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Improving Patient SafetyA journey in Care Transformation

Susan M. Grant, MS, RN, FAANChief Nurse ExecutiveEmory HealthcareNurse Leadership InstituteJune 5-7, 2013

Emory Healthcare

Emory Healthcare OverviewClinical Arm of Robert W. Woodruff Health Sciences Center of

Emory University• Emory University Hospital• Emory University Hospital Midtown• Emory University Orthopedic and Spine Hospital• Wesley Woods Geriatric Hospital• Emory University Johns Creek Hospital• Saint Joseph’s Hospital• The Emory Clinic

1,830 Licensed Beds and over 15,000 employees.Only Academic Health System in Atlanta.All EHC Hospitals are NDNQI Members.

* Denotes Academic Medical Center** Denotes Magnet Facility

1999• 44,000 to 98,000 U.S. deaths annually due to hospital errors• Hospital errors the 8th leading cause of death• System errors

2001• “Between the health care we have and the care we could have lies not just a gap, but a chasm.”• “Trying harder will not work…”

Story of Harm

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Strategic Agenda: 2008 – 2012

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Partnering with our Patients• Ongoing collaboration with patients and families to design the

best with them: from point of care to facilities planning.• Partner with more than 100 Patient and Family Advisors who

provide insight into how we can improve quality, processes and service.

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Embedding Care Transformation Principles into organizational processes

• Staff training on CT concepts and cultural attributes• EHC Quality Academy and Transformational Leader

Program.• Multidisciplinary team training• Patients and families included in hospital orientation,

leadership planning meetings and retreats.• Shared governance structure• Learning from Stories of Harm and Stories of Charm• Unrestricted visiting hours – supporting family presence

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Standardization of practices

• Bedside Change of Shift Report “bundle”• Structured Interdisciplinary Bedside Rounding• Unit Practice Councils• Standard clinical attire

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Date of data collection Put “N” in the box of any element missing, “Y” if Present

Room # Met all Appropriate Elements(Y/N)

Computer in the room

Introduction to Pt &Fly

Verbal Report

SABR

Focus Assessment

Review task

MAR, Labs, Forms

Pt. Goal

Ask Pt Daily

Total # of Pts

Add all the above “Y”

Add up the # of “Y” in the columns above

Daily Bedside report Bundle data collection sheetFacility: ECLH EUH WW Calculate values for each day at bottom of the table

Unit: Transfer daily totals at the bottom to the weekly summary sheet.

Bedside Change of Shift Report

We’re All About YOU!

Nurses will change shifts several times throughout the day and night. During shift change, both nurses will see you and the on-coming nurse will learn about your condition and treatments. Because this is all about you, the nurses value your input and the input from your family members you choose to be present. Bedside Report on this unit is done at approximately: 7am 3pm 7pm 11pm

Bedside Shift Report (BSR)

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Septem

ber

Novem

ber

Janua

ryMarc

hMay Jul

y

Decembe

r

Febru

ary April0.0

2.0

4.0

6.0

8.0

10.0

5G ALOS

Series1Linear (Series1)

• 6G Medical Unit BSRCompliance and Resulting Patient Satisfaction Rankings

EUOSH Patient Satisfaction Scores from opening to end of year 2012

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Average Patient

Satisfaction :

96.4

Challenges• Lack of understanding of PFCC• PFCC means “no limits”• “What about confidentiality?”• Changes in work flow processes and team

dynamics• Patients and families becoming a part of the team• “What about our colleagues”… on our teams?

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The PledgeWe will treat each other the way we want to be treated.We will…

– treat everyone as professionals and with respect and dignity– greet each other by name– welcome and encourage new team members– be honest and open in all interactions– be respectful of everyone’s privacy– be culturally and racially sensitive

We will not…– raise our voices in anger or use sarcasm or profanity – be passive-aggressive– make culturally or racially derogatory remarks– undermine each other’s work– criticize each other and Emory in public spaces

We will cultivate a spirit of inquiry.We will…

– ask “why” when we have questions or concerns, especially about safety

– ask for a pause when we think someone is about to make a mistake or do something unsafe

– thank each other for raising concerns– declare our openness to the inquiry of others

We will not …– respond with anger or sarcasm when someone requests a pause– intentionally belittle or respond in a threatening or condescending

manner when someone asks a question– tolerate rudeness– stifle learning

We will defer to each other’s expertise.We will…

– encourage each other to offer different perspectives– recognize that all members make important contributions to the team– seek help when we don’t know the answer

We will not …– belittle or ignore the ideas and perspectives offered by each other– assume that expertise is overruled by age, profession, or rank

We will communicate effectively.We will…

– listen thoughtfully and ask for clarification when we don’t understand– check that others have understood when we say something important– remain respectful with our body language and tone of voice– remain calm when confronted with or responding to stressful situations– use scripts, read-back, repeat-back, or other techniques where

appropriate to reduce the chance of misunderstandingWe will not …

– stifle clarifying questions– interrupt our team members unnecessarily– say “it’s not my job” or “it’s not my responsibility”

We will commit to these behaviors in support of Emory Healthcare Care Transformation

We will…– encourage and support each other– hold each other accountable for the behaviors identified in this

Pledge

Improving Patient Outcomes

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Note: Data includes EUH, EUHM, EUOSH, and WWH only

Improving Patient Outcomes

08/28/2012

FY10-12 Outcomes:

Nursing Quality

4.05

3.64

3.27

Falls per 1,000 Patient Days

FY10 FY11 FYTD12

4.29%3.60%

3.12%

Hospital-Acquired Pressure Ulcers

FY10 FY11 FYTD12

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EHC includes EUH, EUHM, EUOSH, and Wesley Woods Hospital (WWH); 100% is a perfect score

Improving Patient Outcomes

08/28/2012

FY9-12 Outcomes:Core Measures improvement

Core Measure BundleQ2 CY09 –Q1 CY10

Q2 CY10 –Q1 CY11

Q2 CY11 –Q1 CY12

Acute Myocardial Infarction (AMI) 93.9% 96.6% 99.8%Heart Failure 76.6% 90.3% 96.6%Pneumonia 71.3% 91.5% 96.2%Surgical Care Improvement Project (SCIP) 81.6% 87.9% 94.4%Overall Core Measure 82.0% 90.8% 96.1%

Lessons Along the Way• Changing culture takes time and is hard work.• Nursing and Nurses can play a pivotal role in changing culture.• We continue to better understand the true definition of patient- and

family-centered care/Patient engagement.• It is critical to tie metrics to evaluate the impact of process changes on

patient outcomes.• New processes require ongoing reinforcement, refining and periodic

measurement to validate effectiveness.• Leaders, staff and physicians require ongoing education, updating and

review of Care Transformation concepts.• Continuously bring in new PFAs with fresh perspectives and ideas.

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ImprovementsQuality Leadership Award 2011, 2012University Health System Consortium

• 2006 Rankings #63 EUH and #73 EUHM• 2011 Rankings:

• #10 Emory University Hospital/Emory University Orthopedics & Spine Hospital ranked

• #11 Emory University Hospital Midtown ranked

• 2012 Rankings:• #2 EUH !!!• #6 EUHM!!!

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Questions?

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