Patient safety culture transformation in a children's hospital: an interprofessional approach.

In 2008, a children's hospital based in the Midwest of the USA launched a hospital-wide safety transformation initiative to improve the safety and quality of care resulting in a decrease in the number of critical safety incidents. In order to build on the early successes of the Hospital's safety program and further improve safety metrics, investigators developed a set of multi-pronged, interprofessional interventions designed to improve overall safety outcomes. The interprofessional interventions focused on didactic training, simulation exercises and safety rounding components. Study results indicate that the didactic portion of the study intervention was the most effective component in terms of safety behavior knowledge gained and satisfaction. The student groups had statistically significant higher post-didactic (86.2 versus 77.7, p < 0.001) and post-simulation (85 versus 81.8, p < 0.05) knowledge scores than did the staff groups. After gaining knowledge in basic safety training didactic instruction, students and staff maintained the knowledge gain throughout the study, but no significant knowledge gains were observed after simulation experiences and rounding with safety coaches. An overall increase in hospital metrics (all safety events) of the study year, compared retrospectively to the previous year, was observed. Investigators attribute the increase in the metric indicators to greater attention to reporting safety events.

Disclosure of Adverse Events: A Guide for Clinicians.

INTRODUCTION: Children's Hospitals' Solutions for Patient Safety (SPS) acknowledged a recommendation from the American Academy of Pediatrics to develop education programs on the communication of adverse events with patients and families. SPS set out to create a guide that would outline a standardized disclosure process and provide a training curriculum and tools so that providers would feel better prepared to have effective disclosure conversations. METHODS: SPS disclosure work began with the development of a project team made up of 9 network hospitals. The team utilized key driver diagrams and process maps to show the relationship between the project aims, key drivers, and specific interventions. The team developed a training curriculum, guide, and tools for each area of improvement. To ensure these were effective, they were tested using case studies and plan-do-study-act cycles. RESULTS: One of the cohort hospitals piloted the curriculum and tools, training 48 physicians, nurses, executives, and other allied health professionals. Pretest to posttest scores improved from an average of 82.7% to 90.2%. Survey feedback was favorable with 100% of respondents noting that they strongly agree or agree that attending this educational activity increased or improved their competency, performance, and patient outcomes. CONCLUSIONS: Initial testing suggests that the developed curriculum is empowering for frontline clinicians. Materials are available in an electronic format on the SPS external website. As member hospitals implement these materials, they will be evaluating learner satisfaction and provider usage. SPS will seek out feedback from these hospitals to further develop the materials and support clinicians.

A safety culture transformation: its effects at a children's hospital.

OBJECTIVE: To improve pediatric patient safety at a tertiary, 200-bed children's hospital by changing the safety culture and implementing processes, practices, and measures to sustain improvements. Although many core quality and safety measures exist for adult acute-care facilities, equivalent measures for pediatrics are lacking. METHODS: Helen DeVos Children's Hospital in Grand Rapids, Michigan, part of the Spectrum Health system, led a 2-year initiative beginning in late 2007 to improve pediatric patient safety. Key strategies included safety-based staff training, training in root cause analysis, failure mode classification of events and safety behavior, integration of and collaboration between risk management and clinical staff, consistent coding and classification of serious safety events and adoption of multiple safety metrics, creating a new safety leadership infrastructure, and fostering transparency of data and safety event details. RESULTS: The 2-year initiative led to an estimated 68% decrease in the number of serious safety events and adoption of a serious safety event metric reported monthly. In addition, compliance with the ventilator-associated pneumonia bundle rose from 2% to 96%; hand hygiene compliance rates rose from 56% to 95%; and the Children's Asthma Care-3 core measure, home management plan of care given to patient/caregiver, rose from 0% to 83% within 6 months. Medication errors with serious harm were reduced to only two during the initiative, and ventilator-associated pneumonias dramatically decreased, with only one occurring in 2009. CONCLUSIONS: The initiative led to key improvements in safety culture and patient safety and also had a broad impact on several clinical quality outcome measures. Using safety metrics improves transparency and enables future benchmarking with peer institutions to help improve pediatric patient safety nationwide. Because of the initiative's success in our children's hospital, the entire Spectrum Health system, including more than 16,000 staff members, is now undertaking a similar effort.