Joint Commission seeks high reliability’ patient safety in collaboration with South Carolina hospitals
We asked ourselves what is the next generation of this work?’
In an ambitious attempt to see if patient safety successes can go beyond individual units and even entire facilities, the Joint Commission Center for Transforming Healthcare is partnering with 20 hospitals in South Carolina.
"When we look at health care organizations around the country there is a lot of work being done to improve quality — a lot of places have established a particular [high quality] unit, a particular service," says Mark R. Chassin, MD, FACP, MPP, MPH, president of The Joint Commission (TJC). "What we don’t see is entire hospitals, hospital systems, regions, functioning at very high levels of safety that is maintained over long periods of time. We don’t see in health care the level of excellence and safety of commercial air travel — or even amusement parks."
The project with the South Carolina Hospital Association (SCHA) — the first of its kind for the TJC Center — includes 20 hospitals from seven health systems located throughout the state. CEOs and other executives from participating SCHA hospitals will meet regularly to collaborate on performance improvement projects and discuss strategies to move toward high reliability care. The specific interventions have not been announced yet, but medical errors and preventable infections are expected to be prime targets for reduction and even eradication.
"We will learn together how to move from a project-to-project approach to improvement to a transformative process that moves an entire organization from pockets of excellence — with a lot of variation in quality — to one where it is equally maintained in every service for every patient every time," Chassin says. "That’s the ultimate goal — a health care system where patients do not get harmed."
In the Joint Commission collaboration, improvements will be measured through safety culture survey assessments, evidence that activities have produced significant reductions in patient harm, and associated cost savings. In addition, the South Carolina hospitals will use a Web-based electronic tool designed by the TJC Center to identify critical high-reliability practices in health care and help hospitals assess their performance in these areas.
This "Targeted Solutions Tool" provides a step-by-step process to assist health care organizations in measuring performance, identifying barriers, and implementing the center’s solutions. The TJC Center has developed targeted solutions for improving hand hygiene compliance, reducing the risk of wrong site surgery, and improving hand-off communications. Targeted solutions for surgical site infections, heart failure hospitalizations, safety culture, and patient falls will be added as these projects come on line. (See http://www.centerfortransforminghealthcare.org/)
Mistakes were made
"The primary job is always to deliver the right care for each patient every time," says Thornton Kirby, FACHE, president and CEO of the SCHA. "Unfortunately the fact that medical care is increasingly complex yields the fact that we still make mistakes. We don’t like that mistakes are made, but they are still made. But South Carolina hospitals have been working really hard to improve the quality and safety of patient care over the last several years with really great results."
Indeed, South Carolina has not exactly been a laggard in quality improvement, as hospitals statewide are adopting a surgical safety checklist designed by author and surgeon Atul Gawande, MD, MPH, and colleagues at the Harvard University School of Public Health. (See related story, this page)
"The hospitals have been doing great work," Kirby says. "We asked ourselves what is the next generation of this work? Our conclusion is it’s time to change the culture of hospitals so that we do not make mistakes. That is a tall order but that is why we are focused on this work."
Though zero infection goals have become commonplace in hospitals, some question whether health care delivery can ever achieve the efficiency of business and industry models. In an article lamenting the toxic safety cultures in too many hospitals, Chassin turned an old analogy on its head in conceding that sustaining high reliability in health care is harder than "rocket science."1 Still, collaborations like the one in South Carolina signal the Joint Commission is in it for the long run.
"We know it’s going to take a long time but we designed this so that each organization can take a hard look at itself where it’s strengths and weaknesses are — and learn from each other," Chassin says. "We fully expect that some places will be strong in one area and some in others."
Beyond the hospitals initially participating in the South Carolina project, the collaboration between the Center and SCHA is designed to improve safety and quality in health care organizations across the state. The lessons learned about identifying the underlying causes of specific breakdowns in care and creating targeted solutions will eventually be applied to other health care facilities nationally, according to the Joint Commission.
- Chassin, M. Improving The Quality Of Health Care: What’s Taking So Long? Health Aff 2013;32:1761-1765