Sunday, April 15, 2012

Ohio children's hospitals set the standard

I have made previous mention of the progressive attitude and approach to patient quality and safety that exists in Ohio.  The annual Central Ohio Patient Safety Conference, for example is organized by a number of hospitals in the area who decided years ago that "we compete on everything, but we don't compete on safety."  Likewise, Cincinnati Children's Hospital Medical Center has long had a goal of "pursuing perfect care" and has an an extensive commitment to transparency of clinical outcomes.

Now comes a group of children's hospitals that has established a truly audacious goal -- eliminating all serious harm in Ohio’s children’s hospitals.  The coalition, called Solutions for Patient Safety, is described here.  Their vision is to make Ohio the safest place in the nation for children's care.

But this is no mere slogan.  Supported by Cardinal Health Foundation, the group will focus on eliminating Serious Safety Events (SSEs) in Ohio children’s hospitals.  Complete transparency is an important element of this effort, and they are committed to inter-institutional data sharing to foster an "all teach all learn culture."  The group is developing a patient harm index to capture all elements of harm occurring at children’s hospitals across the state.  Here are the participants:

The group has a top-to-bottom philosophy:

I can't begin to tell you how exciting and admirable all this is.  These folks are adopting, in a collaborative learning environment, audacious goals, process improvement techniques from other industries, and transparency of clinical outcomes.  There is nothing they are doing that every hospital in the country cannot adopt -- given sufficient leadership.  There is nothing they are doing that cannot be accomplished by consortia of hospitals in other regions.  They are not being forced to do it by government regulators or insurers.  They are doing it because they want to hold themselves accountable to the standard of care in which they believe.

Let me include this excerpt from a press release about the Ohio program to give more information about what is possible if people decide to "just do it":

To achieve the network’s goals, participating hospitals will be learning from high reliability industries - such as nuclear power and aviation – that achieve high levels of safety in the face of considerable hazards and operational complexity. In addition, participants will focus on transparent sharing of data; development and use of standardized pediatric measures and process bundles; and the use of common tools and techniques to address organizational culture. Specifically, the network will be working to reduce harm in 11 healthcare acquired conditions, including:

• Adverse drug events (ADE)
• Catheter-associated urinary tract infections (CAUTI)
• Central line-associated blood stream infections (CLABSI)
• Injuries from falls and immobility
• Pressure ulcers
• Surgical site infections
• Ventilator-associated pneumonia (VAP)
• Preventable readmissions
• Obstetrical adverse events
• Venous thromboembolism
• Serious safety events (SSE)

OCHSPS will also be leading the network’s efforts to develop definitions for the above mentioned pediatric domains of harm that will be considered for use by The Centers for Medicare and Medicaid Services (CMS) as national definitions for pediatric harm measures.

When you see this kind of thing, all of the arguments raised by naysayers and skeptics about the potential for safety and quality improvement in America's hospitals, and the accompanying efficiency and cost improvements, drop away.  But we have to ask:  Where are the boards of trustees in other hospitals in America?  Where are the CEOs?  Where are the clinical leaders? Where are the medical schools?

I'll tell you.  Unfortunately.  They live in a self-satisfied, sometimes arrogant world, where they have decided that "these things happen."  They have implicitly committed themselves to the idea that it is all right to continue to kill and maim hundreds of thousands of people per year.  In other venues, that would be considered a criminal act.  In these venues, it is, quite simply, a tragedy of national dimensions.


Anonymous said...

Good stuff, Paul. I might add that the press release indicates this effort is funded by the Partnership for Patients, an initiative of our federal government under the tenure of Don Berwick - and this is one of 26 such funded initiatives. For those who like to disparage the feds, see what can be done if - as you say - you 'just do it.'


Paul Levy said...

Agreed, but it starts with fertile ground locally.

Anonymous said...

Cincinnati Children's Hospital Mental Center?!?!?
Can't even begin to imagine what Freud would say.

Paul Levy said...

Oops, thanks! Fixed.

Julia E said...

Thanks for this post! I lived in Cincinnati for two years before moving to Boston, and one of my favorite things about CCHMC is the work they do to enhance their patients' safety when they leave the hospital and to prevent children from becoming their patients in the first place. Gloria del Castillo from the trauma division at Cincinnati Children's runs an incredible injury prevention effort called Buckle Up for Life that provides families with car seats and car safety training. Every child leaving the hospital must leave in an appropriate car seat, and sometimes this involves obtaining specially adapted ones to fit the needs of each child. Buckle Up for Life also goes out into the community at every opportunity to teach more about car safety and offer car seats to those in need who complete the training. (I believe they fund the car seats through a grant from a partner.) This is one of many interesting community programs at CCHMC, and it's one that is being rolled out at other children's hospitals around the country. Patient safety starts with prevention!

Steve Muething said...

Thanks for including OCHSPS in your blog this week. I would add that another key driver is the network truly believes in "All Teach, All Learn." We believe every organization is contributing to the success of all. We will maintain this belief as we are spreading this work nationally.

Jan jacob said...

Paul thanks for this great post. In healthcare, "what we do has eternal consequences" - OCHSPS participants take the need to learn and improve to heart so that the "consequences" are improved outcomes and healthy children.

My Website said...

Here in the Dayton area, we have Children's Hospital. Our only experience was about 15 years ago and our daughter actually did NOT want to leave. They treated her very well!