Baptist Memorial Hospital-Memphis (TN), a flagship hospital for Baptist Memorial Healthcare System, was experiencing a problem familiar to many hospitals: It could make quality improvements, but had difficulty making those improvements stick, as there was a lack of bedside accountability.
In January 2016, the hospital implemented daily 15-minute safety briefings, and that began turning the tide.
Daily safety briefings are not a new concept, of course, but Baptist Memorial found a way to make them particularly effective.
These stand-up meetings were facilitated by senior leaders and huddle notes were provided to every department for 24/7 dissemination, says Michelle Smith, MSN, RN, NEA-BC, chief nursing officer with Baptist Memorial Hospital-Memphis. After joining the hospital in October 2015, she found that the organization had a serious problem with hospital-acquired conditions (HACs), including catheter-associated urinary tract infections (CAUTIs), central line-associated bloodstream infections (CLABSIs), and falls, with higher rates than she had seen before.
Smith led the hospital’s efforts to implement best practices for reducing those HACs. The implementation was so successful that the reduced rates of CAUTIs and CLABSIs at Baptist Memorial helped reduce the state’s overall rates, Smith says.
With a daily census exceeding 500 inpatients, Baptist Memorial was experiencing more than 100 CAUTIs and CLABSIs per year in 2015. That number was reduced to the teens in 2016, and was down to single digits in 2017 — a reduction of about 85%. Falls with harm were reduced from eight in 2015 to three in 2016.
But implementing the best practices was successful only because managers and frontline staff were held accountable, Smith says. In her prior position, she became familiar with the concept of daily safety briefings and implemented them at Baptist Memorial. The safety briefings are held Monday through Friday, from 8:30 am to 8:45 am, and are attended by managers and any employee who wants to attend, including those from nonclinical departments.
Each daily meeting is attended by 100 to 150 people. Smith is trying to schedule safety briefings on weekends also, but currently there is a problem with data access that makes that difficult.
Smith and her colleagues focus the safety briefings on reducing those problem HACs. Length of stay also is studied because patients are more likely to experience the other conditions the longer they are admitted, she says.
The key to making a difference with safety briefings, Smith and her colleagues soon found out, was to talk about real people and not just data.
“We talk about individual patients and what happened to them, the effect this condition is having on a real person down the hall,” Smith says. “We’re not just talking about rates per 1,000 patient days. That patient … on 3-East is somebody’s father, a real person. We make it real for the managers and the staff, talking about how this patient is suffering right now because of this CAUTI or this fall, and what we could have done to prevent that.”
The meeting is focused on learning from experiences, and the leaders specifically avoid shaming or discussing discipline during the meeting. Smith makes a point of beginning and ending each meeting with a positive story or anecdote about patient care.
“At that briefing, the managers have to talk about what happened on their watch, what went well and what didn’t, whether there was opting out behavior in which our policies and procedures are not followed,” Smith says. “Sometimes they just have to be transparent and say someone didn’t do what they were supposed to do. We keep it positive during the meeting, and any coaching comes between the meetings, not in that setting.”
The reduction in HACs has resulted in a tremendous cost savings to the hospital, helping it meet its margins for the past two years, Smith says.
She notes that CLABSIs can cost the hospital $50,000 each, and recent research suggests CAUTIs can cost as much as $10,000.
“When you look at reducing CLABSIs from 110 in a year down to 17, that’s a huge cost savings,” Smith says.
The HAC numbers were so high initially partly because clinicians and managers did not associate the data with the experiences of individual patients, she says.
“That’s why we always talk about these things now in terms of someone’s journey and try to tug at the heartstrings a little bit,” she says.
“Before, the quality department was left out there on their own, responsible for these numbers and really without a lot of support for making the improvements that would change them. Now I’m joined at the hip with our quality director, who provides me with the data I need, but I’m in a position to hold people accountable for their behavior either in a positive way, or if we need to do some coaching.”
Smith points out that the safety briefings are limited in scope to the specific HACs the hospital wants to address. It is a mistake to let safety briefings morph into more general managerial discussions, she says.
The 15-minute time limit is strict, and it’s a stand-only meeting. The safety briefing is held in a designated “safe room” where people are encouraged to be forthcoming about failures and concerns. It is equipped with boards depicting current numbers, strategies, and annual goals.
“We do not turn ours into an operations meeting and try to boil the ocean. We keep it very specific to our improvement strategies and everything else can be discussed at another time,” she says. “But for it to really work, you have to have a culture in which someone can say their patient fell and they didn’t do all they could to protect them.”
Smith implemented the safety briefings with two weeks of training sessions to make expectations clear about the briefings and why they could improve the HAC rates. Managers were told that staff must notify them immediately of all HACs, around the clock, and Smith will confirm that when a manager reports an event at the morning safety briefing. She wants to hear, “Yes, they called me at 2:42 this morning to notify me.”
“The expectations are high. I make it clear that they don’t need to be walking in at 8:30 a.m. with their purse over their shoulder. They need to be ready at 8:30 to make a report and discuss these issues,” Smith says.
“It was a little scary at first, but they’ve really embraced it now. I have directors and a doctor who can run the meeting without me, so we always do it every single day.”
The meetings are never canceled for any reason. If The Joint Commission comes for a survey or half the staff is absent because of a snowstorm, the daily safety briefing is still held, Smith says.
Baptist Memorial also has made an effort to involve disparate groups in the hospital to improve patient safety related to issues such as falls.
For instance, that means including housekeeping, security, and chaplains in patient safety efforts.
“We don’t want patients sitting on the side of the bed or left alone in the bathroom, and we know that on the day they’re going home they tend to get a little overconfident,” Smith says. “We’ve had nonclinical people go find a nurse and report that the patient was sitting on the side of the bed so we could intervene before a fall.”