In healthcare, there is no shortage of calls to make patient safety and quality improvement efforts more strategic and proactive.
Over the past year, a growing coalition of health systems, patient advocates and other stakeholders have expressed support for the establishment of a national patient safety board that would be dedicated to preventing medical errors, and leaders have increasingly highlighted the need for more proactive approaches to mitigate risk.
Health systems are beginning to put this into action through daily tiered safety huddles, fostering a culture in which all employees understand their role in preventing harm, and establishing processes to learn from and standardize best practices that have led to positive outcomes.
Below are four executives' responses to the following question: What is one tangible way your health system is making quality and safety work more proactive?
Editor's note: Responses have been lightly edited for clarity and length. They are listed in alphabetical order.
Hillary Jalon. Vice President of Quality Management at NYC Health + Hospitals (New York City): The most critical way to promote a proactive culture of quality and patient safety is to first build psychological safety and instill transparency across the healthcare system. At NYC Health + Hospitals, we have developed a quality and safety road map that began with implementing a comprehensive workforce wellness program, building trust across all levels of staff, and redesigning the quality infrastructure, focused on improvement.
These foundational efforts have allowed us to successfully implement proactive quality transformational activities, including a venue to openly share and engage in system-wide learning from root cause analysis procedures, as well as developing a tiered quality improvement capacity building infrastructure, which has resulted in increased engagement in and complexity of quality improvement projects. The entire workforce, from leadership to front-line staff members, are critically important in our quest to continuously engage in proactive approaches to quality.
Matthew McCambridge, MD. Chief Quality and Patient Safety Officer at Lehigh Valley Health Network (Allentown, Pa.): One thing we have done over the past year to be more proactive is to establish a daily Network Executive Tiered Safety Huddle from 9:30 to 9:45 [a.m.]. Safety huddles occur at all 15 hospitals earlier in the morning, and the senior leaders from each hospital meet on this network tiered huddle from 9:30 to 9:45.
We start with [Lehigh Valley Reilly] Children's Hospital and proactively discuss serious safety events, near-miss events, great catches and anything else that may potentially impact patient safety (supply chain, IT, pharmacy, ED holds, nursing staffing, etc.) at all hospitals. We generate a follow-up list to work from. The meeting is run by either myself, the chief nurse executive or another senior leader, and a member of the CEO Cabinet is in attendance. It has been a great way to bring forward patient safety issues and resolve matters as they arise quickly.
Peter Pronovost, MD, PhD. Chief Quality and Clinical Transformation Officer at University Hospitals (Cleveland): We at University Hospitals have a goal of zero harm when it comes to encounters with patients, and taking proactive steps to prevent harm from occurring in the first place is job one. We accomplish this by engaging our caregivers to believe that zero harm is everyone's job, creating a sense of belonging to this mission in all aspects of care, and building structures for shared accountability to boost quality and safety. In short, our approach is to embed the crucial zero harm aim even more deeply into our culture of caregiving, transforming the delivery of care through the powerful actions of believe, belong, build.
We recognize that patients can experience harm in several ways, including physical harm, emotional harm, defects in value and inequities. Across all our hospitals, health centers and physician offices, we implement a multifaceted effort that includes specific clinical initiatives to minimize harms such as these. For example, we have implemented initiatives to prevent hospital-acquired infections, monitor patients more closely for fall risk, utilize community health and social workers to assist with social needs navigation, boost participation in wellness visits and cancer screenings and reduce A1C levels among patients with diabetes, among many other population health initiatives.
To support this work, we issue almost-daily newsletters and other emails to reinforce best practices and build a sense of belief and belonging in our caregivers. The journey to zero harm began with one simple, powerful narrative shift: Stop believing harm is inevitable and start believing it is preventable. We're seeing great results from this proactive approach, in areas from surgical length of stay, to diabetes and hypertension control, to medication safety, and many other areas.
Deborah Rhodes, MD. Senior Vice President and Chief Quality Officer at Yale New Haven (Conn.) Health and Associate Dean of Quality and Professor of Medicine at Yale School of Medicine: We learned from our recent Culture of Safety survey results that front-line team members feel comfortable reporting safety events, but we also learned that we need to communicate more effectively the lessons, team collaboration and improvements that result from those reports. In our safety event common cause analyses, while continuing to learn from "what went wrong," we are increasingly focusing on ways to hardwire positive safety behaviors into care processes.
For example, we recently worked with providers to develop an accelerated triage process and care pathway that alerts in the Epic storyboard whenever a postpartum patient with hypertension arrives in the ED. This pathway integrates rapid, multi-disciplinary team assessment with guideline-based management, with the ability to deploy all relevant orders directly through the pathway. Through this process, we were able to demonstrate immediate improvement in time to medication delivery and to provide this feedback to ED and OB teams. This helps to connect safety event analysis to durable, supportive, and systemwide responses that improve patient care and put Safety II principles into practice.