Earlier last week, The Leapfrog Group released its 2014 spring Hospital Safety Scores. The report showed an overall 6.3 percent average improvement in hospital performance since 2012.
Advocate Health Care, based in Downers Grove, Ill., is one system receiving high marks, especially noting that nine of the health system's hospitals received an A grade.
Kate Kovich, Advocate Health Care's vice president of patient safety, shared five of the health system's key strategies to champion patient safety.
1. Advocate places an emphasis on accountability surrounding health outcomes. Ms. Kovich says the health system's overarching goal is to have top decile performance in all areas of quality and safety outcomes. "Each year as a system, we establish targets for those outcomes, not because of safety scores, but because we believe we owe it to our patients," she says.
Upon establishing the goals, every leader across the Advocate system aligns with these goals and guides hospitals to achieving these outcomes, Ms. Kovich says. "The vision for health outcomes is crystal clear. I think that leader alignment and accountability are first and foremost the foundation of what we're able to achieve."
2. Developing and implementing a patient safety strategic plan is helping Advocate achieve "breakthrough performance." While the health system has always kept patient safety in the forefront, Ms. Kovich says, several years back, they had yet to reach a breakthrough in significantly decreasing adverse events. In 2011, Advocate began developing a patient safety strategic plan to become a high-reliability organization by means of a thoughtful, strategic manner with the ultimate goal of eliminating all events of serious harm across the health system.
"At the time, there weren't many organizations we found who had put that strategic thought to patient safety. Since we began our work, we have started seeing in the literature that other organizations are taking a similar approach," Ms. Kovich says.
3. The health system launched a "Safer Surgery Initiative" to reduce potential adverse surgical events. Advocate initiated a three-year effort focused on safety in operating rooms, which Ms. Kovich notes is the highest area of clinical risk in hospitals.. Areas of focus included effective and correct communication during handoffs from the surgeon's office to the OR scheduler, developing an anesthesia protocol, identifying appropriate and necessary lab tests to be completed prior to surgery and implementing a surgical safeguards checklist. Additionally, Advocate launched an OR team training initiative that focused on "minimizing the hierarchy and power distance in the OR so anybody feels comfortable raising a patient safety concern," Ms. Kovich says.
4. Some of the best results are produced from strategically aligned team work. In addition to aligning leaders across the system around health outcomes, Advocate puts teams together to collaborate on specific topic areas. "We have strong teams led by the system to identify best practices and to implement them at all sites across the system," Ms. Kovich says. "There isn't something at hospital A and something different at hospital B."
For example, in 2010 Advocate was at the 50th percentile for patient falls when compared to the National Database of Nursing Quality Indicators. Within three years, the system reached the 86th percentile by using an aligned team approach to develop and share best practices. "For Advocate, this reinforces that consistent focus on best practices and a system approach really makes a difference," Ms. Kovich says.
5. Leadership plays a crucial role in achieving a high-reliability culture. Every morning at 8:30 a.m., the leaders at each Advocate hospital gather for a daily safety huddle. In the huddle each leader reports any patient safety events, near misses or unsafe conditions that occurred in the past 24 hours and predict any specific risks that may arise in the next 24 hours. The risks could include two patients with the same name on the same unit, critical medication shortages, clinical equipment downtime, a staffing shortage or a projected weather alert. "It creates the shared risk or shared situational awareness of what we as leaders are facing today," Ms. Kovich says. "That 15 minutes lets us establish priorities so we can work together to mitigate those risks."
Ms. Kovich adds the daily safety huddles have been "transformational," with leaders verbalizing how the huddles helped them see how their work can directly impact other people. "People have said to me, 'I don't know how we ever did this without the huddle,'" she says.
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