A Framework for Safe, Reliable, and Effective Care, a new white paper published by IHI and Safe & Reliable Healthcare, provides guidance on how organizations can go beyond a collection of stand-alone patient safety improvement projects to develop a so-called “system of safety.” Health care organizations and systems may use the framework as a roadmap to guide them in applying the principles, and as a diagnostic tool to assess their work to date. IHI Leadership Alliance member MemorialCare Health System in Orange County, California, has done just that. In the following interview, MemorialCare Chief Transformation Officer Helen Macfie describes how her organization has put the safety framework into practice.
How has the Framework for Safe, Reliable, and Effective Care been most helpful to your organization’s patient safety efforts?
At MemorialCare, we leverage the framework to ensure we are working on all critical intersections to get us to clinical excellence. Having worked alongside IHI since 2005, we’ve been learning what’s effective and evolving as we go. For example:
- We introduced the Just Culture algorithms and training, in partnership with our HR teams, and assessed our outcomes with periodic surveys to understand where we have further opportunities to shore up our safety culture.
- We leveraged our multidisciplinary Best Practice Teams to engender consensus on key matters of importance and then hardwire them into our EMR and/or into practice guidelines.
- We adopted our Bold Goals for Quality and Safety, which build from the bottom up with input from team members across the health system; then our executives, physician leaders, and board members adopted the goals.
- We continue to focus on openly sharing performance data and reducing non-value-added variation in care through ever-enhanced use of data (data warehouse, physician portal, visibility boards).
I understand MemorialCare has focused on the Learning System side of the framework, specifically, the Continuous Learning section. What are some examples of how your organization proactively (rather than reactively) identifies problems to address?
- Through our Lean Management System, which is intentionally linked with Performance Improvement/Patient Safety (as opposed to being a separate focus of effort), we use huddles where teams look at the key performance indicators they’ve selected to celebrate performance and identify further opportunities. Executives and managers routinely round and provide encouragement at Visibility walls, as well as support Lean redesign and attend Lean workshops report-outs.
- We use our quarterly Quality Close of executives and then the Physician Society Board/Clinical Committee to look at performance site to site, and identify opportunities to share learning across the health system as well as key needs for drill-down focus. For example:
- Quality Close/Clinical Committee set a Bold Goal of reducing Harm Across the Board (HAB) by 80 percent.
- Based on learnings from the HAB focus, we’ve adopted a new measure for healthcare-acquired infections that simply counts up “all the infections we can’t prove we didn’t cause.” This allowed us to determine which sites were seeing an increase and which were seeing a decrease, which then fed into a Collaborative held this summer and resulted in immediate action and a 30 percent reduction from where we were at the beginning of 2016.
- We regularly review all reported “unusual occurrences” for patterns and trends, and share any root cause analysis or external sentinel event alerts with our risk managers and PI experts across the system to help ensure it doesn’t happen somewhere else.
What examples can you provide to demonstrate how continuous learning benefits your patients and your staff?
- Overall, we’ve seen an increase in our teamwork safety scores from the 13th percentile of AHRQ back in 2007 to now up to the 72nd
- Patient experience ratings have also increased to the 75th percentile, according to CMS.
- Our overall esprit de corps is higher now that it has ever been as an outcome of our combined focus on Safety, Lean Management, and Nursing Center of Excellence (Magnet) focus.
What are the three most important things leaders must do to support continuous learning?
We call it a “SEA Change”:
- Stretch – Set bold goals for the “vital few” and measure the results over time.
- Encourage – Use Best Practice Teams (BPTs), visibility huddles, and management rounds, and provide support to remove barriers or provide tools. For example, the Sepsis BPT has reduced sepsis mortality by 55 percent with use of enhanced protocol design, daily data monitoring, and enthusiastic champions. Also, the MemorialCare boards provided feedback to medical staff to continue focus on medication reconciliation Bold Goal for safety, with rates now at an all-time high for Perfect Care (all meds) of 85 percent on Admit and 92 percent on Discharge.
- Acknowledge – Support the importance of safety as a system property, and celebrate success wherever and whenever possible. We hold an annual Leadership Summit for executives, physician leaders, and boards where we celebrate our “lives touched” and note our “lives left to touch” (harms).