-third of patient harm is related to medication. It's a difficult nut to crack because there are so many different caregivers involved in the process across the care continuum. There's also been a proliferation of new drugs, and providers are not as familiar with all the medications. It's hard for them to keep up, especially when patients are on a lot of medications. 

Q: Any other thoughts?

SJ: Another new investment I'm excited about is a video surgical quality improvement program that provides surgeons with peer feedback. This will let us peer into the really technical aspects of our robotics and microscopic surgery cases to identify any technical changes we can make to improve our outcomes. It's a new way to look at quality in the surgical arena that will be very valuable.

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