Three percent of one percent, or 0.0003, is close to zero for most of us.
For the Ann and Robert H. Lurie Children’s Hospital of Chicago, it was too big. That’s the rate at which they were seeing a serious safety event – one in every 3,000 cases.
Between 20,000-30,000 surgical procedures a year are performed at the freestanding hospital. At the rate of 0.0003, they were seeing approximately 10 serious safety events per year.
“It was a number we were not comfortable with,” said Mehul Raval, MD, the hospital’s division head of pediatric surgery. “We hold ourselves to a high bar of excellence; even though we were doing well, we wanted to do better. Safety is the most important thing when we deliver care to children.”
Raval is part of a team at Lurie Children’s that investigated ways to reduce the number of serious safety events in the pediatric perioperative environment. They developed a plan based on strategies from other industries and on their own unique needs and environment.
They chose to test three strategies simultaneously:
- Surgical safety stand-downs: Twice a year, all non-essential operations are paused and the entire perioperative team gathers to review safety data, listen to a patient’s family, and reset expectations around safety culture.
- Error prevention training: Frontline staff learn practical tools to speak up, ask questions, and communicate detailed information clearly.
- Safety coach program: Volunteer staff members are trained to serve as safety models and provide resources and feedback in real time.
Each of these strategies was chosen for their potential impact not just on the number of serious safety events, but also on hospital staff.
“We really thought about what was needed at our institution and how we could incorporate that into our strategies,” Raval said. “The surgical stand-downs show leadership’s commitment to patient safety. It’s a huge undertaking to pause all operations for an organization as large as ours, so I think it conveys how serious we take this.”
He said error prevention training and the safety coach program give a sense of ownership to staff.
“We solicited volunteers who really wanted to champion patient safety, so we now have homegrown safety advocates to help us carry this momentum forward,” Raval said. “We also gave everyone common lexicon and strategies to speak up if they have concerns, regardless of hierarchy or job title.”
The results speak for themselves. After implementing these strategies, Lurie Children’s went nearly 40,000 cases – more than 18 months – without a serious safety event. That’s a 170% improvement in surgical safety.
“The impact has been phenomenal,” Raval said. “You have to have buy-in and real belief to make this happen and have people at every level feel empowered to speak up for safety. Our folks really rallied around these ideas because we all want what’s best for the kids we care for.”
The investigation and results were published in Pediatrics Journal.
As to hospitals who may want to implement similar strategies, Raval encourages them to look at their data and understand their unique challenges and opportunities. He recommends working with experts in their safety and quality improvement spaces to guide and support efforts – and always remembering the reason behind the work.
“I’ve spoken with parents of children who have undergone dozens of surgeries, and they tell me they feel safe walking into Lurie Children’s,” Raval said. “Hearing testimonials from our own patient families is what really drove this home for a lot of our staff. Patients and their families are our top priority. That is our true north.”
