Building a hospital culture of safety

Navigating the healthcare system can be complicated (sometimes even risky). Although healthcare providers often deliver high-quality lifesaving care, the complex healthcare system that exists today can expose patients to unintended harm.

Identifying areas where safety and quality can be improved, and taking action to prevent harm, can help healthcare stakeholders steer clear of the pitfalls and find the right path to exceptional quality of care and service for patients.

But how?

In the hospital
As a result of the changing pay-for-performance incentives for hospital-acquired conditions (HACs), health systems everywhere are putting processes in place.

There are penalties surrounding HACs, but in the future, some HACs will result in double or triple penalties (depending on the reimbursement models). Getting a handle on common conditions will be vital to reduce harm and waste.

Results from Premier’s QUEST collaborative show the gains are achievable. Cumulatively, nearly 20,000 harm events were prevented from 2010 through Q3 2013. QUEST organizations reduced:

• Central line-associated bloodstream infections (CLABSI) by 82%
• Hospital-acquired injuries by 71%
• Pressure ulcers by 65%
• Staph infections by 36%
• Ventilator-associated pneumonia by 23%

All of this is done through the power of collaboration. By reviewing data and collaborating with other healthcare executives, hospital and health system leaders are able to implement successful strategies that raise the quality and efficiency of their care.

These organizations improved safety and reduced harm through some of the following best practices:

• Effective standardization: The hospitals that made the biggest gains use strategies that “hardwire” best practices into the system.
• Implementation of care bundles: Using a collection of interventions that can be executed together results in better outcomes than interventions implemented individually.
• Encouragement of advocacy: Top performers have implemented training programs or promoted cultures that encourage communication and teamwork, while empowering staff to speak up and advocate for better, safer care.
• Leadership involvement: Executive leaders of top performing systems were committed to improving safety and made this visible to frontline employees through structured leadership meetings in which staff could address their concerns.

In the pharmacy
Hospitals and other healthcare providers also face ongoing drug shortages that can lead to safety issues or the delay of necessary care. Although 38 new drug shortages were reported from January through September 2013 (compared to the 117 reported in 2012), long-standing shortages affect more than 300 drugs.

A survey of Premier’s member pharmacy experts found only 10% of respondents believe a drug shortage has never caused a safety issue or error in patient safety over the last 6 months.

GPOs can help health systems mitigate the drug shortage impact and steps have been taken by lawmakers, the FDA, manufacturers and hospitals to:

• Communicate early about possible shortages
• Add back-up inventory for critically important drug categories
• Hold regular meetings with internal pharmacy staff to prioritize actions in the event of a shortage
• Create failure-to-supply language in contracts

At home
A major aspect of the ACA (and the incentives for accountable care organizations and other new care delivery models) is taking care of people outside of the traditional healthcare system. Keeping people healthy outside of the acute care setting means reducing the risk of harm, as well as driving out unnecessary cost from the system.

Population health management tactics and initiatives are designed to do just that – provide preventive methods through various means that keep people from becoming patients.

More than 1/2 of the respondents to our semiannual survey state that their organizations are dedicating resources to lifestyle and wellness coaching, community engagement programs and home health.

They also indicated a variety of other untraditional initiatives that help to better manage the patient population’s needs outside of the acute setting.

It’s clear that health systems are making strides to move care beyond the hospital walls and better connect patients with resources that can keep them healthy.

It starts by identifying areas of risk and harm – both inside and outside of care facilities. Although navigating the potential pitfalls in both of these areas can be tricky, we’ve seen that hospitals have found success and that there are actionable ways to improve quality, cut costs, and most importantly, keep patients safe across the continuum of care.

This post originally appeared in Action for Better Healthcare