 |
Quality Update
Walking the Talk of Patient Safety
Hopkins Hospital leaders adopt intensive care units and send a message to employees that they’re committed to eliminating medical errors.
 |
|
| Johns Hopkins University President William Brody, M.D., listens to updates on patient safety projects from CSICU staff. |
|
| |
|
Sitting in the cramped break room of the cardiac surgery intensive care unit (CSICU), Bill Brody listened intently as nurse manager Tina Cafeo explained that a checklist the unit had initiated to prevent infections from central lines wasn’t going as well as anticipated. Nurses are supposed to make sure that residents follow each step, but according to Cafeo, “residents sometimes skip steps and the nurses don’t always call a halt to the procedure and insist that the resident adhere to the checklist.”
Cafeo’s complaint didn’t fall on just anyone’s ears. Brody is the president of The Johns Hopkins University, and every month he sits down with the CSICU staff to discuss patient safety issues, come up with solutions and go over results. And he isn’t alone. Every top leader of Johns Hopkins Medicine has adopted an intensive care unit (ICU) as part of an executive safety rounds program, demonstrating the leadership’s commitment to seeing that no preventable harm comes to patients.
The Johns Hopkins Hospital’s patient safety committee launched the
| |
 |
| |
 |
| |
 |
| |
From top: Cardiac SICU's Elizabeth Martinez, intensivist; Nauder Faraday, SICU co-director, and Tina Cafeo, nurse manager. |
| |
|
program two years ago after a survey of about 400 health care staff showed they had little inkling of the leadership’s role in championing safety. Beryl Rosenstein, hospital vice president for medical affairs and committee chair, asserts that the commitment always had been there, it just hadn’t filtered down to employees. “It became important to give executives visibility,” he says, “and let employees know we were serious about protecting our patients.”
According to Richard “Chip” Davis, executive director of the Hopkins Center for Innovation in Quality Patient Care, which is now collaborating with the safety committee on the program, it also gives leaders an opportunity to hear about problems directly from frontline staff, encourages them to take responsibility for finding solutions and knocks down barriers to making changes that improve patient safety.
The executive rounds actually is part of an eight-step process that begins with measuring a unit’s attitude about patient safety. This is followed by a talk by critical care specialist Peter Pronovost, Hopkins Hospital’s safety expert, stressing that correcting medical errors isn’t a punitive exercise, but teamwork aimed at finding and changing system failures before they lead to mistakes. The staff also is asked to produce revealing answers to questions, such as when was the last time a patient was harmed on their unit, how, and when they think the next person could be hurt and how that could be prevented.
Rosenstein, Pronovost and Lori Paine, Hopkins’ patient safety coordinator, go over with the executive the program’s goals and the safety issues facing the adopted unit, then meet with the ICU team to frame safety priorities. “We want them to identify,” Rosenstein says, “two or three problems that can be solved by simple and quick system changes, and then several that could take longer and require more extensive resources.”
Each executive and unit is expected to keep tabs on their progress using a score card that is submitted monthly to the patient safety committee. So far, the results have been encouraging. Since the program started, safety climate scores have risen from 34.6 percent to as high as 67.7 percent in some ICUs. This dramatic increase suggests that patient safety has become a valuable aspect of employees’ work environment.
Back on the CSICU, Brody told Cafeo and the rest of the team that they should insist on zero tolerance for noncompliance with the central line checklist. “I understand that accepting anything less is revolutionary thinking in health care,” he said, “but we owe our patients nothing less.”
|
|
 |
| |
Senior Executive Safety Rounds
Program Goals
• Demonstrate leadership’s commitment for improving quality
• Fuel a culture for change
• Identify new quality-improvement opportunities
• Start development of a “quality feedback loop”
• Establish a framework for quality-based, rapid-cycle improvements
Questions Executives Ask
• Can you think of recent events resulting in prolonged hospitalization for any patient?
• Have we harmed any patients recently?
• What systems fail you on a consistent basis and are likely to harm the next patient?
• What leadership interventions would make your work safe, effective and efficient?
|
|
 |
|
