Patient Safety & Clinical Excellence
Patient care is the heart of our mission--our reason for being. Keeping our patients safe is our number-one priority, so much so that it is woven into our workplace culture as our first guiding principle: "I will take personal responsibility to ensure the safety of patients, co-workers and all others I come into contact with while at work."
This promise is truly essential to every action we take. From the highest levels of the organization to individual patient care at the bedside, our commitment to patients is grounded in our faith-based heritage and our relentless pursuit of excellence. For this reason, we pay special attention to our patients' physical, emotional and spiritual well-being, and we encourage them to participate with us in their care.
But creating a safe environment and ensuring excellent clinical outcomes for every patient does not happen by chance. It requires an intentional and dedicated effort by physicians, hospital staff, patients and visitors. We strive to maintain a culture of safety and a focus on excellence through communication, compassion and a shared sense of accountability. When we work together, we can provide the highest quality care with dignity and respect for all patients.
Creating a Culture of Safety
To keep patient safety top of mind, we strive to create a culture of safety through communication, compassion and a shared sense of accountability. As part of our continued focus on performance improvement, we looked for best practices in this area and adopted the Johns Hopkins Culture of Safety model in 2008.
Since then, we conduct a Culture of Safety survey every year to determine our progress in this area. The survey asks clinical staff members to assess their individual stressors, their work environment and their ability to work in teams, among other things. We analyze the results to compute our overall safety climate score, which is an indicator of how well our workplace culture supports patient safety.
Compared to 2008, our overall safety climate score increased by almost 10 points in 2009. The change is due in part to a greater awareness of the challenges our staff faces in consistently applying patient safety policies and procedures. For example, one of the areas that our staff struggles with is stress recognition—the ability to recognize one's own stress level and to do something about decreasing it. We take results such as these and turn them into action plans to make sure our staff is receiving support to make necessary corrections and improvements.
Another important aspect of maintaining a culture of safety is our Just Culture initiative. By standardizing the way we respond to adverse patient outcomes, our staff feels more comfortable reporting errors. As a result, patient safety issues can be more easily identified and more quickly resolved.
In addition, we have a Patient Safety Champions program, which is a best-practices tool from the Institute for Healthcare Improvement. We have identified a frontline employee, known as a Patient Safety Champion, for each shift on every clinical unit. This person interacts with co-workers, as well as the department's manager and director, to identify opportunities to improve patient safety on a regular basis.
This culture of safety reaches the highest levels of the organization. In 2008, the Governing Board instituted a Safety Subcommittee (called Clinical Quality and Patient Safety) that monitors our safety record and clinical performance, guides our progress and holds leadership accountable for improvements. Members of this subcommittee often join executives on visits to clinical units to see how policies and procedures are being implemented.
Measuring & Improving Patient Safety
Our commitment to patient safety is embedded in our operations. A Patient Safety Committee, chaired by the president of the medical staff and the chief nurse executive, routinely monitors our performance and recommends improvements in this area.
To make sure we are focused on the right things, we are constantly exchanging information and comparing data with other hospitals. We participate in numerous safety initiatives at the local, state and national level, including the Centers for Disease Control National Healthcare Safety Network and the Collaborative Alliance for Nursing Outcomes. This process enables us to benchmark our performance, adopt best practices and promote accountability.
The key patient safety outcomes we currently monitor are the incidence rates of ventilator-associated pneumonia (VAP) in the Intensive Care Unit (ICU), central-line infections, and hospital-acquired pressure ulcers (HAPU) or bedsores. We have action plans in place to make continuous improvements in these areas and create sustainable results.
For example, after successfully reducing severe bedsores two years ago, we shifted our focus to eliminating all bedsores, consistent with new state standards. The philosophy behind this change is that by preventing even the most minor bedsores, we can avoid severe bedsores altogether. We are taking multiple steps to reach our new target, including better identification of at-risk patients, replacement of mattresses and pillows in all patient rooms, regular trainings on wound care and implementation of wound care champions on each unit.
For ventilator-associated pneumonia (VAP), we track the incidence rate for every 1,000 days that a patient is connected to a ventilator in the ICU. Our efforts in this area over the last few years have produced significant improvements. In 2009, we ended the year at 1.5 percent, just slightly above the national standard.
Also, we are focused on reducing central-line infections from 5 to 0.5 percent. A central line is a catheter inserted into a large vein to administer medications and other fluids directly into the bloodstream. One of the reasons our incidence of central-line infections is higher than the norm is that we had adopted a particular type of central line for all situations. New research indicates that central lines can be more effective when tailored to the particular circumstances of each patient. We have taken immediate steps to address this issue, and we are developing guidelines regarding the type of central line that should be used with particular patients in specific situations.
Even though we do not report on all measures, we regularly monitor several other patient-safety indicators in which the hospital excels. For example, in the past we reported on the rate of preventable falls—a common safety hazard in hospitals. As a result of increased staff training and implementation of best practices, our rate of preventable falls has dropped significantly below the state average.
Achieving Clinical Excellence Through Implementation of Best Practices
While patient safety initiatives focus on reducing risks associated with receiving hospital care, our clinical excellence efforts focus on the implementation of best practices and the results of that care. Consistent with our guiding principles, we strive for clinical excellence by reaching for the highest standards of care.
To ensure that we are at the forefront of clinical excellence, we participate in several initiatives at the state and national level, including the Centers for Medicare and Medicaid Services (CMS), Institute for Healthcare Improvement and the California Hospital Assessment and Reporting Taskforce. All of these initiatives enable us to exchange data, compare our performance and adopt best practices.
We are particularly proud of our risk-adjusted overall survival rate. This is the survival rate for all patients who come to the hospital, adjusted for pre-existing medical risks and other factors. In 2009, our overall survival rate was 98.7 percent, in line with the top 10 percent of hospitals in the nation.
Nonetheless, we are particularly interested in increasing our survival rate in our Intensive Care Unit. Our current ICU survival rate is 86 percent, and our goal is to reach 91 percent by the end of 2010 in order to exceed state standards. We are committed to making this important improvement, and are motivated by other hospitals that have achieved similar results.
Additionally, the CMS program asks hospitals to track their implementation of a set of practices that research has shown to be effective in treating several common conditions. These “core measures” are heart attack (acute myocardial infarction), bypass surgery (coronary artery bypass graft), heart failure, pneumonia, hip and knee replacements, general surgery and, as of 2010, stroke. Our goal is to rank in the second decile nationally for all the core measures. We have already achieved this goal for the treatment of heart failure, and we are very close in the other six areas.
Also, we have already taken several steps to improve stroke care and implement new best practices that will allow us to perform well in this new core measure. As a Joint Commission Certified Stroke Center, White Memorial uses best-practice protocols to provide care that can significantly improve outcomes for stroke patients. White Memorial was the first certified stroke center in the East Los Angeles area, an important advancement for our community.
PATIENT SAFETY & CLINICAL EXCELLENCE HIGHLIGHTS
Key Performance Indicators
For a summary of our Performance and Progress in Patient Safety and Clinical Excellence, we have developed a set of key performance indicators (KPI).
Recognition & Awards for Safety & Excellence
Several external organizations have recognized our efforts to improve patient safety and clinical excellence at White Memorial.
Implementing Best Practices
We strive for clinical excellence by reaching for the highest standards of care through the implementation of best practices.
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