Becker's Clinical Quality & Infection Control

12 Sign up for the Free Becker's Clinical Quality & Infection Control E-Weekly at www.beckersasc.com/clinicalquality. How Health Systems Can Create a Robust, Enterprise-Wide Patient Safety Program By Sabrina Rodak  D etroit-based Henry Ford Health System launched its "No Harm Campaign" in 2008, a system-wide approach to patient safety that has a goal of reducing adverse events by 50 percent by 2013. HFHS is already more than halfway there — it has reduced harm events by 34 percent so far. The system also reduced system-wide mortality by 12 percent by 2011, achievements which garnered the system the 2011 Malcolm Baldrige National Quality Award and the John M. Eisenberg Patient Safety and Quality Award in 2011. Embedding patient safety practices in the culture William Conway William Conway, MD, senior vice president and chief quality officer of HFHS and CMO of Henry Ford Hospital in Detroit, and Sue Hawkins, senior vice president of performance excellence at HFHS, describe how HFHS created a patient safety program that spans five hospitals and numerous other sites of care. Embedding these practices in one's workflow is important not only for physicians and staff members, but also for the system's leaders. "We're concentrated on aligning the existing leadership to adopt [eliminating] harm as part of their daily work," Dr. Conway says. For example, the CMO of HFHS is responsible for insulin protocols, and nursing officers are responsible for falls and pressure ulcer protocols. The leaders report their progress on a regular basis, and their performance review takes this progress into account. Sue Hawkins The program's structure To be sustainable in different environments, whether by type of provider or geographic location, an enterprise-wide patient safety program needs to have a clear, robust structure that enables frequent communication across facilities. The No Harm Campaign's structure has three areas of focus: 1. Process: Understanding what the highrisk areas are and what processes can improve the harm rate. 2. Culture: Creating a safety culture through education and training. 3. Safe practices: Following evidence-based safety protocols, such as hand hygiene. All three areas support the campaign's goal of reducing harm. The campaign's goals are executed through several subteams that report to a larger, multidisciplinary committee that meets monthly for two hours. The subteams work toward reducing specific types of harm. The campaign looks at all harm, whether currently preventable or not, and separates them into six categories: infection-related harm, medication-related harm, procedural harm, care delivery harm, employee harm and other, which includes hospital-acquired renal failure, pulmonary embolisms and deep vein thrombosis. Implementing a multi-year patient safety program across different hospitals and care sites depends on a strong safety culture. Making patient safety part of the organization's culture was one of the biggest challenges but also one of the biggest keys to success of the No Harm Campaign. Ms. Hawkins says HFHS tried to make patient safety practices part of people's "daily work and culture so it doesn't feel like an extra activity." Leadership and accountability Managing a system-wide patient safety program also requires accountability to and by leaders — leaders need to hold others accountable for their efforts, and the leaders need to be held accountable for their role in the initiative. In addition to performance reviews, HFHS leaders' progress on meeting patient safety goals also affects their compensation. HFHS drives accountability from the top of the organization down to ensure improvement in meeting the No Harm Campaign's goals. The board evaluates patient safety data and the system's performance. Patient safety leaders at HFHS encourage the board to hold them accountable to their improvement goals to continue to challenge them on patient safety efforts. "We actually insist to our board that they ask us hard questions and keep asking us how it's going on these initiatives," Ms. Hawkins says. "We do the same thing at the next level, which is our quality and safety team, and at the next level, the senior leaders of the organization — they are required to report on what's going on and what's not working. We're very transparent about what's not working." Transparency of results Transparency is a critical component of a system-wide patient safety program, as it promotes communication among different stakeholders. At HFHS, transparency keeps everyone informed on progress toward the common goal of reducing harm by 50 percent by 2013. For example, the system posts each unit's progress on the harm they're responsible for. Transparency of data can motivate physicians and staff to improve their performance. "We don't blind any of the results because it drives healthy internal competition," Dr. Conway says. Constant vigilance One of the challenges of a system-wide patient safety initiative is maintaining energy and performance. For HFHS, taking on the formidable

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