Issue link: https://beckershealthcare.uberflip.com/i/351038
7 have top decile performance in all areas of quality and safety outcomes. "Each year as a system, we establish targets for those outcomes, not because of safety scores, but because we believe we owe it to our patients," she says. Upon establishing the goals, every leader across the Advocate system aligns with these goals and guides hospitals to achieving these outcomes, Ms. Kov- ich says. "The vision for health outcomes is crystal clear. I think that leader alignment and accountability are first and foremost the foundation of what we're able to achieve." 2. Developing and implementing a patient safety strategic plan is helping Advocate achieve "breakthrough performance." While the health system has always kept patient safety in the forefront, Ms. Kovich says, several years back, they had yet to reach a breakthrough in significantly decreasing adverse events. In 2011, Advocate began developing a patient safety strategic plan to become a high-reliability organization by means of a thoughtful, strategic manner with the ultimate goal of eliminating all events of serious harm across the health system. "At the time, there weren't many organizations we found who had put that strategic thought to patient safety. Since we began our work, we have start- ed seeing in the literature that other organizations are taking a similar ap- proach," Ms. Kovich says. 3. The health system launched a "Safer Surgery Initiative" to re- duce potential adverse surgical events. Advocate initiated a three- year effort focused on safety in operating rooms, which Ms. Kovich notes is the highest area of clinical risk in hospitals. Areas of focus included effective and correct communication during handoffs from the surgeon's office to the OR scheduler, developing an anesthesia protocol, identifying appropriate and necessary lab tests to be completed prior to surgery and implementing a surgical safeguards checklist. Additionally, Advocate launched an OR team training initiative that focused on "minimizing the hierarchy and power dis- tance in the OR so anybody feels comfortable raising a patient safety con- cern," Ms. Kovich says. 4. Some of the best results are produced from strategically aligned team work. In addition to aligning leaders across the system around health outcomes, Advocate puts teams together to collaborate on specific topic areas. "We have strong teams led by the system to identify best practices and to implement them at all sites across the system," Ms. Kovich says. "There isn't something at hospital A and something different at hospital B." For example, in 2010, Advocate was at the 50th percentile for patient falls when compared to the National Database of Nursing Quality Indicators. Within three years, the system reached the 86th percentile by using an aligned team approach to develop and share best practices. "For Advocate, this rein- forces that consistent focus on best practices and a system approach really makes a difference," Ms. Kovich says. 5. Leadership plays a crucial role in achieving a high-reliability culture. Every morning at 8:30 a.m., the leaders at each Advocate hospital gather for a daily safety huddle. In the huddle each leader reports any patient safety events, near misses or unsafe conditions that occurred in the past 24 hours and predict any specific risks that may arise in the next 24 hours. The risks could include two patients with the same name on the same unit, critical medication shortages, clinical equipment downtime, a staffing shortage or a projected weather alert. "It creates the shared risk or shared situational aware- ness of what we as leaders are facing today," Ms. Kovich says. "That 15 minutes lets us establish priorities so we can work together to mitigate those risks." Ms. Kovich adds the daily safety huddles have been "transformational," with leaders verbalizing how the huddles helped them see how their work can di- rectly impact other people. "People have said to me, 'I don't know how we ever did this without the huddle,'" she says. n The system had been working to address complica- tions during vaginal births after Cesarean sections. "The care there was not our most proud moment," Dr. Bignotti says. "We were not where we as an orga- nization wanted to be" when it came to complication rates for mothers and children, Dr. Bignotti says. So, the system used it as an opportunity to educate its obstetrics providers on best practices and standard- ize the care not only when it came to vaginal births after C-sections but also around all childbirth prac- tices. There were three main goals of the PPSI: to standardize treatment for vaginal births post-Cesare- an section, standardize use of Pitocin in stage two of labor and to limit elective deliveries before week 39. To implement guidelines — for the PPSI project and countless others undertaken by the UCO — CHE Trinity Health follows four steps, outlined below. Step 1: Establish the burning platform. "Start by making the case," Dr. Bignotti says. Hospital and health system officials or department leaders have to communicate to physicians why they may need to change the way they provide care. He suggests laying out the data and explaining where the system wants to be in terms of benchmarks. Step 2: Weigh the evidence. In this step, organizations should pull evidence from various sources together and sort out any conflicting evidence that may arise. Step 3: Develop the guideline. After examining and sorting out the evidence, it is time to develop the guideline based on that evidence. Many times, CHE Trinity uses its own clinical experts to help develop these guidelines, but "if others have led the way and done the research, we do not hesitate to ask those people to assist us," Dr. Bignotti says. It is also important to allow providers in the field to weigh in during the creation process. Step 4: Implement and give feedback. The final stage involves educating and training clinicians on the new protocols. Then, it is important to provide continual feedback to providers on how they are following the protocols, according to Dr. Bignotti. That way, the clinician knows how he or she is performing against the guidelines By following these four steps, Trinity achieved widespread positive results. For example, prior to the implementation, 15 to 20 percent of pre-39 week deliveries at leaders were elective. Now, that number is down to 0.4 percent. Additionally, the system has not had any babies injured as a result of inability to handle a vaginal birth after a C-section. At the end of the implementation process and when positive results start rolling in, hospitals and health systems should celebrate the success of the process with everyone involved, Mr. Bignotti says. For example, for the PPSI, leaders went back and recognized the physicians who went through the training for the guidelines. Some of the system's hospitals even took out ads in local newspapers to thank them for their work. To further celebrate successes, members of a success- ful team are invited to come to other forums to share their experiences. "We take the learning we had in obstetrics and transfer it to other initiatives," Dr. Big- notti explains. "This knowledge transfer can make other improvements more efficient and timely." A note on sustainability Though the guidelines are up-to-date when they are implemented, medicine is constantly evolv- ing, and often the evidence-based guidelines will change as well. Taking this into account, CHE Trin- ity Health's UCO leverages its electronic health re- cord capabilities in many ways. Clinical leadership regularly extracts reports from the EHR that allows them to make data-driven decisions. They also in- fuse the EHR with rules, processes and protocols that standardize the way care is delivered. For example, as clinicians and researchers become aware of treatments that result in better outcomes for certain diseases or conditions, they can update the systems with the recommended protocols. By using the system to create or implement order sets, all physicians in the network can be prompted elec- tronically and immediately on the latest evidence- based guidelines. "We use technology to provide evidence at the point of care," Dr. Bignotti says. If large changes need to be made to the evidence- based guidelines, the UCO will put together a program to retrain or reeducate the providers as necessary. By following the four steps, celebrating successes and leveraging technology to help its clinicians, CHE Trinity Health ensures the evidence-based guidelines are being implemented — consistently. n Advocate Health Care's 5 Keys to Patient Safety (continued from cover) CHE Trinity's 4 Steps to Implementing Evidence-Based Guidelines (continued from cover)