Creating A Safety Culture Infrastructure to Drive Improvement

Creating A Safety Culture Infrastructure to Drive Improvement

A dedicated, organization-wide safety campaign led to improved awareness and compliance.

After reorganizing a multidisciplinary quality group to focus on reviewing data, with a goal of reaching zero harm, the team at James & Connie Maynard Children’s Hospital (MCH) at Vidant Medical Center, in Greenville, North Carolina, created a quality and safety campaign to align its new initiatives.

The Sea of Safety campaign reaffirmed a commitment of safety within the organization to team members, patients and families. The campaign established that safety, one of Vidant Health’s core values, underpinned everything within the children’s hospital. 

Sea of Safety established a culture of empowerment for team members to use safety actions, hospital safety habits, event reporting, hand hygiene, quality bundles, reduction of hospital acquired conditions and quality group initiatives.

The formal campaign kicked off in 2018 with a celebration of each unit’s current quality and safety highlights. Units then created posters to promote the culture across divisions and distributed buttons for staff to wear to communicate the commitment to safety. 

Division leaders, hospital leaders and executives attended a kick-off celebration to symbolize the buy-in and support from leadership, highlighting the importance and expectation of safety. The visuals, logo, theme and activities further demonstrated the importance of embedding this culture in daily work.

HAC teams

To further the efforts of the campaign, new hospital acquired condition (HAC) teams were created and included representatives from across Maynard Children’s units. The teams’ goals were to reduce events of harm, develop strategies to improve quality bundle and safety practices, implement current best practices, and break down silos of care.

HAC teams focused on:

  • Central line associated blood stream infections (CLABSI).
  • Catheter associated urinary tract infections.
  • Hospital acquired pressure injuries.
  • Ventilator associated pneumonia.
  • Surgical site infections.
  • Unplanned extubations.
  • Adverse drug events.

This work was designed to include “back-to-basics,” CLABSI team initiatives and focus on reinforcing quality bundle compliance, standardizing care of peripherally inserted central catheters, and development of an umbilical care bundle for neonates with umbilical lines. Safety coaches were reengaged on hand hygiene auditing, including real-time coaching for non-compliance. 

Safety event reporting, including safety catches, was highly encouraged. Team members with safety catches were celebrated and recognized during huddles for their commitment to safety. The unplanned extubations team established a collaboration with the respiratory care department that utilized data transparency and development of high-risk airway cards. 

The adverse drug events group began a monthly review of medication related safety events identifying opportunities to reinforce safety habits and improve processes. They also identified insulin related events as high risk and focused efforts on reducing them. 


The aim of the campaign was to decrease HACs to zero events per month in Maynard Children’s patients within six months by engaging multidisciplinary partners at all levels. This was measured through process measures of quality bundle and hand hygiene compliance and an outcome measure of total monthly HACs. 

Baseline data included 18 months of metrics, which demonstrated an overall bundle compliance of 75% and hand hygiene compliance of 96%. With a goal of 95% compliance in each of these outcomes, performance was reviewed monthly through quality audits and hand hygiene surveillance. 

Due to this effort, hand hygiene has sustained compliance above the goal at 99%. Quality bundle compliance through HAC teamwork, data transparency, and real-time rounding demonstrated an improvement to 87% compliance after one year with a notable increase over time. Quality bundles have also sustained improvements with compliance at 96%.

The measure of total HAC improvements included a monthly tally of all events. Prior to Sea of Safety, monthly events ranged from one to 11 HACs per month. Since implementation of Sea of Safety, monthly events have been zero to seven, including three months of zero events. 
The most notable improvement has been the achievement of an 83% reduction of CLABSIs over the last five years. Unplanned extubations improved initially, however they have increased over the past year, leading a new organized quality team to become engaged. 

Sustaining a safety culture

Sea of Safety remains embedded in the culture within Maynard Children’s. The adverse drug events team, as originally organized, continues to meet monthly to review medication-related events. Other HAC teams have dissolved or reorganized to remain aligned with division and organizational strategic framework and real-time quality and safety opportunities. 

With a 62% increase in safety event reporting and over 600 safety catches made, MCH remains committed to achieving zero events of harm and keeping patients and team members safe.

Elaine Henry, M.S.N., RNC-NIC, Tara Stroud, M.S.N., RN, NNP-BC, Kim Crickmore, Ph.D., RN, FABC, and Ryan Moore, M.D., are from James & Connie Maynard Children’s Hospital at Vidant Medical Center; John Kohler, M.D., MBA, Matt Ledoux, M.D., and Jason Higginson, M.D., are from East Carolina University Brody School of Medicine.


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