From reducing infections to preventing readmissions, medication errors, falls and pressure ulcers, there are a plethora of quality initiatives and goals for healthcare organizations, which can become overwhelming for staff and physicians. In addition, physicians and staff members may become burned out during a long-term quality project. Here are five tips to prevent change fatigue in quality initiatives at hospitals.
1. Pursue a safety and quality culture. One way to prevent change fatigue is to implement quality initiatives as part of a broader culture of safety and quality. For example, Houston-based Memorial Hermann Health System has been building a culture focused on high reliability — consistent high quality in a high-risk environment — for about seven years and continues to emphasize this model of care.
Dr. Michael Shabot
"It's easier to get enthusiasm for continued high reliability than for individual projects," says M. Michael Shabot, MD, CMO of Memorial Hermann. "The reason is that people look for projects to end. But high reliability is continuous; it never goes away. And believe it or not, there is less fatigue with that than with individual, one-off projects of fixing one thing, then going off to do something else."
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| Susan Hawkins |
In fact, perhaps the No Harm Campaign would be more accurately titled the No Harm committee, or another phrase that implies a long-term commitment rather than a single project with a definable end, according to Susan Hawkins, senior vice president of performance excellence at HFHS.
2. Communicate continually. Another strategy for preventing burnout with quality initiatives is to constantly communicate with staff and physicians about progress toward their goal and to recognize achievements. For example, HFHS updates its quality measures monthly and makes them available to everyone in the system on an internal website. It also sends electronic communications and features quality projects in an annual quality expo.
Jack Jordan
Keeping front-line workers updated on progress is critical to keeping them engaged in quality improvement efforts. Memorial Hermann gives out high reliability certified zero awards in recognition of hospitals that have gone a year or longer without a certain kind of adverse event. The awards are presented in a ceremony with medical staff, nursing staff or both. For example, Memorial Hermann Northwest Hospital in Houston received an award for maintaining zero retained foreign bodies for 36 months, from January 2010 to December 2012, and Memorial Hermann Katy (Texas) Hospital received an award for zero central line-associated bloodstream infections hospital-wide for 12 months, from July 2011 to June 2012.
3. Empower the front line. People are more engaged in an organization's culture and projects if they have a degree of power — the ability to make real changes. At HFHS, staff members can present quality improvement ideas to the No Harm steering committee, and potentially the system-wide quality group, including the C-suite. Enabling front-line workers to share their ideas gets them invested in the outcome and leads to possible system-wide improvements.
4. Make people accountable. Making individuals accountable for specific tasks and goals also keeps people engaged in quality efforts and prevents fatigue. HFHS cascades goals throughout the organization to each hospital. In the first few years of the No Harm Campaign, goals were also made for individual departments, such as housekeeping, to show how each person contributes to the overall goal of zero harm. Making people and hospitals accountable for specific objectives focuses their efforts and prevents complacency.
5. Retrain employees. Over the course of a long-term quality initiative such as high reliability, it may become necessary to retrain staff to keep them engaged. In 2007, when Memorial Hermann began its high reliability journey, every employee took a four-hour course on high reliability techniques. As new employees and leaders joined the system, they received a shorter high reliability training.
While Memorial Hermann has a relatively high retention rate — 88 percent — it still has 12 percent new staff each year, according to Dr. Shabot. One of the system's hospitals recently conducted a full retraining on high reliability practices, and other hospitals are also considering a full retraining. Investing in training and retraining ensures everyone has the skills and tools to make improvements and helps keep quality improvement top of mind.
Importantly, Memorial Hermann trains every employee, not just staff who interact with patients. It ensures first, that everyone is aware of the high reliability approach and goal, and second, that safety is enforced in every area of the organization, from registration to the operating room. "Safety is everyone's job, even if you're a secretary," Dr. Shabot says.
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