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Zeroing in on Zero Harm

Zeroing in on zero harm: Innovative quality and safety initiatives from Children’s National experts

Zeroing in on Zero Harm

Leaders at Children’s National Health System recently showcased innovative quality and safety initiatives on a national stage at the Children’s Hospital Association’s 2018 Quality and Safety in Children’s Health Conference.

Leaders at Children’s National Health System recently showcased innovative quality and safety initiatives on a national stage at the Children’s Hospital Association’s 2018 Quality and Safety in Children’s Health Conference. While collaborating with other medical professionals in the field, the team made an impact by sharing key projects implemented at Children’s National to enhance patient care and reduce harm, including:

    • Safety in Numbers: Driving 10,000 Good Catches – Presented by Rahul Shah, M.D., vice president, chief quality and safety officer, and Rebecca Cady, Esq, BSN, vice president, chief risk officer: Recognizing barriers to reporting safety events, Children’s National embarked upon a three-year corporate goal to double the number of safety event reports, ultimately leading to reduction of preventable harm. By promoting staff accountability and using incentives to drive reporting, incident reports more than doubled in a three-year time frame.
    • Moving from Disjointed Spreadsheets to a Real-Time Data Management System – Presented by Evan Hochberg, R.N., patient safety consultant, and Neil Bhattarai, C.S.T., process improvement consultant: Tracking hospital-acquired conditions (HACs) requires robust data capabilities, which is why Children’s National sought to improve its HAC data system with increased efficiencies and reduced delays in how staff presented data to the hospital. The team recognized opportunities to improve the management of HAC data, leading to the finding that increased real-time awareness of harm events while utilizing existing infrastructure can accelerate harm reduction.
    • Improving the Surgical Experience for Children with Autism – Presented by Terry Spearman, C.C.L.S., manager of child life services: Staff at Children’s National found that many patients with autism entering the operating room needed special support to make it through pre-op, complicating their path toward surgery and causing frustration for patients, families and the care team. The team solved this challenge by creating a system to identify patients before they arrived for surgery, which allowed staff to create a safe passage plan for each patient and to achieve better care coordination with all care team members. Titled “Help Me Keep Calm,” the hospital’s program provides a more peaceful and individualized experience for both the patient and his or her family.
    • IMPACT Session: Enhancing Psychological Safety to Improve the Safety Climate – Presented by Rahul Shah, M.D., vice president, chief quality and safety officer; Evan Hochberg, R.N., patient safety consultant; and Kathryn Jacobsen, R.N., director of patient safety: Psychological safety around event reporting is a crucial element of safety culture and the ability to voice concerns without reprisal leads to the ideal safe environment.
Electronic medical record on tablet

Children’s National submissions make hackathon finals

Electronic medical record on tablet

This April, the Clinical and Translational Science Institute at Children’s National (CTSI-CN) and The George Washington University (GW) will hold their 2nd Annual Medical and Health App Development Workshop. Of the 10 application (app) ideas selected for further development at the hackathon workshop, five were submitted by clinicians and researchers from Children’s National.

The purpose of the half-day hackathon is to develop the requirements and prototype user interface for 10 medical software applications that were selected from ideas submitted late in 2017. While idea submissions were not restricted, the sponsors suggested that they lead to useful medical software applications.

The following five app ideas from Children’s National were selected for the workshop:

  • A patient/parent decision tool that could use a series of questions to determine if the patient should go to the Emergency Department or to their primary care provider; submitted by Sephora Morrison, M.D., and Ankoor Shah, M.D., M.P.H.
  • The Online Treatment Recovery Assistance for Concussion in Kids (OnTRACK) smartphone application could guide children/adolescents and their families in the treatment of their concussion in concert with their health care provider; submitted by Gerard Gioia, Ph.D.
  • A genetic counseling app that would provide a reputable, easily accessible bank of counseling videos for a variety of topics, from genetic testing to rare disorders; submitted by Debra Regier, M.D.
  • An app that would allow the Children’s National Childhood and Adolescent Diabetes Program team to communicate securely and efficiently with diabetes patients; submitted by Cynthia Medford, R.N., and Kannan Kasturi, M.D.
  • An app that would provide specific evidence-based guidance for medical providers considering PrEP (pre-exposure prophylaxis) for HIV prevention; submitted by Kyzwana Caves, M.D.

Kevin Cleary, Ph.D., technical director of the Bioengineering Initiative at Children’s National Health System, and Sean Cleary, Ph.D., M.P.H., associate professor in epidemiology and biostatistics at GW, created the hackathon to provide an interactive learning experience for people interested in developing medical and health software applications.

The workshop, which will be held on April 13, 2018, will start with short talks from experts on human factors engineering and the regulatory environment for medical and health apps. Attendees will then divide into small groups to brainstorm requirements and user interfaces for the 10 app ideas. After each group presents their concepts to all the participants, the judges will pick the winning app/group. The idea originator will receive up to $10,000 of voucher funding for their prototype development.

Electronic medical record on tablet

Combating ENT wrong patient errors

Electronic medical record on tablet

A recent article published in ENTtoday highlights specific ways ENT physicians can improve quality and care for patients to work towards eliminating wrong patient errors and achieving a zero-harm environment.

In the article, Rahul Shah, M.D., Vice President and Chief Quality & Safety Officer at Children’s National Health System, points out that ENTs are especially vulnerable to wrong patient errors (WPEs) due to the wide variety of settings in which they see patients. He asserts that with this knowledge in mind, ENTS can find ways to “block and tackle” to prevent WPEs from occurring. Key to success is the development of a supportive culture of reporting where all staff are encouraged and empowered to speak up.

“With any size of practice, you need to talk about safety and quality. If doesn’t have to be formal, and don’t overthink it. Something as easy as a safety huddle a couple of times a week goes a long way toward shaping the culture.”

Read the full article here.

Rahul Shah

A big transformation starting with small changes from within

Rahul Shah

“It was novel and exciting to see managers, chiefs, and even front-line staff identify potential ‘projects’ that could potentially fall under this work,” said . Rahul Shah, M.D., Vice President and Chief Quality & Safety Officer. “The change, as the executive leadership hoped, was organic and recognized a true cultural shift.”

Like many health care systems, Children’s National realizes that in order to provide top care to patients, the hospital and health system have to constantly evolve. In 2013, across the country, the importance of a strong safety and quality program were growing and the organization’s executive leadership made it a key priority to deliver the best care and follow best practices to ensure that we were driving value in healthcare. Children’s National embarked on a long-term journey, known as Transformation 2018, that would ultimately prove successful in improving quality of care while reducing costs across the hospital system.

When starting this initiative, the leaders at Children’s realized that in order to successfully transition from volume-based to value-based care, the change had to occur organically – in other words, led by our own internal teams. Continuously striving to be on the forefront of quality and safety innovation, Children’s National has always valued a culture that empowers staff at all levels to be part of transformations, and this initiative was no different. Rahul Shah, M.D., Vice President and Chief Quality & Safety Officer, and Linda Talley, R.N., Vice President and Chief Nursing Officer, would lead the effort.

Rather than setting their sights on first targeting populations of patients, as is common practice, the team aimed to make an impact at a more micro level by focusing on particular diseases or diagnoses. This strategy allowed the initiative to start on a small scale and involve staff in numerous divisions across the health system, which would eventually pave the way for bolder and broader population health initiatives.

By integrating changes through individual initiatives, Children’s National achieved a combination of quality and cost savings in a number of disease areas, including autism, testicular torsion, idiopathic posterior spinal fusion and sickle cell disease vaso-occlusive crisis.

As the benefits of this effort were realized, leaders throughout the hospital approached the transformation team to see how they too could be a part of the project to transition their divisions.

“It was novel and exciting to see managers, chiefs, and even front-line staff identify potential ‘projects’ that could potentially fall under this work,” said Dr. Shah. “The change, as the executive leadership hoped, was organic and recognized a true cultural shift.”

Rahul Shah

Speaking up for safety: Virginia Hospital and HealthCare Association spotlights culture of reporting at Children’s National Health System

Rahul Shah

Rahul Shah, M.D., Vice President and Chief Quality and Safety Officer at Children’s National recently sat down with VHHA’s REVIEW magazine to share best practices and success strategies.

For Children’s National Health System, fostering a culture of safety meant empowering everyone to play a role, from front line staff to providers to the C-suite. Recently, pediatric quality and safety experts at Children’s National sat down with Virginia Hospital & Health Association (VHHA)’s REVIEW magazine to share best practices, success strategies and leadership from Children’s National in this arena. Rahul Shah, M.D., MBA, Children’s National vice president and chief quality and safety officer, and Lisbeth Fahey, MSN, RN, executive director for quality, safety, accreditation, regulatory and emergency preparedness, discussed how establishing a non-punitive culture of reporting where anyone can raise a concern led to improved safety outcomes.

“Our approach has been to make it fun, make it exciting and to reward people,” said Shah, noting the inverse correlation between reporting frequency and safety results.

Read the full story here (pages 10-12) to learn more about how Children’s National is leading the way in quality and safety and the importance of giving all employees permission to speak up.

Doctor-putting-mask-on

Promoting a culture of safety with 10,000 good catches

Doctor-putting-mask-on

In today’s fast-paced health care environment, it has become increasingly important to create a culture of safety where improvement opportunities are recognized and welcomed. With medical errors cited as the one of the leading causes of morbidity and mortality in the United States, health care organizations are working to rapidly identify and respond to errors before long-term issues develop.

Improving event reporting is a critical step. To create an effective culture of safety, employees from throughout a hospital or health system must be empowered. They must be educated and have the ability to easily raise awareness of potential problems and risks and they must be able to proactively resolve problems. With this mindset, Children’s National Health System set out to double the number of voluntary safety event reports submitted over a three-year period; the intent was to increase reliability and promote safety culture by hardwiring employee event reporting. With the goal of growing from 4,668 reports in fiscal year 2014 to 9,336 in 2017, the initiative became known as 10,000 Good Catches. And, the positive framing of the endeavor added to a sense of ownership and reporting among staff members.

Following a Donabedian quality improvement framework of structure, process and outcomes, Children’s National formed a multidisciplinary team and identified three key areas for improvement:

  1. Technology: Make reporting user-friendly, fast and easy
  2. Safe to Report: Create a non-punitive environment in which staff feel secure reporting safety events
  3. Makes a Difference: Develop a culture and system to provide feedback and advance meaningful improvements stemming from safety event reporting

Over the next three years, the team, via subcommittees, routinely solicited feedback from front-line users and met as a larger group monthly to propose interventions, review quantitative data and prioritize next steps. In tandem, employees were educated through internal communications on how, what and when to report. The primary outcome measure was the number of safety event reports submitted through the electronic reporting platform. Event report submission time, number of departments submitting events and percent of safety event reports submitted anonymously were also tracked.

These efforts paid off, as Children’s National more than doubled the number of voluntary safety event reports filed over the three-year period from 4,668 in fiscal year 2014 to 10,971 in 2017, with steady annual improvements. Other metrics included decreased event reporting time and anonymous reports. Interestingly, there was a marked increase in the number of departments submitting reports.

This successful initiative not only resulted in increased safety reporting and engagement, but was an important step toward improving organizational reliability and building a culture of safety first. Future steps will focus on how to sustain improvement, how to more efficiently leverage reporting data and how to apply the data to prevent future safety events.

Children’s National safety experts share strategies

Rahul Shah

Rahul Shah, M.D., Vice President and Chief Quality and Safety Officer at Children’s National Health System (CNHS), and his team joined pediatric quality and safety leaders from across the country in Orlando, Fla. for the Children’s Hospital Association’s 2017 Quality & Safety in Children’s Health Conference.

Earlier this month, Rahul Shah, M.D., Vice President and Chief Quality and Safety Officer at Children’s National Health System (CNHS), and his team joined pediatric quality and safety leaders from across the country in Orlando, Fla. for the Children’s Hospital Association’s 2017 Quality & Safety in Children’s Health Conference. Dr. Shah shared findings and strategies that have led Children’s National to be a leader in this field, and collaborated with peers to move the needle on pediatric safety in hospitals and improving the quality of care hospitals deliver.

Notable presentations from the Children’s National team included:

  • The Children’s National utilization of a safety culture survey called the Safety Attitude Questionnaire (SAQ), and the crucial role of ensuring leadership alignment in the survey process. Obtaining leadership buy-in and alignment allowed Children’s to accelerate the spread of identified opportunities for improvement within the organization.
  • The importance of an ongoing multi-disciplinary approach to care for psychiatry patients, a patient population that that continues to increase in American pediatric healthcare and requires innovative approaches. Children’s National team members emphasized the importance of training the hospital’s security teams and front-line caregivers in therapeutic interventions to seek optimal outcomes for patients, while respecting the complexity of their diagnoses.
  • How to drive reliability through apparent cause analyses. Kristen Crandall, Director of Patient Safety at Children’s National, shared examples of how to leverage data to effectively drive change in cause analyses. Cause analyses are fundamental tools for implementing improvement. The team highlighted the upcoming launch of a High Reliability Toolkit© developed at CNHS to ensure that action plans created from cause analyses are of adequate depth and sophistication to drive improvements.

Dr. Shah and his team also had the honor of delivering an Impact session on the final day of the conference, in which they discussed the applications of merging patient safety with patient experience. The team also shared the Children’s National approach to safety and service, which includes delivering a unified framework of high reliability through consistent messaging to demonstrate that when safety and service integrate and align, the sum is greater than the parts.