In the everyday chaos of a busy hospital, it can become easy to find work-around solutions that push standards to the side in favor of getting the job done faster. But at what cost?
That's the question Michael Seim, MD, senior vice president and chief quality officer of York, Pa.-based WellSpan Health, started to ask repeatedly as he looked to turn up the quality at the health system's six acute hospitals and other facilities and reduce incidents of harm to clinicians and patients.
Dr. Seim told Becker's he discovered environments where employees didn't feel safe enough to speak up about near-misses or even to point some problems out before they caused damage. He immediately set out to attack the "work-around mentality" that hospital employees might tend to lean toward for efficiency's sake by instituting a "safety first" protocol.
"A safety first report doesn't mean something went wrong; it means someone noticed something that could go wrong," Dr. Seim said. "We are obsessed with finding failure before it happens."
When employees opt to get their jobs done without following standard procedures, instead doing things in a way that is faster and, perhaps, easier, he said, the behavior creates statistics that no hospital leader wants to see on reports.
WellSpan adopted a lean management strategy in 2021. The first step, Dr. Seim said, was to create "psychologically safe" environments where employees were encouraged to see anything, say something.
Focusing on finding potential mistakes before they happen — and even reporting safety events that did occur — created a "significant reduction in serious events."
In 2021, the first baseline year, 21,000 safety reports were filed. "In the year that just ended on June 30, we had 41,100 'safety first' reports — we doubled our numbers," Dr. Seim said.
"We have built a culture where people are more comfortable reporting potential harm," he said, noting they do so because they see the hospital's senior executives working to fix the problems that are reported.
More specifically, Dr. Seim said two of his hospitals have been central line-associated bloodstream infection-free for almost 1,000 days and three others haven't reported a CLABSI for 300 days. Three of the system's facilities have been catheter-associated urinary tract infection-free for over a year, as well.
Rooting out the problems
"Solving to root" is one of Dr. Seim's mantras. He doesn't look kindly at work-around behaviors that ignore standards and, in the end, create more problems. He said a focus on continually improving processes and sharing success throughout the healthcare system is priority No. 2.
Priority No. 1 is focusing on potential failure. "Whenever a problem exists, we have to make sure that we're not just looking at the easiest answer, but actually addressing the cause of the problem. And that means looking at process breakdowns," he said.
As an example, if infection rates increase, he immediately wants to know what is preventing team members from washing their hands to standard. "We can't just tell people that they need to wash their hands. It's about understanding why they are not doing it. Whenever there is a safety issue, it's almost always because of a poorly designed process. It's not because team members are acting recklessly."
All 20,000 employees at WellSpan Health have been trained in the system's customized lean management protocols. There are huddles everyday at several levels of the organization. Employees are empowered, led by hospital leadership in a six-tier program, to develop processes and determine how to achieve their safety goals.
If there is a problem, there is a mechanism to report it and find a solution. "Every day, within two hours, every safety event that's identified on the frontline, either through written record or through escalations, can be discussed," he said.
As chief quality officer, Dr. Seim said his goal is to be a resource for his leaders and their teams to see challenges as opportunities for improvement.