There are several key factors in establishing a successful patient safety performance improvement strategy. Peter Pronovost, Senior Vice President for Patient Safety and Quality at Johns Hopkins Medicine and Director of the Armstrong Institute for Patient Safety and Quality, led a study that examined the model employed by Johns Hopkins Health System to improve care systems and processes for treating patients who require surgery or suffer from serious ailments; after two years, the study yielded positive results. The participating hospitals successfully achieved the goal of 96 percent compliance on six of the seven targeted measures.

The following are four methods Johns Hopkins Medicine employed for improving patient safety in the study.

Develop Clear Goals

Ineffective or insufficient communication among healthcare professionals is one of the leading causes of medical errors and adverse events. The following three strategies were deemed as effective in a separate study by Denver Health Medical Center:

1. Employing a standardized communication format, the SBAR, is effective in bridging the difference in communication styles and helps to get everyone on the same page. It enables healthcare staff to exchange information regarding changes in patient status or needs for non-emergent events, related issues, or for events on the unit, in the lab, or within the healthcare team. SBAR is an acronym for:

   Situation: What’s going on with the patient?
   Background: What is the clinical background to context?
   Assessment: What do I think the problem is?
   Recommendation: What do I think needs to be done for the patient?
    

2. A mandatory daily team huddle can be a quick 15-minute interdisciplinary meeting between key operational and care personnel to set the day/shift in motion via commentary. These are useful for teams to quickly assess changes in clinical workload, identify relevant issues, and provide a means to prioritize.
3. Daily Goal Sheets during multidisciplinary rounds are a simple way of clarifying work goals among providers involved in the patient’s care (e.g., physicians, respiratory therapists, nurses). The form is completed during rounds on each patient, signed by the fellow or attending physician, and given to the patient’s nurse. The information is then communicated at shift changes between the incoming and the outgoing care providers.

Strong Leadership and Infrastructure

Researchers identified that organizations need a commitment from leadership to invest in organizational structures and governance to hold member institutions accountable. According to an article by Michael Leonard and Allan Frankel, great leaders know how to use and manage attitudinal and behavioral norms to protect against inevitable dangers in complex and hectic settings. This can be accomplished in the following three ways:

1. Creating psychological safety is a fundamental responsibility of leadership in creating a safety culture. It’s an environment where no one is hesitant to voice a concern about a patient or anything that puts the organization at risk.
2. Organizational fairness can only be successful if it’s supported by leadership. Human error is common—even among skilled practitioners. In order to learn and improve, caregivers need to know that it safe to discuss mistakes and near misses.
3. Leaders can influence a culture of safety through their support of a learning system: a visible structure that captures the concerns and defects from front-line caregivers. By spending time on the clinical units with staff, they can address and reinforce the improvement work already accomplished and enable staff to learn how to independently troubleshoot future issues.

Support Staff Engagement

Organizations engaging staff need to do so in ways that bring different groups together (e.g., doctors, managers and allied health professionals). Engagement is fostered by providing staff with jobs that have meaningful, clear tasks, some autonomy to manage their work, involvement in decision-making, and the ability use a wide range of skills. Staff work harder, think more creatively and care more when they feel involved.

Staff engagement can be measured using these three dimensions:

1. Psychological engagement is judged by three questions: “I look forward to going to work”; “I am enthusiastic about my job”; and “Time passes quickly.”
2. Advocacy is measured by whether an employee would recommend their organization as a place to work or be treated.
3. Involvement in gauged by three questions: “I am able to make suggestions to improve the work of my team”; “There are frequent opportunities for me to show initiative”; and “I am able to make improvements happen.”

Establish a Transparent Reporting System

Each clinical unit, department and hospital is responsible for reporting on its performance, according to the Johns Hopkins study. Enabling a transparent reporting system allows an organization to not only highlight successful areas, but it also gives an organization the opportunity to assess current processes and eliminate unnecessary barriers that are preventing them in achieving their goal.  What gets measured gets improved, so it’s critical to have a transparent, effective reporting system in place.

What are your thoughts on this Johns Hopkins Medicine study? Do you foresee your healthcare organization employing these methods? I’d love to hear from you!