How MN's reporting laws have changed the state

Report shows safety higher priority across state

Five years after implementing the Adverse Health Care Events Law, which requires hospitals and ambulatory surgery centers to report on 28 quality measures, the Minnesota Department of Health published a retrospective report: "Adverse Health Care Events Reporting System: What have we learned?"

In its evaluation, the health department has found the law has changed the way safety is viewed at facilities across the state. According to the report, 72% of responding facilities say they feel that the reporting law has made Minnesota safer than it was in 2003, when the law was introduced.

Diane Rydrych, MA, assistant director of the division of health policy at the Minnesota Department of Health, says "the reasons we know we're safer are that our processes are more standardized, people are following them more closely, leadership is more involved than they were, we're talking about these issues much more than we have in the past, we're talking about things that go wrong or where things could potentially go wrong and making sure we're putting processes in place to prevent those things from happening. Just the awareness overall of risk and of the potential for risk is so much higher than in the past."

Adopting best practices

A central element of the health department's work, in conjunction with the Minnesota Hospital Association, is ensuring that hospitals are implementing and using best practices. Rydrych says the association has established four campaigns called "calls to action" related to the top four adverse events reported between 2003 and 2008: stage 3/4 pressure ulcers, foreign objects, wrong-site surgery, and unstageable pressure ulcers.

The hospital association has worked "with content experts to determine what the best practices should be for prevention of those events, and they've designed a whole campaign to get hospitals from around the state to sign on," and to get CEOs on board, Rydrych says. Each quarter, the association tracks what percentage of those best practices are used in each facility, which are provided with tools, training, and conference calls in which participants can discuss what they're doing. "They've just had great results," she says.

In the beginning, the average of best practices implementation at participating facilities was about 60%. For each campaign, that number has risen to 90%. "The percentage of best practices for each of those events has grown hugely from what it was before the campaign started," she says.

The next step, Rydrych says, is tracking the outcome measures related to the use of each best practice. "It's harder to get that connection," she admits, "but we're trying to work on that."

In the report, hospitals were asked about the implementation of best practices related to data sharing and transparency. Since adoption of the law, hospitals are reporting at least an 80% improvement on these best practices:

  • sharing of adverse event data with the board;
  • sharing of adverse event data with staff;
  • sharing of adverse event data with other facilities;
  • policy of disclosing adverse events to patients/families;
  • leadership walk arounds;
  • administration sets measurable patient safety goals;
  • regular assessment of patient safety culture.

One message that came out of the report, Rydrych says, was that hospitals wanted more help on how to disclose adverse events to patients and their family members. The hospital association has put some guidelines together for facilities to use, and Rydrych says, "that's something we would like to provide more resources on going forward."

Leadership walk arounds are something "we've hoped would happen," and seem to be doing a good job in generating a strong culture of safety, Rydrych says. "If staff don't feel like these efforts aren't supported at the top of the organization, then they're just not going to stick. Solutions often come from frontline staff, but they need to know that they're supported. They need to know resources are going to be available to them."

Looking back now five years since the start of the reporting legislation, Rydrych says, "I do feel like we've started down the road in changing the culture here, although there's a long way to go. Health care is so complex and involves so many shifting groups of people, and there's hierarchies all over the place. But I do feel we're starting to make some real progress here."