In healthcare, many of us are motivated by a need to fix whats not working, whether thats curing a patient of disease or remedying ineffective safety protocols. Take it from Hartford HealthCare, an integrated healthcare system that reduced its serious safety events by 70 percent over five years.
When leaders at the six-hospital system in Connecticut set a goal to lower the incidence of patient harm, they began with executive alignment and the basic principles of accountability and respect. From there, they defined the foundational elements required to achieve high reliability: business intelligence and collaboration.
By focusing on data-driven opportunities and engaging staff and clinicians, leaders reasoned, safety would naturally improve. They were right. Not only did Hartford HealthCare significantly decrease its incidence of serious safety events, but its values-driven culture enabled the spread of the work from the facility level to systemwide.
Hartford's success exemplifies how critical organizational readiness is to optimize care delivery, as competitive positioning starts with understanding where you are to determine where you need to go. Empowered by a clear vision and powerful analytics, health systems can remove unwanted variation and improve outcomes.
Crystalize the Why
For many organizations, a journey to becoming a high reliability organization (HRO) begins when staff and clinicians hear about an awful event that occurred that could have been prevented.
"It should never have happened" and "there has to be something that can be done" are two refrains that begin at the frontline and reverberate toward the c-suite. With momentum from staff, it’s not often difficult to find a leader champion to align executives toward action.
While an HRO objective may not be a tough sell, leaders must mind other strategic priorities that are in motion. In a Premier survey of 260 health system leaders, 51 percent identified competing priorities as a barrier to achieving high reliability.
To ensure success, leaders can integrate HRO aims into current performance improvement efforts –enhancing present initiatives versus instituting new ones – and encourage the linkage between zero harm and the organization's behaviors and values. Connecting HRO communications to preestablished values demonstrates how this goal fits seamlessly into the culture and vision.
Let Data Drive Action
With leaders and staff aligned, organizations should set measurable, achievable benchmarks using timely and robust data on facility and system performance, as well as risk-adjusted data that enables comparison to national peers. At Hartford HealthCare, for example, PremierConnect® quality analytics produced regular optimization reports pinpointing clinical variation, allowing leaders the business intelligence needed to target specific efforts to reduce harm across the system.
With objectives identified, the next step is to cascade the goals to facility leaders who determine how individual units and departments will contribute.
It’s important to keep HRO successes and barriers in constant conversation to heighten organizational awareness of the new care delivery model. Successful HROs use monthly data reports to encourage transparent discussions on progress and continually refer back to why patients deserve highly reliable care.
Maintain the Momentum
Perhaps the most difficult aspect of care delivery optimization is sustaining the improvement. Results like Hartford HealthCare’s require time and commitment to a long-term strategy, but we’ve seen that when an organization is ready to change, results follow.
Take this example: In 2015, Texas Health Huguley in Fort Worth recognized it had an opportunity to better educate staff to recognize patients at risk of maternal harm. The women’s services leaders studied existing nationwide hemorrhage bundles and modeled their own after it. They also committed to standard measurement of blood loss during delivery versus estimating it.
From 2015-2018, the facility marked a 36 percent decrease in severe postpartum hemorrhage cases and a 60 percent decline in units of blood used. As staff and physicians recognized the value in quantifying blood loss from delivery, they bought in on standard language to ensure proper protocols for patients at risk. Today, postpartum hemorrhage management is built into the culture through chart audits on every delivery, nursing drills and debriefs, and continuous information sharing on progress and outcomes measures.
As Texas Health shows, a culture that revolves around the patient and continuous improvement is ripe for care delivery optimization through the lens of high reliability.
Optimal care delivery is not about short-term wins or fixing mistakes. It's about preventing problems in the first place so that over time, patients receive the highest-quality, safest care. We’ve all seen care delivery efforts that dive right into goal-setting and process maps, but the most impactful efforts begin with conversation, alignment and analysis before action.
Erika Sundrud, MA, LSSMBB
Vice President, Care Delivery Optimization, Premier Inc.
Leading Premier's efforts in clinical quality consulting solutions, Erika has more than 18 years of experience in healthcare performance improvement.