Putting focus on safety is key to hospitals improving patient care
You have just received the quarterly statistics, and the numbers aren’t any better. Your number of critical sentinel events hasn’t dropped, central-line infections still remain high, medication errors are still occurring at an unacceptable rate, and, most important, staffers are frustrated and angry that they are being cited as the reason for the mistakes.
Yet despite multiple outside consultants, several years of failed initiatives and countless disappointing board meetings, there has been little progress in your hospitals’ efforts to undergo a complete transformation and become a truly safe hospital. With so much focus, effort and money being thrown at this critical initiative, why is it that so many hospitals are not making this crucial transformation?
Understanding the issues that lead to these repetitive failures is critical for all healthcare executives. We will describe the factors that build barriers to establishing a safe hospital. Leadership or lack thereof.
There is substantial evidence that safety is not the first priority with many hospital CEOS. The American College of Healthcare Executives’ annual survey in 2010 of more than 500 CEOS showed that financial challenges, healthcare reform implementation and government mandates were all prioritized above patient safety and quality. No one is going to be naive enough to argue with these priorities as challenging financial issues loom large, but leadership should recognize that you must either invest now or pay later via pay for performance or public scrutiny. Critical mass.
Institutions and healthcare systems historically relied on the quality and safety office to drive safety in their organizations. It is now clear that a broader base of personnel must be the driving coalition pushing these safety initiatives. This takes resources to support individuals and an enormous effort. How large a coalition is required? Consider taking the square root of the total number of personnel in your organization as a starting point. (Thomas Lee in Harvard Business Review, April 2010, “Turning doctors into leaders.”) This quantitative approach may not be entirely evidence-based, but it does reinforce the necessity to expand the coalition to push your safety initiative. Data and transparency.
Most individuals working in healthcare are heavily data-driven. Physicians and nurses are wed to the idea that if you cannot measure it, you cannot improve it. So how does a hospital generate data that is reliable and highly transparent? By being involved in data acquisition and analysis from the onset; otherwise, its reliability will be questioned. In addition to valid data, transparency must be embraced at the highest levels within the organization using public venues such as town hall meetings, showing where you stand on your quality metrics compared with other institutions and appealing to the clinicians’ competitive nature. Also, presenting closed claims cases, sentinel events and other meaningful clinical cases in your institution to your staff and hospital board is critical in establishing a culture of safety. Consultants.
Consulting firms focusing on hospital safety are a cottage industry that has blossomed to feed the hunger of CEOS and hospital boards desperate to hardwire safety at their institutions. However, one of the largest client pools comes from repeat clients because of their lack of embedded change. Consultants are useful with the unique skill set they were hired for, but the structural changes must be made from within. Once the consultants leave, they will return in 24 to 36 months with smiles on their faces and money in their pockets if the infrastructure changes are not made that will truly embed safety in the institution. Lack of communication.
Beating the safety drum relentlessly in every venue and communication that a hospital has is crucial to putting this initiative at the forefront. To build our communication platform, we hired a patient safety communications director to help drive our agenda. At Medstar Georgetown University Hospital, we use 19 communication tools monthly to promote our safety initiatives. Lack of investments.
Safety costs. It is not a budget-neutral initiative. If your organization wants physicians to be heavily involved in safety, it is quite clear that you need to invest in their time. Without incentives and some degree of investment in these initiatives, they will sputter to a halt. A lack of early wins.
When an institution takes on a large broad-based initiative in safety and cannot show some early success, then the initiative will be threatened in its infancy, just when it is getting traction. Be sure whatever you take on in the early phases is measurable, benchmarked and can be successful with data that are easily understood by everyone. The idea that the early investment paid off will enhance your hospital and healthcare system’s profile and add resources for bigger issues to come.
We are all charged with confronting this difficult task of establishing a culture of safety within the walls of our hospitals. The factors outlined in this article are some of the common reasons why safety transformations fail. By understanding these factors, we should become more effective at an ethos of safety in our hospitals and delivering safer care to our patients.
Beating the safety drum relentlessly in every venue and communication that a hospital has is crucial.
Dr. Stephen Evans is
vice president for medical affairs and chief medical officer at Medstar Georgetown University Hospital