In February, leaders of Cleveland-based University Hospitals realized two intensive care units at one of the system's 21 hospitals were not achieving zero harm. After encouraging front-line workers to find their own solution, the units reported "breathtaking results," according to Peter Pronovost, MD, PhD.
Dr. Pronovost, chief quality and clinical transformation officer for University Hospitals, sent an email to the hospital's clinical, operations, quality and ICU leaders saying, "Our goal is zero harm. You're not at it." He shared resources and told them he would visit them in one month to hear their improvement plan.
At one ICU unit, a nurse said the current dressing for dialysis catheters did not stay on well, so the team prototyped a new dressing for the central supply team to manufacture. The product clung better than the original dressing, so other ICU units began using the improved dressing.
That same unit also found a connection between high infection rates and low adherence of basic practices. The team created a checklist for inspecting catheters, and when nurses had a few minutes, they would audit one another and provide immediate feedback if compliance was not met.
At the second ICU unit, which had several new and travel nurses, the team added special training and focused audits with instant feedback about best practices.
After one month, the units reduced central line-associated bloodstream infection rates by 50%. Since then, they have reported zero CLABSIs.
When presenting the success to the board, the employees "were just bubbling with excitement because they solved it themselves," Dr. Pronovost told Becker's. "The energy that that ICU team had when they were able to present to the board, it was infectious."
When there is an accountability problem like this one, it is difficult to enforce change from the top down, he said. Leaders can provide resources, share goals and influence culture, but it is the power of local teams working together to solve problems that propels transformation.
"They were proud of what they did, and now they're taking that energy to say, 'OK, well, let's go apply it to these other problems that we're trying to solve."