A prescribed set of hospital-wide patient-safety programs can lead to rapid improvements in the “culture of safety” even in a large, complex, academic medical center, according to a new Johns Hopkins University study published in the journal Quality and Safety in Health Care.
“It doesn’t take decades or tons of money to get from a culture that says ‘mistakes are inevitable’ to a belief that harm is entirely preventable,” says Peter Pronovost, MD, PhD, professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine. “What it takes is leadership.”
From 2006 to 2008, Pronovost’s research team implemented a comprehensive, unit-based safety program (CUSP) at the 1,000-bed, 144-unit Johns Hopkins Hospital in Baltimore. The program was designed to make mistakes more transparent and use that and other tools to improve the culture of safety. CUSP relives heavily on “local staff” training in the science of safety—how to identify problems, report them, measure them, plan and implement corrections, and measure again. It also embraces discussions about improving communication and teamwork.
According to the researchers, a novel layer of CUSP is buy-in from senior hospital management, with an executive meeting monthly with each unit’s patient-safety team and other staff to ensure that resources are made available for quick, evidence-based interventions necessary to reduce risks to patients.
Johns Hopkins also put in place an electronic event-reporting system, which all staff members were encouraged to use. All reported events were reviewed by the hospital’s patient safety office, categorized, and assigned to a designated and accountable improvement team. The review helped identify trends and give feedback to staff.
In the study, hospital staffers were surveyed annually from 2006 to 2008 to assess safety attitudes and to determine whether the CUSP program appeared to be working. Researchers determined that a safety goal was achieved when a unit met or exceeded a 60% positive score on a five-point Likert response scale, from strongly disagree to strongly agree.
In 2006, the first year, 55% of the units achieved the safety “culture” changes set for them. In 2008, 82% reached the goal. The teamwork goal was met by 61% of units in 2006 and 83% of units 2 years later. In both years, survey response rates hovered near 80% of staff members.
“We want a culture where nurses aren’t afraid to raise concerns with doctors, where problems are solved not by looking at who is right but what is right for the patient, where staff believe that hospital leaders are committed to make health care safe,” says Pronovost. “We don’t want a place where the staff wouldn’t be comfortable being treated as patients.”
Pronovost adds that if a large institution like Johns Hopkins can achieve such gains in culture, smaller hospitals may be able to achieve even more success.
Pronovost concedes that one limitation of the study was that improved safety culture could not be tied to improved patient outcomes.
Source: Johns Hopkins Medicine