HAIs, sepsis and more: 8 leaders share patient safety goals for 2019

Patient safety is a top priority for healthcare executives, with leaders constantly looking for new ways to achieve a safe and positive healthcare experience for all patients.

Becker's Clinical Leadership & Infection Control asked healthcare leaders to share their patient safety goals for 2019. Read their responses below:

Note: Responses have been lightly edited for length and clarity.

Michele Saysana
Vice President of Safety, Quality and Performance Improvement at Indiana University Health (Indianapolis)

"In 2019, the system's patient safety goals will once again aim at a long-time adversary — hospital-acquired infections — while adding goal-setting around three new areas: mortality, sepsis and the opioid epidemic. Our efforts against HAIs will target central line-associated bloodstream infections, catheter-associated urinary tract infections and Clostridium difficile infections. Next year's goal is to reduce HAIs by about 15 percent. That is similar to this year's goal, which IU Health is on track to meet.

"Our new mortality and sepsis goals will aim to wrap the right palliative services around patients who are in end-of-life stages and address sepsis through better identification and treatment. To fight sepsis, we are leveraging education, simulation training and data resources like EHRs. As opioid abuse continues to challenge Indiana, IU Health has set goals for 2019 that include examining appropriate prescribing and better addiction treatments, and detecting opioid diversion within our system."

Mark Jarrett, MD
Senior Vice President and Chief Quality Officer at Northwell Health (New Hyde Park, N.Y.)

"We all have a lot of safety goals. One of the top goals we're focusing on in 2019 is trying to encourage the reporting of near misses and using near miss data to be proactive in preventing harm, rather than always being reactive based on adverse events. We're rolling out a new incident reporting system in January across the system. We hope to harness the size of the health system to provide data that might be lost if only looking at one or two hospitals. By looking across our 23 hospitals, we're hoping to build a significant database of near misses that will help generate new projects to prevent harm.

"The second big goal is boosting patient involvement in our safety processes. In 2018, we started to engage patients more in efforts to improve diagnosis and hope to expand that in 2019. The rationale is that if providers engage the patients with the proper communication, educate them about their conditions and share why they came to that conclusion, it will probably help or stall diagnostic errors."

Carole Stockmeier and Craig Clapper
Partners in Strategic Consulting for Press Ganey

"Transforming the culture within healthcare organizations is important, yet transforming the culture of the healthcare industry is imperative. While we exist as individual organizations, we are all human-based systems. Rather than seeking to be different when it comes to safety, we should strive to be the same when it comes to safety. In safety, we do not compete — we all share and learn from one another. Let our focus in 2019 be on continuing the good work in improving safety within healthcare organizations while advancing efforts to influence and forge a shared safety culture across the healthcare industry."

James Hunter, MD
CMO of Atrium Health (Charlotte, N.C.)

"Before it was part of the national conversation, antibiotic stewardship was on our radar at Atrium Health as a key component of infection reduction. We've tracked antimicrobial utilization as a systemwide patient safety goal since 2015 and aim for an additional 5 percent reduction in 2019.

"Atrium Health has a dedicated Antimicrobial Support Network for our Charlotte-area hospitals and a robust collaborative that extends to our regional partners. Our experts assist in choosing the optimal selection, dosage and duration of antimicrobial therapy. We measure the total days of therapy for most antibiotics — calculated as the total number of doses dispensed divided by the patient's total inpatient and observation days at the facility— and standardize it to account for our hospitals of different sizes.

"The results are dramatic: we've seen a 24 percent reduction in antimicrobial utilization in our Charlotte-area hospitals since 2013, while decreasing the rates of C. diff and MRSA. Since debuting an outpatient antibiotic campaign in fall 2017, we've already observed a 5 percent decrease in antibiotic prescribing in eligible primary care encounters."

Peter Pronovost, MD, PhD
Chief Clinical Transformation Officer at University Hospitals (Cleveland)

"There is broad agreement that healthcare needs to improve value, yet there's limited evidence that value is improving. Healthcare costs too much, harms too often and improves too slowly. The National Academy of Medicine, in fact, estimates that 30 percent of healthcare spending is wasted. University Hospitals has set a goal to address this, namely, to provide the highest value to both those who receive care and those who pay for care. We define value as achieving the highest quality and experience and the lowest possible annual total cost of care.

"Applying the principles of high reliability organizing and borrowing from previous work using a checklist to reduce bloodstream infections, we've created a checklist that helps us identify defects in care that reduce value — and actions we can take that promote value. This includes helping people stay well by providing preventive care and immunizations, helping people with chronic disease remain adherent on evidence-based therapies and helping those managing an acute illness have their care coordinated with their primary care provider, among other aspects. We are testing our novel approach of eliminating all defects in value, both in our ACO and importantly in our employee health plan."

Shannon Phillips, MD
Chief Patient Experience Officer at Intermountain Healthcare (Salt Lake City)

"Our priority in safety is around caregiver burnout and resilience. Now, you might say that isn't patient safety, but it is hard to expect our caregivers to provide reliable, high-quality care when they are exhausted, not engaged, or don't feel psychologically safe to speak out when they see an issue. Of course, we — like everyone else — will focus on reducing error and harm, and we will work on the best ways to address restoring joy in the work. We have a commitment to high reliability, and we want our caregivers to be situationally aware and feel comfortable to speak up when something is not right. As caregivers, we can reflect on what drew us all to healthcare in the first place. Caregivers who feel joy in their work, connect with their patients and families and feel valued are the ones who ensure we are extraordinary and eliminate harm. We are working on practice efficiencies to remove what is getting in the way of care and caring. Improvement of safety, outcomes, experience and joy will deliver on our mission to help people live the healthiest lives possible."

Stanley W. Marks, MD
Senior Vice President and CMO at Memorial Healthcare System (Hollywood, Fla.)

"Our patient safety goal for 2019, as it is every year, is to be the safest family of hospitals in the United States. What may sound idealistic to some is, we believe, realistic for our healthcare system. All five of Memorial's adult hospitals again received 'A' grades in Leapfrog's Hospital Safety Guide, and we're constantly working to exceed standards of excellence set by quality-related metrics. This is true not only in areas rated by Leapfrog, but also those measured by the Society of Thoracic Surgeons, ACS National Surgical Quality Improvement Program, American College of Cardiology, and the National Association of Children's Hospitals, among others.

"While our benchmarks are consistently high in comparison to national standards, that doesn't mean there isn't room for improvement, and that's what we'll seek within Memorial Healthcare System in 2019. Available data will provide new and evolving metrics to measure ourselves against, so there will always be higher levels of care and safety to aspire to. We've also made a significant investment in technology by increasing access to EHRs, adding safety-related data to our website and reinforcing security within our IT systems. Through these initiatives and others, we'll again have safety as a top priority in 2019."

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