Becker's Clinical Quality & Infection Control

Sign up for the Free Becker's Clinical Quality & Infection Control E-Weekly at www.beckersasc.com/clinicalquality. retrieve personal items. "If an RCA improvement action is still working in six months, that measure would be a more robust indication of commitment to safety," Dr. Beltz says. Responding to 100 percent of call lights within three minutes would be a stronger sign of safety commitment than distributing a certain number of fall risk assessments. 2. Be creative in developing measures of safety culture and engagement. Since there is no single measure of patient safety culture or patient engagement, leaders should look at several measures that can combine to reflect culture or engagement. Dr. Beltz says some creative measures she has seen for safety culture include the number of responses to a safety culture survey and the number and kind of disciplines represented in root cause analyses. Some examples of creative patient engagement measures include the number of patients partici- Turning Healthcare in to a High Reliability Industry: Memorial Hermann Shares 5 Steps (continued from page 1) Dr. Shabot has led the charge for Memorial Hermann to become a high reliability organization through the High Reliability: Journey from Board to Bedside Initiative. After its implementation in 2006, the Board to Bedside Initiative has led to the healthcare system receiving the 2012 John M. Eisenberg Patient Safety and Quality Award in the category "Innovation in Patient Safety and Quality at the National Level" from the National Quality Forum and The Joint Commission. Root of high reliability The transformational high reliability program began at the 12-hospital system because the Csuite and board realized change was necessary. "To be honest, the high reliability program grew out of a series of adverse events that occurred in 2006," Dr. Shabot explains. "There was a realization in the system that, in spite of the quality measures [already] undertaken, there was a need to totally change the approach to safety and quality in the healthcare system." From there, the system's leadership and board developed the high reliability initiative late in 2006. pating in process improvement teams, community attendance at health fairs and educational events and the number of "hits" on the quality measures tab of the hospital's website, Dr. Beltz says. It's the journey that matters Methods to measure soft aspects of patient safety such as patient safety culture and patient engagement are far from perfect; they rely on staff perceptions and often have low response rates. However, measuring soft patient safety constructs can be useful in launching discussions about safety, identifying areas for improvement and increasing awareness of patient safety. "The commitment to trying to measure (albeit imperfectly) [safety culture] in the face of its complexity is in itself an indication of the organization's commitment to safety," Dr. Beltz says. n reliability industries — the board chair is the CEO of the Houston zoo, for example. Ultimately, the board's support and funding has made the From Board to Bedside Initiative possible. 2. Make patient safety a core value. Many hospitals and health systems have sets of priorities and values along with a mission statement. Like many other systems, Memorial Hermann has several priorities; however, the system has just one core value: patient safety. "That represented a change," says Dr. Shabot. "Patient safety had been a priority among other priorities." But since 2007, patient safety has been at the heart of everything the system does, which helps promote high reliability. 3. Put employees through a high reliability education program. As part of the program, every single employee — about 20,000 individuals — went through a high reliability educational program off of their job site. "We taught nurses, pharmacists, cooks, maintenance personnel and secretaries, among others, how to do their job safer and ensure the safety of all patients and visitors in our facilities," Dr. Shabot explains. The training program is ongoing, with new-hires also receiving high reliability training upon joining the system. Steps to high reliability transformation Through the educational program, employees receive high reliability training and learn techniques from leaders in other high reliability fields, such as airline pilots and nuclear engineers. 1. Get the board's support. As the name of Memorial Hermann's initiative suggests, a successful high reliability program has to start with the board. 4. Follow safety checklists. To prevent various risk events, Memorial Hermann developed safety checklists in departments such as the intensive care unit and the operating room to ensure high reliability and reduce patient risk. For instance, prior to any procedures or surgeries, nurses and physicians run through a checklist with various steps, including verifying the patient's identification, the operation being performed, the specific body part and materials necessary for the procedure. Additionally, before a blood transfusion or administering a high-risk medication, two licensed providers complete a double-check to ensure safety. Also, all medications are bar-coded and checked against a patient arm band and computerized medication list before they are given. Since then, the high reliability initiative has grown from being implemented just in Memorial Hermann's hospitals to being used in all of the system's nearly 150 facilities. The following are steps to develop and implement a healthcare high reliability program, based on the formula Dr. Shabot and Memorial Hermann developed. "Our board members are learning this along with us," Dr. Shabot says. Board members go to safety and quality conferences and take educational courses to learn how to improve patient safety measures. Some board members are even in high 13 The checklist system has helped prevent patient harm by eliminating human error and ensuring patient safety. 5. Reward success. Becoming a high reliability organization doesn't just take work from leadership and the board, the success of the initiative relies on every employee in each Memorial Hermann facility. To recognize and reward hospitals and other facilities that embrace the program and achieve excellent results, the system created the High Reliability Certified Zero Award. The award is presented to hospitals that have gone 12 or more months without a patient harm event such as blood stream infections, falls with injuries and other adverse events. The award certificate is presented with much fanfare at employee gatherings. In the last two years, Memorial Hermann has presented 91 Certified Zero awards. Results As a result of the award-winning From Board to Bedside Initiative, the rate of preventable harm incidents in Memorial Hermann's facilities has dropped significantly. For example, since January 2007, more than 775,000 blood transfusions have been given with no transfusion reactions, a vast improvement since 2006. Hospitals in the system have also gone for years at a time without a single pressure ulcer, retained object during surgery or medicine-related safety event, which used to be common, according to Dr. Shabot. And, the hand hygiene program has an audited compliance rate of 92 percent. Despite the success of the high reliability program, Dr. Shabot says he and the rest of the system cannot rest on their laurels when it comes to patient safety. "The program will never stop. Patient safety is not something you can take your eyes off of or declare, 'we've solved that problem, we can go on to the next one.' Achieving safety is [an] all-day, every-day process," he says. So, the system will continue to strive toward the goal of zero safety events across the system through its High Reliability: Journey from Board to Bedside Initiative. n

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