Lifespan leaders focus on patient safety

WARWICK – Nearly 400 Lifespan managers and executives gathered at the Crowne Plaza Hotel at the Crossings last Thursday for a symposium on patient safety, which President and CEO George Vecchione said is now “the highest priority” of the organization.
The event featured presentations by national experts in the field as well as Dr. David R. Gifford, the state health director, followed by a panel discussion that brought in the voices of local leaders in health care quality improvement.
The first speaker, Dr. Edward Miller, CEO of Johns Hopkins Medicine and dean of The Johns Hopkins University School of Medicine, gave an overview of the approach the Maryland institutions have taken to patient safety – which are considered a national model and have informed the efforts of the Rhode Island Intensive Care Unit Collaborative.
Miller spoke about how Johns Hopkins has replicated strategies from other industries, such as manufacturing and aviation, not only to reduce medical errors, but also to improve efficiency, benefiting its bottom line.
For example, by streamlining its imaging ordering system, the hospital halved the average turnaround time for portable radiology from 52 to 26 minutes, he said. And an effort to reduce blood wastage has so far saved a combined 3,385 units of blood valued at $653,000.
From the airline industry, the hospital learned that teamwork and good communication are crucial to safety, he said, and much of the work done at Johns Hopkins has been in that field – from creating a process that expanded pre-surgery “timeouts” into full-fledged briefings with written checklists, to formalizing how patients are handed off from shift to shift, to getting operating-room team members to call one another by their first names, to promote familiarity.
Miller also stressed the importance of teaching trustees about patient safety issues and keeping them abreast of how investments in safety are paying off, and he talked about how Johns Hopkins has used “leadership rounds” focused on safety to expose hospital leaders to the issues and also get feedback from people who care for patients directly.
And Miller noted that incentives and accountability measures are crucial. At Johns Hopkins, almost a third of executive pay incentives are linked to safety efforts, he said, and a biweekly “Quality Update” highlights the value and successes of the safety initiatives.
“You have to make sure the whole organization knows how important this is,” he said.
Gifford, the second speaker, said the first step to creating a “culture of safety” is to acknowledge that “we are error-prone,” even though doing so “cuts right to the core of what we do,” given health care providers’ pledge to “first, do no harm.”
Part of the problem, Gifford said, is that the regulatory system, through current and proposed laws, and the medical malpractice system all focus on blaming individuals anytime there is an error that harms a patient. Individuals are often responsible, he said, but just blaming them and either punishing them or seeking to “educate” them more doesn’t really get to the core of the issue – how their errors were possible in the first place.
It’s important to see safety as a systemic issue, Gifford said, because improving systems can make a much bigger impact on safety. Looking at the big picture, and promoting communication and collaboration among institutions, ensures that a problem at one place can help others prevent it in their own facilities, he said.
This is why Rhode Island would benefit from the patient safety organization he has proposed, Gifford said, and he hopes the General Assembly will approve it. But he worries that it will not because the Hospital Association of Rhode Island has objections to the legislation.
The third speaker, David Marx, president of the Dallas risk management firm Outcome Engineering and founder of The Just Culture Community, which helps organizations develop more open learning cultures, also spoke about the individuals vs. systems dichotomy.
Marx acknowledged that there are valid arguments for both approaches and suggested the best thing is to tackle both simultaneously. And on the personal-responsibility front, he said it is important to distinguish between three scenarios: “human error,” or inadvertent mistakes; “at-risk behavior,” which involves choices that increase risk but where the risk isn’t recognized or believed to be serious; and outright “reckless behavior,” in which a serious risk is consciously disregarded.
By distinguishing between these three kinds of situations, Marx said, organizations can better determine the appropriate response to an adverse incident. In cases of human error, he said, he recommends consoling the person and using the situation as a learning opportunity. At-risk behavior requires coaching about the risk-taking. Recklessness warrants punishment.
Lastly, Marx urged hospital leaders to focus not on the outcomes – whether patients are harmed in specific incidents – but on the “quality of your choices,” because it’s the choices that create or remove risks.
Dr. Arthur Klein, senior vice president and chief physician officer of Lifespan, said by looking at both systems and individual choices, the symposium addressed the full scope of what needs to be done to promote patient safety.
“We felt philosophically that to concentrate on one part and not talk about the other would do the whole vision a disservice,” he said.
Klein also noted that people from every department within Lifespan – director-level and up – had been asked to attend because the health system recognizes that patient safety involves not only clinicians, but also housekeeping, purchasing, finance, etc.
“You can have the best clinical environment in the world,” but it doesn’t end there, he said – “it’s facility, it’s cleanliness, it’s the standardization of your systems, it’s how you design your rooms. … You can’t separate the clinical from the non-clinical and get the best outcomes.”
Klein told the audience that he expects events such as last week’s symposium to be held regularly in the future, given the importance of patient safety to the organization.