How to build a lasting safety culture in the era of drug resistance and value-based care


Since the landmark release of the U.S. Institute of Medicine's 1999 report "To Err is Human: Building a Safer Health System," the attention to patient safety in the American healthcare system has increased significantly.

The modern emphasis on patient safety is further intensified by two main factors: the shift to value-based care and the growing issue of antibiotic resistance. Hospital patients today are at risk of becoming infected with increasingly virulent pathogens resistant to even last-resort antibiotics, making infection prevention efforts a serious concern for health systems. This issue is compounded by the transition to value-based reimbursement models, in which hospitals are rewarded or penalized based on patient outcomes. Since outcomes and value are expected to become increasingly significant determinants of reimbursement in the foreseeable future, healthcare leaders are becoming increasingly concerned with establishing an effective and sustainable culture of safety within their organizations.

According to a survey released by the American College of Healthcare Executives in January, hospital CEOs ranked patient quality and safety as their third highest concern, just behind governmental mandates and financial challenges. Patient safety outranked personnel shortages and six other concerns.

During an April 5 webinar hosted by Becker's Hospital Review and sponsored by disinfection technology company Xenex, Paul Hiltz, a healthcare leader with more than 25 years of executive leadership experience and the former CEO of Springfield, Ohio-based Community Mercy Health Partners, and Kelly Curry, the former executive vice president and CFO for Health Management Associates, led a discussion on the financial implications of patient safety, the tools to improve safety and the future of safety culture.

"No money, no mission"

During the webinar, Mr. Curry said understanding the financial implications of hospital-acquired conditions is central to the establishment of a safety culture.

"'[If] there's no money, there's no mission,'" said Mr. Curry, quoting a proverbial statement made by a former colleague.

Mr. Curry argued that establishing any type of service in the healthcare setting will ultimately rely upon fiscal incentives. From a financial standpoint, the reasons for fostering a culture of safety are manifold.

A 2013 study published in JAMA, found the excess cost on a per case basis associated with Clostridium difficile infection — a common HAI — to be $11,285. For surgical site infections, the added cost was $20,785. For central line-associated bloodstream infections, the added cost was estimated to be $45,814.

Given the high costs associated with treating these infections, the financial incentive for preventing them can be exponential, according to Mr. Curry.

"If you take actions that reduce infections by say 10 and a quarter [percent], then that's a significant savings to the institution. I mean, that's as much $800,000 real dollars in a year that can be brought back to the institution," said Mr. Curry.

Get the right tools to support a culture of patient safety

To establish an effective and sustainable culture of patient safety, it is essential that healthcare leaders identify and select the right tools for their institution to help clinicians and administrators protect patients from harm.

An essential starting point for establishing safety culture is making use of data analytics. These systems consistently engage frontline providers in patient safety initiatives, track progress based on patient outcomes and guide improvement. Hospital scorecards that track a facility's 30-day readmissions, mortality and hospital-acquired infection rates and offer comparisons to national benchmarks can be an effective way to maintain awareness among providers regarding hospitalwide safety goals. These scorecards can also offer actionable information on matters like wait times and the number of occupied and dirty rooms.

"When you put up metrics around mortalities, CLABSIs and CAUTIs (central-line associated urinary tract infection), more of the frontline staff are getting interested and saying 'what is that? What can I do to impact and improve those metrics?" said Mr. Hiltz, during the webinar. "I really think that is key developing an entire culture around patient safety."

With rise of multi-drug resistant pathogens, it is critical that hospitals implement infection prevention protocols like hand hygiene initiatives and antibiotic stewardship programs. It is also crucial that hospitals make use of the most effective disinfectant products available to ensure the care environment does not become a reservoir for pathogens. The use of ultraviolet light as a disinfectant has arisen as an effective way to take environmental cleaning to the next level.

While multiple manufacturers offer single-spectrum UV disinfectant equipment, these products exhibited mixed results regarding C diff reduction in a recent study published in The Lancet. However, the Pulsed Xenon UV Disinfection system developed by Xenex uses multi-spectrum UV light and has displayed high levels of efficacy in multiple clinical studies. One study published in the American Journal of Infection Control, found the Xenex system to be associated with 70 percent reduction in C diff rates at Westchester Medical Center in Valhalla, N.Y.

"The multi-spectrum UV light [products], if you look at the data on that, it's pretty compelling what that can do to an already clean room. The benefits are kind of amazing to me," said Mr. Hiltz. "I think it's a key part of the arsenal."

Protect the bottom line with sophisticated infection prevention technology

While there is uncertainty around healthcare at policy level, the emphasis on outcome-based reimbursement is poised to continue, as is transparency regarding performance. Therefore, it is paramount that the healthcare community not take its eye off the ball when it comes to patient safety.

"I think with all the uncertainty around healthcare reform or repeal, one of the things I think is important for us as healthcare leaders when we're working with our teams is keeping a focus on patient safety," said Mr. Hiltz.

To view the webinar, click here.

To view the webinar slides, click here.

To view past webinars, click here.

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