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Safety Across the Board: Activities and Opportunities...In June 2015 baseline was 12 days between...
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Safety Across the Board: Activities and Opportunities Lucia Austin, RN Senior Director, Patient Safety September 5, 2017
Transcript of Safety Across the Board: Activities and Opportunities...In June 2015 baseline was 12 days between...
Safety Across the Board:Activities and Opportunities
Lucia Austin, RNSenior Director, Patient SafetySeptember 5, 2017
Partnership for PatientsAlaska, Oregon, Washington: Driving Excellence Together
Why “Safety Across the Board”?• Hospitals need to create a culture of safety that
engages multiple stakeholders in efforts to eliminate all harm for all people.
• CMS Partnership for Patients (PfP) introduced the concept of Safety Across the Board (SAB) as a ‘new norm’ for hospital safety by shifting to a focus on reducing all potential forms of harms occurring in the hospital setting.
• PfP contributed to 87,000 lives saved, 2.1 million fewer patients harmed, and nearly $20 billion in cost-savings between 2011 and 2014.
SAB Strategies• Electronic triggers to identify and prevent harm. • No Harm Across the Board Initiative (focus on the
number of patients harmed rather than rates; gap analysis and checklist tools to engage front line in SAB interventions).
• Promoting systems approach to identifying, measure and evaluate harm toward a cultural transformation.
• Developing reports that includes all hospital-acquired conditions per 1,000 discharges for hospitals—use during consultations.
* CMS SAB Affinity Group 7/18/17
SAB Strategies• Engaging hospital leadership toward 4 tenets (culture
of safety, PFE inclusion, composite scoring of all forms of harm, health equity as a performance strategy).
• Publicly displayed patient safety outcomes dashboards; Quality Management System approach to identify and track all harm events collectively.
• Culture of excellence efforts.
* CMS SAB Affinity Group 7/18/17
HIINs Operational Definition of SAB• Identification of concurrent harm and mitigation. • The integration of all prevention/safety activities into
the nursing care delivery system seamlessly while increasing the frontline staff capacity to continuous improve to a highly reliable system.
• The state in which our hospital workers and patients are not experiencing any form of harm.
• The total number of harms across all adverse event areas per 1,000 patient discharges.
• Includes 4 tenets (culture of safety, PFE inclusion, composite scoring of all forms of harm, health equity as a performance strategy).
* CMS SAB Affinity Group 7/18/17
How HIINs are Measuring SAB• Percent (%) of patients harmed. • Not using one measure; using the annual AHRQ
Culture of Safety survey and targeting improvement/changes in those safety practices that are well vetted such as falls, PU, CAUTI.
• Combining several of the PFP measures. • AHRQ National Scorecard Methodology; the sum of
the numerators for the HIIN core harm areas over the sum of all hospital discharges (excluding mortality) with the rate reported per 1,000 discharges. • See https://www.ahrq.gov/professionals/quality-patient-
safety/pfp/index.html.
* CMS SAB Affinity Group 7/18/17
AHRQ National Scorecard on Rates of HACs
* CMS SAB Affinity Group 7/18/17
Biggest Impact Toward SAB
• Smart technology accessed by clinical expertise and strong patient safety initiatives.
• High reliability practices. • See https://psnet.ahrq.gov/primers/primer/31/high-reliability.
• Addressing unit based nursing practice such as purposeful rounding, bedside report, and effective use of white boards.
• Targeted unit based safety gap analysis and safety tools to frontline staff involvement.
• Building capacity to address multiple topics at once in the facilities.
• Develop and disseminate educational materials, resources/tools on how to adopt and utilize SAB principles to transform culture and improve patient safety outcomes
* CMS SAB Affinity Group 7/18/17
• “Quality Management System” approach which identifies and tracks collectively all harm events together and drives quality improvement strategies which cross cut institutions, departments and disciplines.
• PFE has a strong connection to SAB. • Correlate the impact on clinical outcomes to
implementation of safety culture improvement strategies, i.e. CUSP, TeamSTEPPS, HRO.
• Engaging the front line staff in identifying defects and quality improvement.
• Health equity goals informing all of the work- stratify data to address disparities.
* CMS SAB Affinity Group 7/18/17
Biggest Impact Toward SAB
Example 1 (2 hospitals; 338 beds / 198 beds)
Experiencing “uncomfortable meetings” with CEO and Board about recurring patient harm (something needed to change). Bold SAB Aim: ▪ 60-80% reduction of all moderate to severe harms in one year – evaluate days between harm events. SAB Strategy:
▪ Investment and roll out of a Safety Culture and “Just Culture” ▪ Workforce and Medical Staff Train the Trainer (physician champions).▪ Daily safety huddles delineated from patient experience huddles. ▪
Safety tool of the month messaging/newsletter. ▪ Working on an employee serious safety event system.
SAB Measurement: ▪ In June 2015 baseline was 12 days between serious safety events.
Current rate is 6 days between serious safety events at one hospital and 27 days between safety events at another hospital.
* CMS SAB Affinity Group 7/18/17
Example 2 (5 Hospital System)
Siloed, separate approach for each facility --needed to better leverage systems/pathways to better manage harms SAB Strategy:
• Multi-disciplinary systems approach for 4 harms: CAUTI, CLABSI, CDI and SSI
• C-Suite of all 5 campuses, meet monthly to discuss the 4 harm areas
• Assigned executive sponsors to take on the lead for each initiative (EHR, develop pathways)
• Developed quality councils at each campus lead by C-Suite. Councils address implementing pathway packets and modify PDSA (looked at workflows, audit tools)
• Identified units with largest needs and piloted changes in those units
* CMS SAB Affinity Group 7/18/17
Example 2 (5 Hospital System)
SAB Strategy: • Culture of Safety: “Mess Up- Fess Up”—Just Culture • Daily patient-safety huddles • Administered Safety Culture and employee engagement surveys • Assess each department’s improvement over time (using color
coding). Ask underperforming departments for action plans to become more safe
• Magnet campuses use the NDNQI engagement survey and share results at the department level with action plans for improvement
• Hand hygiene i-survey (the ability audit with an iPad or iphone) • Safety video of the month-staff person reducing harm (shown at
each staff meeting)
* CMS SAB Affinity Group 7/18/17
Example 3 (275 bed hospital)
SAB Measurement:• Identified highest harm events by looking at 2015 HACS and PSIs
and pulled in the ones with the highest incidence of occurrence. (Chose 6-8 highest harm indicators).
• Count the # of events that occurred of these harms, then divide this by 1000 discharge days, then multiply this by 1000 to get a “whole harm score number”.
• Also define the number of events with stick figures to show how many people we harmed (to get a visual to publicize) and display the number of harms in a pie chart for staff to see.
* CMS SAB Affinity Group 7/18/17
Example 3 (275 bed hospital)
SAB Measurement:• This “whole harm score” is understood by staff at all levels and is
talked about at all staff meetings; even the finance Dept. has to identify how they influence the number.
• Each unit gets a monthly unit scorecard of their events and what their “whole harm score number” is with the stick figures they harmed.
• The board loved this concept-it became a transparent conversation at every board meeting.
* CMS SAB Affinity Group 7/18/17
Hospital 4
* CMS SAB Affinity Group 7/18/17
Hospital 4
SAB Strategy: • Poster representation of SAB data in hospital front lobby with
accompanying article every month on how to prevent harm (written at 8th grade level and vetted by family members for comprehension).
• “Thank you for washing your hands”--business cards for patients to hand out to staff.
• General orientation presentation on safety and quality, near misses, serious safety events, etc.
• CNO presents SAB graph at every medical staff committee. • SAB rate is also on balanced scorecard quarterly as part of bonus
structure. • Dedicate first 15 minutes of every board meeting for a safety
topic and patient story.* CMS SAB Affinity Group 7/18/17
SAB Elements: 3 Imperatives
Culture Strong Safety Processes Engagement
Safety Across the Board
* CMS SAB Affinity Group 7/18/17
Imperative: CultureComponents Tactics to Consider
Patient Safety Rounding/Huddles
Workforce Safety Bedside Report
High Reliability Increased Reporting of Harm
Continuous Learning Environment Identification of Harm
Just Culture (non-punitive) Monitoring Harm (composite/dashboards)
Transparency Evaluating Harm
Health Equity Relentless/Constant Monitoring of Safety
Accountability (SAB is everyone’s role, not just quality department)
Including Health Equity to Inform Efforts (understanding the community)
Caring for staff/creating joy Keeping a Pulse on Future Potential Harm Areas by Mining data
Reslience/Mindfulness Increasing the Capacity to Address Multiple/All Harms
Forward Thinking* CMS SAB Affinity Group 7/18/17
Imperative: Strong Safety ProcessesComponents Tactics to Consider
Evidence Based Processes Formal Organizational Process Improvement Strategy
Performance Improvement Utilization of Unit Based Safety Tools/Resources
Systems Thinking Approach Performance Improvement Training
Human Resources (HR) Ensure HR has a prime role/process in quality/safety/behavioral standards/expectations (annual evaluations, competency, reward systems)
Utilization of technology triggers
Timely/Appropriate Training
How to support the frontline manager’s development in safety/quality (day to day culture reponses)
Coach and Mentor—Trianing
Team Building Training (frontline, management, C-suite)* CMS SAB Affinity Group 7/18/17
Imperative: Strong Safety ProcessesComponents Tactics to Consider
Evidence Based Processes Formal Organizational Process Improvement Strategy
Performance Improvement Utilization of Unit Based Safety Tools/Resources
Systems Thinking Approach Performance Improvement Training
Human Resources (HR) Ensure HR has a prime role/process in quality/safety/behavioral standards/expectations (annual evaluations, competency, reward systems)
Utilization of technology triggers
Timely/Appropriate Training
How to support the frontline manager’s development in safety/quality (day to day culture reponses)
Coach and Mentor—Trianing
Team Building Training (frontline, management, C-suite)* CMS SAB Affinity Group 7/18/17
Safety Across the Board• Transparency and Collaboration.
• Annual CEO and Trustee Summit and CMO safe tables.
• Person and Family Engagement and addressing disparities.
• Rural Quality Leaders—CPHQ certification.
How Does WSHA Approach?
Safety Across the Board
• Quality Fellowship to be developed to train leaders at various levels to adopt “systems thinking” and effective performance improvement methodologies.
• System level Quality Management Systems driving improvement at local hospital level.
• Provision of meaningful data reports which support performance improvement.
How Does WSHA Approach?
Safety Across the Board
• Many of our hospitals have begun their journey towards becoming a High Reliability Organization.
• Workforce Safety initiative to promote the quadruple aim, “Caring for our Caregivers.”
• Please share your ideas with your peers as we continue to grow our SAB community!
How Does WSHA Approach?
