Hospitals of all sizes learn from each other, adapt patient safety strategies to fit their needs and proactively address risk. Here's how.
Whether large or small, children's hospitals have the same goal: to prevent patient harm. But when it comes to implementing patient safety improvements, does size matter? While larger institutions potentially have access to more resources, smaller organizations may be better positioned to more nimbly react to situations and enact change.
Regardless of size, by sharing information across all types of hospitals, teams can find and adapt strategies that proactively address risk. By having open conversations with each other, hospitals don't have to experience harm to learn from it.
East Tennessee Children's Hospital, a 152-bed facility in Knoxville, averages about 6,000 admissions annually. Of 145,000 patient encounters a year, it has never had a safety event caused by a retained bite block, an oral guard that protects a patient's mouth and medical equipment during a transesophageal echocardiogram. But during weekly huddles with hospitals in the Child Health Patient Safety Organization (PSO), Jeanann Pardue, chief quality officer, noticed multiple hospitals reporting safety events with retained bite blocks. "Likely because of our relative size, we had not experienced that type of harm," she says. "And these reports illuminated an area of risk we had not yet identified."
After hearing about what some of the hospitals were experiencing, Pardue and the surgical leadership team moved to action. They performed a risk assessment of these cases and identified gaps in the hospital's processes that they may not have realized until an incident of harm occurred. The organization then implemented two quick action items—Pardue's team engaged providers to verbally identify the placement and removal of the bite block and added the use of the bite block to the surgical count. "We made efforts to address this and hopefully prevent harm in our organization," she says.
Without the information from other children's hospitals, East Tennessee may not have made the necessary changes. To eliminate harm, Pardue says it's crucial for hospitals with lower patient volumes to learn from others.
Larger hospitals' role
At Cincinnati Children's Hospital Medical Center, a 629-bed hospital with 1.2 million patient encounters a year, it was Gari Ann Dunn's responsibility as patient safety administrator to develop the hospital's Patient Safety Evaluation System. It is also her role to gather safety information from other hospitals, make it useful to teams at Cincinnati Children's, and share the organization's information with other hospitals.
Last year, Dunn created a standardized process for collecting and leveraging safety information, shared it with PSO members, and provided them access to the tools the organization uses to achieve its goals. "Regardless of an organization's size or resources, this is a new system for leveraging information in an effort to keep kids safe that any hospital can adapt and implement," Dunn says.
East Tennessee adapted Cincinnati Children's process and tools to make it work for a smaller organization with competing priorities and limited resources. "Sometimes, you feel like you are drinking from a fire hose, and the work seems overwhelming," Pardue says. "While our resources are different from a larger organization, the process was easy to modify and adapt—we just needed the insight to help us get there."
Learning from Cincinnati Children's, East Tennessee clearly identified high-risk events for rapid response. The hospital built accountability into its existing structure by using a daily safety brief, unit huddles and existing committees to track long-term improvement. "There is no need to reinvent the wheel, and a smaller organization may have an advantage in being more nimble to implement change," Pardue says.
Pardue says East Tennessee blended these new efforts into current processes and made it all part of a standard workflow by managing the information from the PSO's weekly safety huddles. "The rapid-fire learning that comes with these huddles benefits from a structured risk assessment tool, and what I use was directly borrowed and modified from Cincinnati Children's," she says.
However, there can be competing priorities within a relatively smaller pool of resources, making senior leadership's commitment to the work important. "Without executive leadership helping to establish a firm foundation of support, identifying a resource for PSO management, and cultivating the expectation of active participation from frontline through senior executives in proactively assessing and mitigating risk, it would have been impossible for us to maximize our potential the way we have to date," Dunn says.
Dunn also says it's not the size of an organization that predetermines its success in optimizing the benefits of the Child Health PSO membership, but rather the presence or establishment of two fundamental principles: Executive leadership's complete buy-in and support of active PSO participation, and the hospital's ability to standardize and integrate the work required to maximize PSO learnings into an already existing, effective operational structure.
Regardless of differences in size or budget, hospitals can contribute to learning that will improve patient care at all children's hospitals. It is this cooperative spirit that can make a significant impact on safety and quality of care.
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