Hands-on safety culture — 4 leaders discuss improving patient safety

As hospitals continue to work under the pressures created by the rise of antibiotic resistance and with value-based care poised to remain the model of care for the foreseeable the future, hospitals must make patient safety a chief priority.

In the era of antibiotic resistance, patients are at risk of contracting increasingly virulent pathogens, which can be deadly and costly to treat. According to a recent survey released by the American College of Healthcare Executives in January, hospital CEOs are reportedly becoming increasingly concerned about care quality and patient safety. Survey respondents ranked patient safety issues as the third highest out of 10 possible concerns, just behind governmental mandates and financial challenges.

During a panel discussion at Becker's Hospital Review 8th annual meeting April 18, Gemma Rama-Banaag, BSN, MSN, RN, CNO of Paradise Valley Hospital in National City, Calif., Carey Albright, MSN, RN, administrative director of ortho-neuro/med-surg services at Maury Regional Medical Center in Columbia, Tenn., Leslie Marsh, MSN, RN, CEO of Lexington (Neb.) Regional Health Center, and Mary Erslon, senior director of medical affairs with Medtronic, discussed current patient safety issues and strategies to improve quality and safety in the hospital setting.

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The importance of metrics

Despite hospitals and health systems' potential trepidation in facing new and often unprecedented challenges, administrators are not without resources. Modernity has brought with it a swath of technology that can provide leadership with guideposts for quality improvement initiatives.

Speaking from her experience as an executive at Medtronic, Ms. Erslon discussed the importance of knowing where to focus infection prevention energies. Ms. Erslon said Medtronic is consistently working to build better, more actionable metrics for hospital leaders to use as targets for quality and safety improvement programs.

"We're not relevant unless we're addressing the issues and the problems that you're trying to solve," said Ms. Erslon, during the discussion. "We're really focused on trying to prevent the preventable. Our monitoring technologies are focused on trying to capture an adverse event before it occurs."

Regarding the use and importance of quality metrics, Ms. Marsh spoke on the frustration setbacks may cause and the importance of ingraining the use of quality measurements into the workflow.

"We'll think that we have something hardwired, something that we think we're doing really well, that we corrected in a huddle and that will be measured on a dashboard and then in about six months or so we'll see a little bit of slide backward and we'll wonder why that happened," said Ms. Marsh. "We're working to keep these initiatives in front of our nurses every day to make it an integrated part of the process."

Responding to problems with scope reprocessing

During Ms. Rama-Banaag's time as CNO at Paradise Valley Hospital, the facility has seen significant improvements in quality and safety. In 2007, the hospital was nearly forced to close its doors. Today, the facility is regularly recognized for quality and safety and has received Healthgrades' Patient Safety Excellence Award for the past three consecutive years.

With duodenoscopes linked to multiple superbug outbreaks around the globe in recent years, Ms. Rama-Banaag discussed how her hospital completely transformed its scope sterilization process

To address shortcomings in the hospital's scope sterilization process identified by CMS, Ms. Rama-Banaag examined the leadership structure's influence on medical device sterilization. She found the director of central reprocessing was overloaded with additional duties. Ms. Banaag took sterile processing off the directors plate and, in an unconventional move, gave the responsibility to the hospital's respiratory therapy director, a position not typically associated with sterile processing. Despite the unconventionality of the move, she believed the director's detail oriented personality would mesh well with the task. The program has since undergone vast improvements.

"We changed our sterilizing processing a whole lot — it's not even recognizable," Ms. Rama-Banaag said during the discussion. "You have to look at your resources and assess how you think you can make improvements. You can bring in a lot of technology, but if you pay attention to culture you can find the right people to do the job. One thing that is not replaced by the technology is the people running that technology."

Hands-on safety culture

When just one leader openly embraces safety culture, the impact can ripple throughout the hospital and reach the top of the leadership branch.

During the panel discussion, Ms. Albright relayed the story of Maury Regional's CNO challenging the hospital's nursing directors to better understand what it's like to be on the front lines of care, dealing with patient safety issues hands on. The directors were challenged to spend half a shift alongside nurses, outfitted in scrubs, caring for patients. The CNO also met the challenge, spurring other hospital leaders to embrace similar exercises.

"Last week, our CEO was with our central supply tech delivering supplies to the unit in scrubs, doing that person's day to day job," said Ms. Albright. "And on Tuesday, our COO was mopping floors with one of our environmental services people. So it was really a good way to connect the people who were in the meetings every day to people doing this work every day. To see what their life is like and see how their role really impacts the safety of our patients every day."

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