Lifespan: Patient safety is ‘highest priority’

The senior clinicians were there, of course, but also the managers in everything from personnel to housekeeping, corporate executives and trustees – almost 400 in all, gathering for a morning April 10 at the Crowne Plaza Hotel at the Crossings to discuss patient safety.
It’s the “highest priority” of the Lifespan organization, President and CEO George Vecchione told them, and they all have a role to play. So to help them better understand the issue, the health system invited two national experts and Dr. David R. Gifford, the state health director, to give presentations, followed by a panel discussion with people involved in local initiatives.
The first speaker was Dr. Edward Miller, CEO of Johns Hopkins Medicine and dean of The Johns Hopkins University School of Medicine, which is considered a national model in patient safety and advised 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.
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.
(Edward J. Quinlan, president of HARI, said in an interview that the group’s objection isn’t to the concept but to the notion of it being government-run and mandatory, which he said goes against the federal vision of voluntary, industry-run safety organizations.)
The third speaker, David Marx, president of the Dallas-based risk management firm Outcome Engineering and founder of The Just Culture Community, which helps organizations develop more open learning cultures, said systems and individual choices both matter, and he offered a structure for how to deal with both in promoting safety.
He said it is important to distinguish between “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 recklessness. Human error is best handled by consoling the person and using the situation as a learning opportunity, he said. At-risk behavior requires coaching about the risk-taking. Only recklessness really warrants punishment.
Conversely, Marx argued against handling situations differently based on the outcomes. What matters, he said, is the “quality of your choices,” even if a patient isn’t always harmed.
In an interview, Dr. Arthur Klein, senior vice president and chief physician officer of Lifespan, said the event’s organizers had made a point of addressing both systems and individual choices in the program, because together they provide a full picture.
Klein also noted that people from every department within Lifespan – director-level and up – had been asked to attend because clinicians alone can’t assure safety.
“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.” •