Crit­i­cal case

Putting fo­cus on safety is key to hos­pi­tals im­prov­ing pa­tient care

Modern Healthcare - - OPINIONS COMMENTARY -

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

in Washington.

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