Healthcare reform's emphasis on patient safety and quality has motivated many hospitals and health systems to create a culture that supports safety and quality. Embedding a patient safety and quality focus in a hospital's culture is essential to improve in these areas because it illustrates to physicians and staff that quality and safety initiatives are not one-time events, but part of an overall, long-term commitment to quality and safety. Allan D. Siefkin, MD, CMO of UC Davis Medical Center in Sacramento, Calif., explains how strong leadership and continuous improvement can help create a robust culture of patient safety and quality.
Accepting responsibility
A culture of safety and quality requires everyone in the organization to accept that improving safety is possible. "You have to get beyond denial, saying our patients are different or we are referred all the socioeconomically challenged people," Dr. Siefkin says. Debunking the myth that clinicians have no control over adverse events is crucial to fostering an environment that encourages physicians' and employees' engagement in safety and quality initiatives.
A culture of safe and quality care needs to start from the top and spread across the entire organization. At UC Davis Medical Center, the CEO holds monthly leadership meetings that include reports on every patient safety and quality initiative. About 50 percent of the agenda at these meetings is related to safety and quality, according to Dr. Siefkin. By prioritizing safety and quality in the hospital, executives demonstrate to physicians and employees the importance of these issues to the entire organization.
Leaders can also show their commitment to safety and quality by developing formal safety and quality programs. The University of California launched its Center for Health Quality and Innovation in October 2010. The center provides grants to UC medical centers for quality initiatives and other innovative projects. For example, CHQI funded an effort to standardize the assessment of deep vein thrombosis across all UC hospitals.
Educate the next generation
Focusing on safety and quality as key factors in a hospital's success is a relatively new trend and may be difficult for hospital leaders to adjust to. Dr. Siefkin suggests academic medical centers may face a greater challenge than non-academic institutions in balancing safety and quality targets with other goals because of the centers' multiple missions, including education. Integrating safety and quality with academic medical centers' educational role can help hospitals shift efforts to more directly address safety and quality.
In 2011, UC Davis Health System launched the Integrating Quality Symposium: Linking Clinical and Educational Excellence, in which residents present papers and posters on safety and quality projects they're working on. UC Davis School of Medicine and the Betty Irene Moore School of Nursing are also looking into ways to include process improvement in the curriculum.
Be transparent
A culture of safety and quality requires leaders to be transparent about safety and quality initiatives — whether they are successful or not. Communicating successes and failures to the whole organization demonstrates the importance of these initiatives to the hospital or health system. UC Davis created an Intranet site that shows the hospital's performance on different safety and quality metrics, such as mortality rates, complication rates and hospital-associated infection rates. All employees and clinicians can access the site.
Continually measuring and tracking safety and quality metrics gives the hospital clear, quantitative goals and motivates leaders and staff to always strive for improvement. Setting goals in safety and quality based on benchmarks helps create a culture of safety and quality because everyone in the organization is expected to do their part to meet these goals. Continuing to measure performance also indicates the hospital's long-term investment in safety and quality.
About five years ago, the CMOs and CNOs of all five University of California medical centers met to discuss quality and decided to create a system-wide dashboard of quality indicators. This dashboard allows the hospitals to compare their results to each other and track improvements. Results on the dashboard motivated UC Davis to target central line-associated bloodstream infections, as its performance in this area was ranked "worse than average," according to Dr. Siefkin. UC Davis and the other UC hospitals implemented best practices to lower the rate of CLABSIs and saved a little fewer than 100 lives and between $14 million and $15 million in direct costs across all five hospitals, Dr. Siefkin says.
Engage staff in improvement efforts
Engaging clinicians and staff in safety and quality initiatives is also crucial to building a culture that promotes patient safety and quality care. Forming work groups to address specific problems creates accountability and gives front-line workers an opportunity to apply their direct experience to safety and quality problems. UC Davis created a congestive heart failure readmission reduction team to prevent patients with congestive heart failure from needing to be readmitted. The group has reduced readmissions for this patient population 20 percent within eight months.
Promoting collaboration between clinicians and staff also contributes to a culture of safety and quality. UC Davis supported clinician collaboration in a project to reduce ventilator-associated pneumonia. The hospital involved nurse specialists as change agents to help teach physicians standard protocols, such as daily sedation holidays, in which sedative infusion is stopped until the patient wakes, and is then restarted.
Never give up
While continuous improvement is always the goal, there will inevitably be some initiatives that do not meet the target. Instead of giving up and viewing the initiative as a failure, hospitals should learn from the experience and try different tactics until they reach the goal. Dr. Siefkin suggests analyzing each separate event for its root cause and acting to prevent the event from recurring. "Once you get to a certain point, you don't get discouraged," Dr. Siefkin says. "You figure out another way to do it," he says. Hospitals can also keep improvement teams motivated when an initiative does not succeed by creating some competition. For instance, UC Davis posted providers' success with reducing pressure ulcers in each unit to encourage everyone to improve.
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Accepting responsibilityA culture of safety and quality requires everyone in the organization to accept that improving safety is possible. "You have to get beyond denial, saying our patients are different or we are referred all the socioeconomically challenged people," Dr. Siefkin says. Debunking the myth that clinicians have no control over adverse events is crucial to fostering an environment that encourages physicians' and employees' engagement in safety and quality initiatives.
Leadership
Leaders must prioritize patient safety and qualityA culture of safe and quality care needs to start from the top and spread across the entire organization. At UC Davis Medical Center, the CEO holds monthly leadership meetings that include reports on every patient safety and quality initiative. About 50 percent of the agenda at these meetings is related to safety and quality, according to Dr. Siefkin. By prioritizing safety and quality in the hospital, executives demonstrate to physicians and employees the importance of these issues to the entire organization.
Leaders can also show their commitment to safety and quality by developing formal safety and quality programs. The University of California launched its Center for Health Quality and Innovation in October 2010. The center provides grants to UC medical centers for quality initiatives and other innovative projects. For example, CHQI funded an effort to standardize the assessment of deep vein thrombosis across all UC hospitals.
Educate the next generation
Focusing on safety and quality as key factors in a hospital's success is a relatively new trend and may be difficult for hospital leaders to adjust to. Dr. Siefkin suggests academic medical centers may face a greater challenge than non-academic institutions in balancing safety and quality targets with other goals because of the centers' multiple missions, including education. Integrating safety and quality with academic medical centers' educational role can help hospitals shift efforts to more directly address safety and quality.
In 2011, UC Davis Health System launched the Integrating Quality Symposium: Linking Clinical and Educational Excellence, in which residents present papers and posters on safety and quality projects they're working on. UC Davis School of Medicine and the Betty Irene Moore School of Nursing are also looking into ways to include process improvement in the curriculum.
Be transparent
A culture of safety and quality requires leaders to be transparent about safety and quality initiatives — whether they are successful or not. Communicating successes and failures to the whole organization demonstrates the importance of these initiatives to the hospital or health system. UC Davis created an Intranet site that shows the hospital's performance on different safety and quality metrics, such as mortality rates, complication rates and hospital-associated infection rates. All employees and clinicians can access the site.
Continuous improvement
Measure and track performanceContinually measuring and tracking safety and quality metrics gives the hospital clear, quantitative goals and motivates leaders and staff to always strive for improvement. Setting goals in safety and quality based on benchmarks helps create a culture of safety and quality because everyone in the organization is expected to do their part to meet these goals. Continuing to measure performance also indicates the hospital's long-term investment in safety and quality.
About five years ago, the CMOs and CNOs of all five University of California medical centers met to discuss quality and decided to create a system-wide dashboard of quality indicators. This dashboard allows the hospitals to compare their results to each other and track improvements. Results on the dashboard motivated UC Davis to target central line-associated bloodstream infections, as its performance in this area was ranked "worse than average," according to Dr. Siefkin. UC Davis and the other UC hospitals implemented best practices to lower the rate of CLABSIs and saved a little fewer than 100 lives and between $14 million and $15 million in direct costs across all five hospitals, Dr. Siefkin says.
Engage staff in improvement efforts
Engaging clinicians and staff in safety and quality initiatives is also crucial to building a culture that promotes patient safety and quality care. Forming work groups to address specific problems creates accountability and gives front-line workers an opportunity to apply their direct experience to safety and quality problems. UC Davis created a congestive heart failure readmission reduction team to prevent patients with congestive heart failure from needing to be readmitted. The group has reduced readmissions for this patient population 20 percent within eight months.
Promoting collaboration between clinicians and staff also contributes to a culture of safety and quality. UC Davis supported clinician collaboration in a project to reduce ventilator-associated pneumonia. The hospital involved nurse specialists as change agents to help teach physicians standard protocols, such as daily sedation holidays, in which sedative infusion is stopped until the patient wakes, and is then restarted.
Never give up
While continuous improvement is always the goal, there will inevitably be some initiatives that do not meet the target. Instead of giving up and viewing the initiative as a failure, hospitals should learn from the experience and try different tactics until they reach the goal. Dr. Siefkin suggests analyzing each separate event for its root cause and acting to prevent the event from recurring. "Once you get to a certain point, you don't get discouraged," Dr. Siefkin says. "You figure out another way to do it," he says. Hospitals can also keep improvement teams motivated when an initiative does not succeed by creating some competition. For instance, UC Davis posted providers' success with reducing pressure ulcers in each unit to encourage everyone to improve.
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