Zero Adverse Events: How Dignity Health Achieved a New Standard

As a whole, clinical quality in American healthcare is slowly improving. In May, CMS released a report on the progress of quality improvements, revealing incidents of patient harmsdecreased 9 percent from 2010 to 2012. Through various quality improvement efforts, hospitals nationwide have prevented an estimated 15,000 hospital deaths and saved $4.1 billion in healthcare costs over the same period.

One of these quality improvements is CMS' Partnership for Patients. Launched in April 2011, the initiative tasks hospital engagement networks — health systems and other organizations geared toward identifying and disseminating best practices — to spearhead the movement toward higher-quality care. The efforts of these HENs undoubtedly played a role in the reported quality improvements, though one HEN's results in particular are especially laudable.

From 2012 to 2013, the 38-hospital San Francisco-based Dignity Health HEN reduced catheter-associated urinary tract infections by 52.7 percent, central line-associated bloodstream infections by 31.4 percent, surgical site infections by 36.3 percent, ventilator-associated pneumonia by 52.1 percent and patient falls by 25.5 percent, just to name a few.

Barbara Pelletreau, senior vice president of patient safety at Dignity Health, says the success can be attributed to the culmination of the health system's commitment to quality coupled with a national effort to improve.

"This has been two roads coming together with the work we're committed to doing anyway and being part of a national movement," she says.

While the health system reported outstanding results as a whole, one Dignity Health hospital in particular, St. Mary Medical Center of Long Beach, Calif., achieved particularly noteworthy results, reaching zero events of VAP and early elective deliveries.

"All those successes are a combination of our medical staff engagement, clinical staff engagement, support and resources that we received from this grant [Partnership for Patients awarded a total of $218 million to the 26 HENS] as well as resources from the Dignity Health office," says Ardel Guillamas Avelino, associate administrator at St. Mary Medical Center.

As part of their strategy, Dignity Health employed the unique role of MeasureVentionists, specially trained nurses who not only measure and record clinical adherence to best practices but also intervene and take action to fix any lapses in protocols. The term MeasureVentionists was first coined by Greg Maynard, MD, a hospitalist at University of California, San Diego. Dignity Health worked with Dr. Maynard in implementing MeasureVentionists across the system.

"MeasureVentionists would go out in real-time and see how we're doing on the units and give feedback to the care providers at the bedside or the charge nurse. That would be the 'measure' part. The 'vention' part is in real-time making the correction so the patients benefit from the intervention that is not being adhered to at that time," Ms. Pelletreau says. "We wanted people to go out and not just measure but intervene and do the intervention."

Mr. Avelino adds MeasureVentionists were critical in preventing infections and complications by concurrently reviewing patients' charts and proactively addressing any potential issues.

The positive outcomes across the Dignity Health system have "ignited" the health system's values and approach to focusing on care for every patient, says Ms. Pelletreau. "This has been a great journey for our organization. There has been a huge amount of collaboration and focus and celebrating what we're doing really well and at the same time identifying where we can have MeasureVention and where we can improve with that."

Jeanne Tapia, director of epidemiology and employee health at St. Mary Medical Center, says the next step in improving clinical quality is to expand improvement practices to the entire medical staff and other employees, rather than just the bedside clinical staff.

Instituting quality controls that reduce complications and save money have the added benefit of increasing patient satisfaction as well. There is an increased demand for infection control and clinical quality, not just from a reimbursement standpoint, but patients are becoming more knowledgeable and aware of these quality issues, and they are demanding safer treatment, Ms. Tapia says.

"Infection prevention used to typically be one practitioner in an office collecting local statistics about hand hygiene, watching our local infection rates and presenting them to local committees, checking the literature and giving medical staff and nurses recommendations on how to improve on those," she says. "Suddenly infection prevention is at the forefront of not only the national regulatory requirement focus, but the consumers are looking for quality of care in the arena in infection prevention as well, and that's what they're demanding in our service to them."

Zero Adverse Events: How Dignity Health Achieved a New Standard

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