Specific patient safety steps urged for hospitals
The head of The Joint Commission is urging hospitals to make substantial changes to achieve the ultimate goal of zero patient harm by adapting lessons from high-risk industries.
President and CEO Mark R. Chassin, MD, FACP, MPP, MPH, called for the safety improvements in an article along with Jerod M. Loeb, PhD, executive vice president for healthcare quality evaluation at TJC. The article was published in The Milbank Quarterly and is available online at http://tinyurl.com/kq34mgt.
Chassin and Loeb report that too many hospitals and healthcare leaders experience serious safety failures as routine and inevitable parts of daily work. To prevent the harm that results from these failures, which affect millions of Americans each year, the article specifies a framework for major changes involving leadership, safety culture, and robust process improvement. This framework is designed to help hospitals make progress toward high reliability, which is the achievement of extremely high levels of safety that are maintained over long periods of time, such as safety comparable to that demonstrated by the commercial air travel, nuclear power, and amusement park industries.
TJC tested the high-reliability framework, detailed in the article, at seven U.S. hospitals, as well as through face-to-face meetings and testing with healthcare leaders. In the article, Chassin and Loeb outline the 14 components of the high-reliability framework and contend that:
• Hospital leaders must commit to the ultimate goal of high reliability or zero patient harm rather than viewing it as unrealistic. The leadership section of the framework identifies specific roles for the board of trustees, the chief executive officer, and all senior management (including nursing leaders), the engagement of physicians, the hospital quality strategy, its use of data on measures of quality, and the use of information technology to support quality and safety improvement.
• Hospitals must create a culture of safety that emphasizes trust, reporting, and improvement. This means hospitals must put a stop to the intimidation and blame that drive safety concerns underground and instead emphasize accountability and the early identification of unsafe practices and conditions. A systematic approach that includes safety culture measurement is crucial.
• Hospitals need new process improvement tools and methods, in the form of a combination of Six Sigma, Lean, and change management (known together as Robust Process Improvement), to make far greater progress toward eliminating patient harm. Government regulation is unlikely to drive high reliability, but identifying and eliminating mandates that do not directly contribute to or distract from quality challenges is necessary. Well-crafted programs that require public reporting of reliable and valid quality measures also are recommended.
"Although no hospital has been able to achieve high reliability, there are some very practical changes that can be made to improve safety and quality," Chassin wrote in the article. "The time is now to start taking the steps needed to get from where we are today to where we want to be."
The article by Chassin and Loeb notes that the primary drive for change must come from within the healthcare industry and from hospitals themselves. TJC is developing an assessment tool that will allow hospitals to measure their current state of maturity across each of the high-reliability framework's 14 components. In addition, TJC is field testing tools that can be used to work toward high reliability.