2018 Safety Goals Point D-H toward Continued Improvement
Dartmouth-Hitchcock’s (D-H’s) focus on safety is paying off. Between 2015 and 2016, the number of serious safety events affecting patients decreased by 50 percent. The next year, 2016 – 2017, D-H staff cut the rate of serious safety events in half again. Because of the complexity of modern medicine, and emphasis on creating a culture of safety has been a priority for health care organizations across the country.
Sam Casella, MD, MSc, associate chief quality officer and co-chair of the D-H Safety Committee, attributes that progress to the teams across D-H who are working together to continually improve health care and building a culture of safety. He outlines the 2018 Safety Goals, which started on July 1, 2017, and how D-H is positioned to further reduce the number of serious safety events that can affect patients and employees.
What are the 2018 Safety Goals and how are they developed?
Casella: We have two main qualitative goals: to improve patient safety reporting and event closure and to keep employees safe. We also have two quantitative goals: to reduce serious safety events by 33 percent and to reduce employee injuries by 10 percent.
The D-H Safety Committee develops the goals by assessing risks. We consider both the frequency of occurrence as well as the severity of the harm. So problems, which result in high harm will be ranked as high risk even if they occur infrequently. Similarly, an issue that causes less harm but occurs often represents a high risk. Once we have identified the highest risks, we target them with focused efforts.
D-H Quality signs off on the goals and reports them to the Value Committee for final sign off.
Having already made so many gains, how will D-H achieve those further reductions?
Casella: First, we have to continue to operate as a high reliability organization. That means, in part, that individuals and teams follow procedures the same way every time. Last year we proved that reliability by successfully reducing the number of central line associated bloodstream infections (CLABSI). This year, we’ll aim for the same results with clostridium difficile (C. diff) and catheter associated urinary tract infections (CAUTI).
In the coming year, we will embrace a new high reliability theme—deference to expertise. People on the front lines of care know the most about their areas and we count on them to apply that expertise.
Second, and most important, we have to continue to build a culture of safety. Everyone has to attend to detail and practice situational awareness. It is the change in culture that lowered serious safety events from one every two weeks, to one every two months.
Do the new goals call for any new initiatives?
Casella: We are going to start a new insulin safety initiative. If a patient with diabetes is given too much insulin, their blood glucose may drop to dangerously low levels. If they are not given enough insulin their recovery from surgery might be more difficult, and they may be at higher risk for infections. By focusing on insulin dosages and glucose levels, we can increase the probability of good outcomes.
In the area of employee safety, we will be applying many of the same techniques that so successfully improved patient safety.
We will also continue safety behaviors training for all employees who have patient contact—physicians, nurses, schedulers, therapists, environmental services staff. Three-thousand employees completed training last year. We will also build on the success of Team Care, which is critical to instilling a culture of safety and incorporates deference to expertise. This year’s high-reliability theme of “deference to expertise” is particularly relevant to our safety work. To continue to reduce serious safety events, everyone has to be involved.
We should all be very proud that, despite the challenges of FY17, we achieved remarkable improvements in the safety of our patients and our fellow employees. I am confident we will continue to improve in the coming year.