Why we’re obsessed with ZERO at Memorial Hermann
FACT: Hospital-associated preventable deaths are the third-leading cause of death in the United States, resulting in over 250,000 deaths per year.* When it comes to patient harm and medical complications, zero is the best you can do. It’s what we aim for every day at Memorial Hermann. Our mission to become Houston’s first high-reliability healthcare organization and deliver care free of harm stems from an operational model more commonly associated with aircraft carriers, nuclear power plants and commercial aviation, where avoiding accidents in high-risk, highly complex environments is critical. Although many business sectors have operated as high-reliability organizations for years, the concept is not as widespread in health care. For over a decade, Memorial Hermann has been working to change that, garnering national recognition in the process. In 2006, when we set out to improve the quality and safety of the care we deliver at Memorial Hermann, we didn’t do it to win awards. We did it in the best interest of our patients and their families. “We are absolutely devoted to providing an exceptional patient care experience and that has to be based on an absolute bedrock of quality care and patient safety,” says Dr. Ben Chu, Memorial Hermann President and CEO. “The organization is totally devoted to do everything we can to provide the best care experience for our patients and our members.” With preventable hospital deaths now ranking as America’s third-leading cause of death, focusing on patient safety and quality has never been more important. Here’s a look at how we’re moving closer to our goal of delivering safe, effective, harm-free care every day.
MAKING HOSPITALS MORE ACCOUNTABLE FOR QUALITY AND SAFETY
At Memorial Hermann, we believe that quality care delivery is everyone’s job. Our continuous focus on patient safety is a core value adopted by our Board and senior leadership teams and is reinforced in our strategic plan with welldefined goals and metrics. Safety is viewed as a shared responsibility, and high-reliability behaviors that lead to zero harm are recognized and rewarded. To recognize high-reliability behavior, we created the Memorial Hermann High-Reliability Certified Zero Awards for hospitals that go 12 consecutive months or longer without adverse events in federally defined categories. Awarded by Memorial Hermann’s System Quality Committee, the awards are based on results that are formally certified in monthly reports to the Centers for Medicare and Medicaid Services (CMS). Since the program started in 2011, Memorial Hermann hospitals have earned more than 247 Certified Zero Awards for avoiding hospital-acquired infections and other conditions causing patient harm. Many hospital and health systems across the country, and even entire states, have adopted their own versions of Certified Zero Awards based on the Memorial Hermann model. In collaboration with virtually every discipline, our 17-hospital system has reached new heights in our quest to achieve high-reliability health care. Together, employees, physicians and leadership have built a new system for ensuring timely, accurate and effective treatments. And we have emerged as a leader in Houston – and across the nation – in patient safety.
IMPROVING QUALITY AND SAFETY THROUGH INNOVATION AND SHARED GOALS
Every day, Memorial Hermann’s ongoing quality and safety initiatives are proving that high reliability can exist in medicine through a disciplined approach and an aligned organizational structure. Memorial Hermann Physician Network, MHMD, operates the MHMD Clinical Programs Committee (CPC), the clinical arm of the independent physician organization. With affiliated physician representation from all 17 Memorial Hermann hospitals, the CPC continues to partner with Memorial Hermann, aligning the quality and safety programs of the physician organization and its health system. There are now more than 50 specialty subcommittees and task forces composed of more than 450 physicians, nurses, pharmacists, care managers and administrators from Memorial Hermann. Each subcommittee explores ways to advance the health of the community and the patients we serve by adopting evidence-based care. The multidisciplinary CPC structure fosters greater collaboration between specialties. This has led to significant advances to improve clinical outcomes, including transitions to home and other care services, enhancements in information technology, detection and management of sepsis, prevention of deep vein thrombosis (blood clots) and coordination of efforts between providers of care.
MAKING HEALTH CARE SAFER WITH ROBUST PROCESS IMPROVEMENTS
Memorial Hermann believes that our frontline caregivers are the best positioned to lead care innovation and improvement. In 2013, Memorial Hermann Health System adopted The Joint Commission Center for Transforming Healthcare’s Robust Process Improvement® methodology for performance improvement. As part of the program, employees and physicians from across the health system undergo training in the appropriate application of specific improvement methods and techniques. The training culminates in Memorial Hermann’s annual Robust Process Improvement (RPI) Quality and Safety Expo, where course participants gather to share the results of their projects with Memorial Hermann leaders and healthcare leaders from around the country. Memorial Hermann’s Fifth Annual RPI Expo was held in February 2017, achieving record attendance and featuring over 60 RPI projects from around the health system. To date, more than 145 quality initiatives have been launched through the program. The annual event is now attracting dozens of visitors from more than 20 health systems from across the U.S. and Canada. A second day was added, to share best practices and offer tips and guidelines for implementing Memorial Hermann improvement projects in their own hospitals. “The RPI Quality & Safety Expo started out as a small expo to celebrate the processes that we put in place when we first started our centralized Quality, Patient Safety and Infection Control department,” says Dr. Angela A. Shippy, Chief Quality Officer at Memorial Hermann. “Now it’s grown to over 60 projects from all across the system. We’re learning more about good process and how we can work together to improve the care we provide to patients.”
COLLABORATING WITH THE JOINT COMMISSION TO IMPROVE CARE
Memorial Hermann has long been committed to increasing hand hygiene compliance to reduce the incidence of healthcare-associated infections. As part of those efforts, Memorial Hermann, along with only seven other facilities in the nation, elected to voluntarily take part in The Joint Commission Center for Transforming Healthcare’s 2009 inaugural project to improve hand hygiene. In 2010, Memorial Hermann implemented the center’s web-based Targeted Solutions Tool® in 150 inpatient units across all hospitals. In just four years, the System achieved a marked improvement in hand hygiene compliance, sustaining a 95% average compliance rate from June 2011 through December 2014 and continuing to the present. At the same time, the adult central line-associated bloodstream infections and ventilator-acquired pneumonia rates in the intensive care units decreased by 49% and 45%, respectively. Now we’re working together with The Joint Commission Center for Transforming Healthcare on fall prevention. Together, we’re identifying root causes of falls and employing new technology and encouraging behavior changes that are leading to fall-free environments.
ENCOURAGING BEHAVIORS THAT FOSTER COLLABORATION AND REDUCE ERRORS
In 2006, we implemented a patient safety culture program called “Breakthroughs in Patient Safety.” We engaged engineers and other experts from industries like nuclear power and commercial aviation to train our employees to perform tasks in a safe, highly reliable manner. Since its inception, more than 25,000 employees have been trained in these behaviors and techniques for improving patient safety that encourage employees to think critically, communicate openly, ask questions and consider alternatives. Below are two of the tools we use to deliver safer care.
EMPLOYING TECHNOLOGY TO MAKE CARE SAFER
For 12 consecutive years, Memorial Hermann has been selected as one of the nation’s “Most Wired” healthcare systems, according to data released by the American Hospital Association. Hospitals & Health Networks magazine sponsors the annual survey that measures how fully information technology has been adopted by hospitals and healthcare systems in the United States. Memorial Hermann’s comprehensive Electronic Health Record (EHR) in all patient care areas along with Computerized Physician Order Entry (CPOE) are helping to prevent errors and streamline delivery of safer patient care. When doctors enter orders into the computer electronically, we’re eliminating potential transcription errors as well as preventing medical errors by automating clinical decision support. Built-in safety alerts pop up when physician orders contradict medical guidelines or patient information. At Memorial Hermann, Project MEDSAFE goes even further to increase reliability at the point of medication administration by providing an electronic doublecheck that compares medical barcode information at the bedside against a verified physician’s order. We’re also using electronic screening tools to pick up early signs of sepsis, a blood infection that kills more than 230,000 annually, and employing radio-frequency identification technology in the OR to make surgery safer by carefully tracking and retrieving all surgical items before the operation is completed. Using a secure, encrypted electronic network, Memorial Hermann Information Exchange (MHiE) facilitates access to important clinical information to provide safer, more efficient and more equitable patient-centered care. With patient consent, records can be shared between treating physicians, allowing for continuity of care across multiple settings by making critical information available at the point of care. While we are encouraged by our early achievements, we also recognize that becoming a High Reliability Organization is a never-ending quest toward the achievable goal of zero harm to patients under our care. We salute our employees and affiliated physicians who make these achievements possible through their continued attention to high-reliability behaviors, evidence-based care and harm prevention. “We think it’s important for every hospital in the city and every hospital in the country to operate under high-reliability principles. This is needed,” says Dr. M. Michael Shabot, Memorial Hermann Chief Clinical Officer. “We were actually one of the first hospitals and health systems to adopt high reliability 11 years ago as our goal, and as such we have become a leader – but we really just did it for our patients.”