Safety culture’ approach guides health system’s efforts

Health system takes cue from manufacturing world

It’s not that unusual these days to find health care professionals modeling their performance improvement efforts on proven strategies from the world of business. It is, however, unique to find a health care system’s safety culture taking its cue from the manufacturing world.

But that’s precisely the case at the University of Michigan Health System (UMHS), Ann Arbor, whose patient safety enhancement program is one of the most comprehensive in the country.

"I read a story in a business publication about Alcoa Aluminum," recalls Darrell Campbell, Jr., MD, chief of clinical affairs at UMHS, who is overseeing the safety initiative.

"It dealt with the new CEO, [former treasury secretary] Paul O’Neill, who had been asked about his strategy for the company. He said he would base his whole tenure on the safety of the employees who worked there, and that he would make Alcoa the safest manufacturing company in the world," he says.

As a result of that safety culture, employee retention and recruitment improved, productivity improved, the quality of Alcoa’s products improved, and profitability improved, Campbell explains.

"This basic core value resonated with the people working there, and it’s even more appropriate for a hospital. If we emphasize safety as the bedrock priority, then a lot of good things will flow from that — how people feel about coming to work, retention, and recruitment," he adds.

"And patients will trust that things will be handled well. If we have a safety culture that is prominent in everyone’s mind, it’s the right thing to do and a lot of good things will happen," says Campbell.

No less important, says Maureen Thompson, MSN, CCRN, patient safety coordinator, is that leadership for these efforts comes out of the office of clinical affairs.

"The organization could very easily have delegated it to a nonclinician," she concedes, "but the loss in that is you don’t have a chief of staff who is intimately knowledgeable about what the safety concerns of frontline individuals are. If you listen and hear their concerns, and the communication is bilateral, then in all the different meetings he will hold, all that information is morphed and used to inform others, such as how difficult it is to know certain information and their safety implications."

A multifaceted program

The patient safety program, which got its start in late 2002 with a conference called "Improving Patient Safety in Hospitals: Turning Ideas Into Action," has numerous components, overseen by a multidisciplinary safety team.

Thompson is patient safety coordinator; the other members include Karl Weick, a professor of organizational psychology; John Gosbee, professor of human factors engineering; Marilynn Rosenthal, a medical sociologist; Heather Wurster, a nurse with a public health degree; and Jim Bagian, MD, director of the Veterans Administration National Center for Patient Safety.

The UMHS web site (www.med.umich.edu) contains a wide variety of resources for patients and health care professionals. Resources for patients include:

  • UMHS patient safety;
  • UMHS patient rights;
  • UMHS patient responsibilities;
  • how to register a complaint with UMHS;
  • how to register a compliment with UMHS;
  • UMHS patient relations office.

Resources for health professionals include:

  • Patient Safety Toolkit (www.med.umich.edu/patientsafetytoolkit/): Funded by Blue Cross/ Blue Shield, the toolkit was developed for participants in the 2002 conference. Major components include a safety plan; adverse events; infection prevention and control; safety culture; safety curriculum; medication safety; and disclosure.
  • Improving Patient Safety in Hospitals: Turning Ideas Into Action (http://cme.med.umich.edu/iCME/patientsafety03/default.asp): a CME program for the U-M medical school.
  • U-M Patient Safety Enhancement Program: Seeking to prove new methods of preventing errors, infections, and hazards.
  • Good Medicine: Measures of health care quality.
  • Prescribing Safety: A site devoted to preventing medication errors.

A new kind of walk around

Perhaps one of the most effective tools used in this wide-ranging program is the patient safety rounds approach, which involves a walk around every two weeks. "This is an important way for me to find out what’s happening," Campbell explains.

"I gather myself, Maureen, maybe someone from pharmacy, nursing, a patient advocate, materials services, and descend on a unit. We tell them we want a half hour or 45 minutes of their time to hear their key concerns in patient safety," he says.

That is an effective way of obtaining front line information, Campbell explains, and often begins with questions like, "What do you worry about most when you come to work?" or "What happened recently that was a bad thing?"

Practical solutions come out of such rounds, Thompson adds. "Two weeks ago, we were in our adult operating room." (The hospital has both adult and pediatric operating rooms.)

"We talked about how difficult it can be when you have emergency procedures in the middle of the night and have to have kids cared for in an adult setting," she recalls. "You need to have some pediatric equipment ready, so you don’t have to run over to a pediatric operating room for supplies."

A materials services staff member subsequently discussed the issue with clinical staff, and they identified certain equipment that could and should be made available for such cases.

"You don’t want to have duplicates of all equipment, but you can identify the most common things you need for the most common occurrences," Thompson notes.

"Perhaps, they’re stored in a place far away from the frontline person who needs them, but some supplies can be moved around and stocked a little closer. These small things really matter," she points out.

Sharing information with others

Much of what is learned and developed at UMHS is being shared with other facilities.

For example, Thompson notes, the Patient Safety Toolkit "has been used widely in hospitals around Michigan." Not only that, but UMHS staff have visited some of these facilities to share their expertise.

"Folks would visit hospitals, help them do a root-cause analysis, and also help them walk through the use of the toolkit," she adds. These individuals have included UMHS medical staff, risk management representatives, and quality professionals.

Some of the web-based tools, however, are not available to people outside the U-M web space. For example, there is a link right on the home page that most of the clinical staff use for their work, which they can click to start reporting an incident or near miss. The form is password-protected, and the system is nonpunitive.

The potential impact of errors that are not prevented may be illustrated by a tiered structure, Thompson explains.

"At the peak would be lawsuits brought against the hospital," she adds. "If you adequately monitor all of your patient safety situations and you mine the opportunities out of that big broad base, you attend to the second tier where there is an error but nothing terrible happens. Then you arc to the very top: how to manage safety and work with medical staff on how best to address those errors."

(For more information, contact:

  • Darrell Campbell, Jr., MD, Chief of Clinical Affairs, University of Michigan Health System, Ann Arbor, MI. E-mail: darrellc@umich.edu.
  • Maureen Thompson, MSN, CCRN, Patient Safety Coordinator, University of Michigan Health System, Ann Arbor, MI. E-mail: maureent@umich.edu