What it takes to be safest hospital in the nation’

Hospital sets high safety goals in all areas

Self Regional Healthcare in Greenwood, SC, isn’t satisfied with a 48% reduction in needlesticks or a 53% decline in the recordable injury rate. In fact, Self Regional has raised the bar much higher than that.

"Our overall goal is to be safest hospital in the nation," says Mary Margaret Jackson, CPHQ, director of Performance Outcome Services.

That philosophy comes from the top — from the hospital’s CEO, John Heydel. It pervades the hospital’s operations, with programs geared toward Managing Risk Enterprise-Wide. Instead of selecting just a few key indicators, Self Regional developed a comprehensive approach to employee and patient safety. Departments that impact safety — including employee health, infection control, engineering (facility safety), and nursing (clinical safety) — work together to set goals and monitor progress.

The resulting scorecard is a daunting grid that includes the rate of days away from work due to injury, compliance with standards and National Patient Safety Goals of the Joint Commission on Accreditation of Healthcare Organizations, return-to-work statistics, and myriad other worker and patient safety items.

"You really need to proactively look at all areas," Jackson explains. "We want to help every employee think about safety every day they come into the organization."

It may sound overwhelming to take on so many areas at the same time. But for Self Regional, it’s part of an overall effort to boost the hospital’s safety culture and to rise to international standards.

Ever notice the signs at manufacturing plants that boast about how many days they’ve gone without an injury? You don’t see them at hospitals. But that’s the sort of zero accident goal that Self Regional would like to have, at least for preventable, serious errors that the hospital sets as a priority.

"We’re going to measure the days between never’ events and publicize that with our staff [to show] what they’ve been able to achieve," Jackson notes.

How can you set so many goals and still be effective? Self Regional has approached safety both from a facilitywide approach and with individual improvement projects.

All frontline managers have had training on error reduction. The hospital worked with Performance Improvement International of San Clemente, CA, to measure its safety culture. It recorded a high level even before the interventions — but set the goal even higher.

The hospital developed a set of behavior expectations, including "Communicate clearly" and "Do the job right the first time." Employees were encouraged to ask questions and even to intervene if they saw someone doing something contrary to proper procedure.

The hospital also adopted the Stop Think Act Review (STAR) approach to encourage employees to pay attention to their actions. It used Red Rules to designate safety measures that always should be followed.

"We want employees to use techniques like that [to focus on safety]," says Jackson.

Yet the hospital also drafted action plans for targeted improvement projects. For example, the hospital noted slips and falls were occurring from spills in the dietary area. So dietary workers received new no-slip shoes — and the hospital required their use on the job. The slip rate declined by 58%.

A sharps committee evaluated all the sharps used in the facility and made sure safety devices were used where they were available. The most challenging area has been the operating room, adds risk manager Brenda Smith, RN.

The hospital brought in Marc Davis, MD, a former surgeon who now specializes in reducing OR sharps injuries, to promote the use of blunt suture needles among surgeons. The overall sharps rate at the hospital dropped from 2.49 per 100 full-time equivalent employees in 2002 to 1.20 in 2003.

With construction of a new laundry facility, the hospital has been able to reduce injuries from workers lifting heavy bags and being stuck with hidden sharps. Trucks pull up to a conveyor belt, where employees use long hooks to guide them as they’re dumped and to rip open the bags. Other employees sort the washcloths from the towels and sheets and look for signs of biohazard material.

"That’s the last time it’s touched," says Jay Kirby, CHE, vice president of support services. "It’s fully automated from that point until it comes out clean, ready to be folded."

Self Regional tracks numerous safety indicators, but six key patient and worker safety indicators are reported to the board on a quarterly basis.

"They want to see results," Jackson notes. "We’re reducing risk to the worker and risk to the patient and visitor."

Partners in safety

Self Regional hasn’t made all this progress alone. PHTS Services in Columbia, SC, a state workers’ compensation insurer and risk management consultant that focuses on health care, promoted some of the initiatives and provided staff education.

In fact, PHTS has encouraged the enterprise-wide approach to managing risk among its member hospitals.

The hospital also is working toward ISO (International Standard Organization) certification. The pharmacy is working to become the first to receive the ISO designation in South Carolina and only one of 16 in the nation with that recognition, says Jackson.

The pharmacy reduced its policies and procedures by half, then trained employees to comply with the streamlined system. Surveyors from Canada will visit the hospital and evaluate their performance.

The goal is simple, Jackson explains. "Do the right thing all the time."