Hospital’s safety goal: No more injuries

Strategy includes transparency, reporting

Forget about modest goals and incremental progress. Cincinnati Children’s Hospital Medical Center wants to cut its rate of employee injury in half by June 2015. And it already has an injury rate that is just one-third of the average rate for hospitals.

You can see their monthly stats on a chart they post on a quality website, where they explain the goal: At Cincinnati Children’s, we are working to make our institution the safest it can be for our employees. We do this not just because we value our staff, but also because we know that employee and patient safety are inextricably linked. We must address the two as one system — you cannot achieve one without the other.

Or, to put it another way: “In order to care for others, you have to feel safe in taking care of yourself,” says Terri Thrasher, the hospital’s senior director of human resources and professional services.

“I really believe in that. Until you embrace safety as just one thought, the way that you approach everything, you’re going to continue to experience problems in your patient safety journey,” she says.

When employers set goals for low injury rates, there’s always a concern that employees will just stop reporting their injuries. But Cincinnati Children’s actually provides a job performance incentive for employees to report more injuries, incidents and near-misses.

“We’re looking for a 30% increase in reported patient safety incidents and a 25% increase in employee incidents,” says Thrasher. “We want more reports. In order to understand our situation well, you have to report.”

Cincinnati Children’s also uses outside benchmarks — but not from other hospitals. “We really don’t use health care as our benchmark,” says Stephen Muething, MD, vice president for safety. “Once we woke up to how far behind health care is in this work, we have been using other industries as our benchmark.”

For example, Cincinnati Children’s benchmarks against Alcoa, the aluminum manufacturer which set a goal of eliminating employee injuries. Paul O’Neill, former chairman and CEO of Alcoa, set a “no excuses” attitude. “It doesn’t cost more money to investigate things gone wrong in real time and do something about them. It has to be a part of the culture,” he said in a recent webinar on the emotional and physical health of the health care workforce.

Starting the day with safety

As with most hospitals, Cincinnati Children’s initially placed a strong focus on patient safety. A new CEO reviewed the program and asked, “Why aren’t you making employee safety equal to patient safety?” says Thrasher. “Even though we had it on the [quality] dashboard and we had improvement efforts, it did not carry that same kind of weight.”

Today, safety efforts address both patient and employee safety. Cincinnati Children’s also took a cue from military operations, which hold briefings to review their activities and progress and conduct “situational awareness.”

Every morning at 8:35 a.m., department heads and leaders of the clinical areas gather on a conference call for an operational briefing. Their mission: to report what went wrong the day before, what they’re going to do about it, what potential issues they might face today, and what they’re working on fixing.

For example, if they’re short-staffed or if they are introducing a new piece of equipment, they anticipate problems and brainstorm solutions, says Muething. They might even talk about children in the mental health area who at risk of harming themselves or employees and how they can respond.

“We use that information to plan the shift. It’s been a huge change for us and it’s resulted in some significant reductions in harm,” he says.

The hospital has an online reporting system and a call line for employees to report incidents and “potential harm.” For example, if someone sees a spill or water on the floor, they can use the reporting system to get response from environmental services — and prevent a slip or fall, says Thrasher.

Small steps to a big goal

The hospital’s safety goals are impressive, but it takes many small steps to get there, Thrasher and Muething say.

For example, employees working with severely autistic children or other children in the mental health unit sometimes suffered from bites or other injuries. The hospital undertook “very focused improvement work in trying to understand how these injuries are occurring and what we have to do to prevent them,” says Thrasher.

Employees learned about triggers of aggressive behavior and how to diffuse them. They also have access to personal protective equipment, including Kevlar gloves, sleeves and collars. “I think they really appreciate the fact that we care enough to try to help them be safer,” says Thrasher.

Cincinnati Children’s reviewed the techniques used in lifting and patient handling, and purchased additional equipment. The hospital evaluated office work stations and improved the ergonomics. Maintenance workers regularly look for irregularities in sidewalks, steps or curves and correct them to prevent falls.

Preventing needlesticks has been a challenge. The hospital is continually reviewing its devices. Some incidents occurred because the patient suddenly moved. So nurses received additional training on “how to appropriately engage a safety device as well as how to securely and safely hold a patient in order to have the best success in terms of giving an injection,” Thrasher says.

Except in an emergency, nurses who need help holding a patient are told to wait for assistance before giving injections.

Even as those efforts succeed in reducing injuries, the hospital continues to look for new prevention strategies. “It’s a forever journey,” says Muething. “We believe as soon as you start getting comfortable, you are going backwards. We believe being a high-reliability organization is constantly and forever being uncomfortable.”