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Achieving High Reliability in America’s Most Dangerous Industry
TripleTree, the country’s largest healthcare merchant bank providing investment banking services, posed the question on their latest blog, “what does a culture of safety in healthcare look like?”
Provoked by the grounding of the Boeing 737 Max aircraft after the second fatal crash in March, TripleTree highlighted that there are no true regulators in healthcare to step in when there are widespread safety issues. In the instance of the Boeing 737 Max, all three U.S. airlines that flew the Max — Southwest, American and United — canceled thousands of flights pulling the planes from their schedules through the summer months in reaction to the crashes that killed a total of 346 people.
In striking contrast to the airline industry, the healthcare industry cannot “ground” operations when a negative patient outcome occurs, given the severity and variability of providing medical care to a community. This leaves a large gap, or rather opportunity, for healthcare organizations to follow the lead of high reliability from other industries, including airline and nuclear power.
By adopting high reliability organization (HRO) principles, healthcare organizations can implement processes that improve the quality of care they provide by building the appropriate tools, procedures, and mindset in order to achieve “zero harm.” By definition, highly reliable organizations succeed in avoiding catastrophes in an environment where normal accidents can be expected due to risk factors and complexity.
TripleTree outlined three tools and tactics leading health systems are using to support high reliability: consistent use of rounding and checklists, encouraging event reporting, and peer review to examine provider safety.
Verge Health, through the Converge Platform, supports these three areas when empowering health systems to proactively protect and defend patients against medical errors and adverse events. The Converge Platform unifies safety, risk, and quality data giving leaders an enterprise view of risk. Sharing data across all aspects of risk management allows for robust analytics to gain actionable insights for proactive decision-making to create an environment where “zero harm” is the standard of care.
Below we’ll review these three patient safety tools to highlight the importance of adopting each.
Rounding and Checklists:
It’s commonly accepted that rounding can greatly increase safety, improve communication with staff and patients, and boost patient satisfaction. How it is implemented and incorporated into an organization’s culture and operations, varies greatly, however. When fully implemented, rounding allows systems to audit processes, engage front-line staﬀ, and listen to patients. Actively seeking out issues and understanding the current state not only ensures rapid improvements, but fosters a resilience mindset, handling problems before they grow and building trust with patients and employees.
In a recent webinar Verge Health and Cleveland Clinic partnered to discuss Cleveland Clinic’s approach to Patient Experience and partnership with Verge’s rounding tool to improve nurse and leader rounding and boost the patient and caregiver experience.
“Sometimes innovation is not always creating a bright shiny new explosion, but rather finding ways to adapt or build a good solid practice to meet the changing needs of not only our patients, but also our caregivers … Sometimes this requires just blending the human touch with technology,” said Lori Kondas, executive director of patient experience at Cleveland Clinic.
Research found that when hospital leaders, nurses and physicians rounded daily, the dimensions of the HCAHPS scores, including hospital ratings, nursing and physician communication, cleanliness and medication communication, improved.
Beyond ensuring work orders could be implemented into the technology tool, Cleveland Clinic wanted a tool that didn’t take away from the human interaction of rounding, tracked issues in real time and aggregated and trended data on the documented issues.
Health networks need to build a culture that incorporates a mindset of continuous improvement including encouraging event, near miss, and unsafe condition reporting, empowering caregivers to make decisions based on expertise and experience and embracing existing processes in new ways.
Safety culture requires everyone within an organization to be transparent and act. The common goal is to provide safe, and consistent high-quality care while reducing risk to patients. Learning culture offers the next step in a cycle of continuous improvement, taking what’s been learned through events, near misses, and safety rounds and applying it through actionable steps.
Making it easier to identify and report events – including near misses and complaints – provides opportunities for improvement, with learnings of proactive prevention as the ultimate goal. The more issues and good catches reported, the greater the opportunity to identify risk and develop long-term safety improvements.
Tidelands Health, with the use of Verge Health’s Event Management System, reduced serious safety events by 78%. The Converge Platform helped Tidelands Health ensure accurate data was in the hands of the users, which gave them the ability to quickly enter events and act on data for safety improvements. Additionally, they were able to transition from managing most serious events to greatly increasing near miss reporting and sharing data with the peer review and credentialing process.
“When we looked at our current risk management system, not a single physician in the system had access to enter their own incident. Now every person who wears a Tidelands Health badge is just one click and 60-90 seconds away from filing any occurrence.” said Greg Nobles, Patient Safety Officer at Tidelands Health.
With an effective system in place, Tidelands Health significantly reduced risk and improved system-wide initiatives while improving their culture of safety. The strongest and most successful safety cultures encourage event reporting, learn from past mistakes, and focus on continuous improvement by tracking and trending performance improvement initiatives in order to minimize recurrence.
Effective peer review enables physicians and nurses to review professional practice and take a closer look at the patient experience with the intention of improving quality of care and safety. For improvement, and often cultural change, to occur, opportunities need to be identified and understood. With a centralized system in place to capture this data, trends can be more easily uncovered, helping to identify individual versus system issues that lead to breakdowns in safety.
Healthcare leaders and physicians have been observing a shift in the culture from punitive to a culture of support, encouraging performance improvement for the greater good of the organization. And while the focus continues to be on the physician staff, the peer review process also opens up the conversation for physicians to provide feedback on supervisors and hospital managers. In addition, many organizations are expanding their physician peer review process to the nursing process, as well. Ultimately, organizations must move away from a“blame game” mentality, ensuring parity of review for complex cases and focusing on eliminating breakdowns in care to promote protection for patients, physicians and the organization.
By using an integrated platform, Verge Health clients can compile data from across the organization, including complaints, grievances, events and audits, to inform peer review and tie credentialing to real-time safety issues rather than dated quality data. Data ﬂows between modules in the Converge Platform, increasing the eﬃciency of processes, breaking down silos, and tying practitioners back to safety issues. Converge users have seen up to 50% of peer review referrals coming from Converge. Processes that were historically disparate now pull shared data to drive collaboration and improvements. On average, of the Converge referrals, Verge clients have seen as many as 65% move to a peer review.
The road map to high reliability requires health systems to connect each medical error to a process, implement system-level improvements to mitigate risk across the enterprise, and constantly measure those initiatives to ensure improvements are sustained. Hospitals have a true path to achieving zero harm, but only if they connect siloed data and develop the necessary tracking to ensure safety issues are continually addressed.
Contact Verge Health to learn how clients continue to evolve from reactive to proactive advancing their high reliability journey using the Converge Platform and Strategic Advisory Services.