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Patient Safety Week March 2-6: Patient Safety Begins with the Safety of One Another

Published March 2, 2015

By Dr. Joanne Roberts, Chief Medical Officer

We at Providence Regional Medical Center have earned a great reputation as one of the safest hospitals in the Northwest. Over the past few years, our commitment to work together as teams has helped us to reduce our rate of harm by about 50%.

Last year, with leadership from Tracy Courtenay and Dr. Ellen Farrokhi, we worked with other hospitals in Washington to reduce the risk of injury, illness, and death by 20% in areas of hospital acquired events such as infections, falls, and pressure ulcers.

In 2014, we continued to earn a grade of “A” by the Leapfrog Group, a consortium of large employers that is trying to help hospitals become safer. We reduced our Medicare 30-day readmission penalty to zero, indicating that we now rank among the 20% of “best performers” in the United States. We continue to rank among  high-performing U.S. hospital in preventing hospital-acquired infections. And we performed well in 2014 in the Medicare Value-Based Purchasing program. Finally, and perhaps as significant as all those advances, we worked together to reduce employee injuries from 845 in 2013 to770 in 2014. Our teammates in Environmental Services reduced their injuries from 58 to 25 – a 57% reduction. The journey to patient safety begins with the safety of one another.

All of those great results are the result of years of work by all of us working together on behalf of our patients, their families, and one another. And we still have more to do to bring us all together to do great work every time, with every patient, every day – to build a High-Reliability Culture.

Over the past six months, we have been serving as the primary test site for Providence Health & Services in order to introduce High Reliability principles to our work. The Northwest Washington Region was chosen for several reasons:

  • Patient and Family-Centered Care: This philosophy of care has set us apart for nearly a decade. We aim to ensure that all care will be based on the values of each patient and family
  • Culture of Safety: Our Culture of Safety is among the highest in the Providence System, and we have improved substantially in the past three years
  • Daily Patient Safety Briefing: We were an early adopter of the daily huddle of about 50 leaders who gather each morning to review the past 24 hours and to look forward to the next 24 hours
  • Weekly partnership council: This weekly gathering of clinical leaders reviews data and reports from the daily briefings to improve safety, readmissions, lengths of stay, and other quality outcomes
  • Just culture: We recognize that nearly all of us are working to keep patients safe and that most events of harm are due to system issues
  • Second victim support: We also recognize that when harm befalls our patients, our caregivers suffer, as well, and we must respond to all of our suffering
  • Disclosure and apology: Our caregivers have committed to rapid disclosure (and apology, when appropriate) to patients and families when harm has occurred
  • Strong interaction of our Community Ministry Board members: Our board members sit on most quality committees, including those of the Medical Staff, and carefully follow our progress in promoting safety
  • Robust quality sharing agreements: We have continued to work with our partner medical groups to ensure transparency of quality information so that we can continue to build a culture of safety across our entire medical community.

Over the past six months, a group of safety experts from Healthcare Performance Improvement (HPI) has been working with us to review all serious safety events over the past three years. Together with clinical and executive leaders, they drilled down on each of the 44 events and found 153 factors that combined in order to result in patients’ death or injury.

Beginning later in 2015, HPI will help us roll out a bundle of “tones and tools” that will help us to focus the work we have done into a single set of practices. Among the tones:

  • Smile and greet one another
  • Assume positive intentions
  • Call each other by our names
  • Invite questions

The tools are familiar but could all be improved in day-to-day practice:

  • Self-checks
  • Three-way read backs
  • SBAR communication
  • Specific teamwork behaviors
  • Assertive, professional language to express concerns about safety

Building a safe environment for our patients and ourselves takes tremendous work, and most of that work has already been pioneered all of us working together with patient safety at the forefront of all we do. Few hospitals in the United States have progressed to the level of safety that PRMCE has achieved.

Now it is time for us to make the ultimate commitment – all of us together – to make ensure that every person who crosses our threshold will leaved feeling better from the experience of care that we provide.

“Know me, care for me, ease my way”: We at PRMCE are poised to deliver on this promise.