EDITOR’S NOTE: Children’s Hospitals across the country are collaborating together to reduce hospital acquired conditions and changing the hospital culture to one of patient safety. Will other hospitals take note of these improvements and follow suit?
In contemporary society, we like to talk about thinking outside the box. Sometimes, though, you have to build an entirely new box. Such is the case for children’s hospitals working to improve patient safety in their facilities.
Since the Institutes of Medicine first published “To Err is Human: Building a Safer Health System,” their report on patient safety in 1999, health care has struggled with how best to protect those cared for in our system. Now, 16 years later, the search for how to do just that might be close to finding that elusive treasure.
In a relatively unprecedented move for the times, in January 2009, the eight children’s hospitals in Ohio decided to band together with Cardinal Health Foundation and other business leaders to support an effort to improve care and decrease costs for pediatric patients in the state. Their mission: working together to eliminate serious harm across all children’s hospitals. To accomplish this task, they completely destroyed the previous box and built a new one with three radical foundations: agreement to have no competition regarding patient safety; complete transparency in data sharing around safety; and adoption of an “all teach all learn philosophy.” The Ohio Children’s Hospitals’ Solutions for Patient Safety network was born.
In two years, the project had garnered such great results in its home state that the team was asked to lead a national effort in pediatric patient safety. That year, they brought in 25 additional hospitals. Within a year, the collaborative, now simply known as SPS, grew to 78 hospitals in 33 states and the District of Columbia. Now at 88 hospitals, the collaborative can boast of a membership of nearly every children’s hospital in America. All working side by side to improve the health of children. No competition. No putting lipstick on the data. Everyone teaching. Everyone learning.
Odd? Strikingly so. Medicine is now big business – estimates put U.S. health care spending at more than $3 trillion annually. Eighteen million are employed in the industry. Nearly 55 percent of children are on Medicaid and the reimbursement is generally less than 25 cents on the dollar. In similar circumstances, corporations would be guarding their data and innovations with every means possible. After all, no money no mission. And yet, SPS shares all. Why? Because in this case, the mission means more than the money.
The major premise behind the efforts of SPS is to build children’s hospitals as high-reliability organizations, or HROs, similar to the nuclear and aviation industries. These are groups that operate under extremely high-risk situations but have less than their expected number of adverse events. The tenets of sensitivity to operations, preoccupation with failure and the reluctance to simplify should lead to better outcomes and fewer harm events for children treated within their walls – an extremely high-stakes business that must function with the least number of incidents as possible.
The work of the collaborative has been focused in two major areas: reducing hospital acquired conditions, also called HACs, and transforming hospitals into places that uphold a culture of safety that permeates every aspect of care, well beyond the bedside in fact. The HAC work has centered on standardizing processes put in place to guide care. Much of this work has involved the “bundle concept” – small interventions that when used together can have a major impact in preventing the common ways patients are harmed in hospital settings – such as infections, adverse drug events, falls, pressure ulcers and blood clots. The culture of safety work includes classes on error prevention and eight easy tools to decrease errors in less than five minutes a day.
Thousands of pediatric providers and support staff now speak the same safety language across the country thanks to the efforts of all the SPS collaborators. How did that happen? With massive amounts of hard work by all involved in the collaborative. By building relationships between competing hospitals committed to learning from and teaching each other; so far, more than 225 webinars have been presented, 60 work groups have been formed, 30 videos have been recorded and four learning sessions have been taught, spreading a wealth of knowledge among all participating parties. Data have been posted for all collaborators to see and share, including how well hospitals adhere to bundle compliance and what their outcomes are.
A major goal is to identify best practices used by high performers and to encourage the adoption of those measures everywhere. Great. Unprecedented work. Lots of it. But what has it done? Quite a bit actually. The incidence of hospital-acquired conditions has fallen between 1 and 81 percent. Health care dollars have been saved to the tune of an estimated $79,189,000. And, most importantly, 3,699 children have been spared harm during their hospital stay. All by the 4th birthday of the national collaborative.
When families have been asked what they want from their child’s health care team, they replied “don’t hurt me, heal me, be nice to me,” in that order. Thanks to SPS, they are much closer to getting what they ask for from these teams. The network’s goals are to decrease HACs by 40 percent and serious safety events by 25 percent in the next year. This is truly what no child left behind means to pediatric caregivers. Take a bow Ohio. Take notice adult health care. The box has been rebuilt and the bar is set pretty high.