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Improving Patient Safety
A journey in Care
Transformation
Susan M. Grant, MS, RN, FAAN
Chief Nurse Executive
Emory Healthcare
Nurse Leadership Institute
June 5-7, 2013
Emory Healthcare
Emory Healthcare Overview
Clinical Arm of Robert W. Woodruff Health Sciences Center of
Emory University
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Emory University Hospital
Emory University Hospital Midtown
Emory University Orthopedic and Spine Hospital
Wesley Woods Geriatric Hospital
Emory University Johns Creek Hospital
Saint Joseph’s Hospital
The Emory Clinic
1,830 Licensed Beds and over 15,000 employees.
Only Academic Health System in Atlanta.
All EHC Hospitals are NDNQI Members.
* Denotes Academic Medical Center
** Denotes Magnet Facility
1999
• 44,000 to 98,000 U.S. deaths
annually due to hospital errors
• Hospital errors the 8th leading
cause of death
• System errors
2001
• “Between the health care we
have and the care we could have
lies not just a gap, but a chasm.”
• “Trying harder will not
work…”
Story of Harm
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Strategic Agenda:
2008 – 2012
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Partnering with our Patients
• Ongoing collaboration with patients and families to design the
best with them: from point of care to facilities planning.
• Partner with more than 100 Patient and Family Advisors who
provide insight into how we can improve quality, processes and
service.
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Embedding Care Transformation Principles
into organizational processes
• Staff training on CT concepts and cultural attributes
• EHC Quality Academy and Transformational Leader
Program.
• Multidisciplinary team training
• Patients and families included in hospital orientation,
leadership planning meetings and retreats.
• Shared governance structure
• Learning from Stories of Harm and Stories of Charm
• Unrestricted visiting hours – supporting family presence
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Standardization of practices
• Bedside Change of Shift Report “bundle”
• Structured Interdisciplinary Bedside Rounding
• Unit Practice Councils
• Standard clinical attire
Daily Bedside report Bundle data collection sheet
Facility: ECLH EUH WW
Unit:
Date of data collection
Room #
Total # of
Pts
Calculate values for each day at bottom of the table
Transfer daily totals at the bottom to the weekly summary sheet.
Put “N” in the box of any element missing, “Y” if Present
Met all
Appropriat
e
Elements(Y/
N)
Computer Introducti Verbal
in the
on to Pt
Report
room
&Fly
SABR
Focus
Assessme
nt
Add all the
above “Y”
Add up the # of “Y” in the columns above
Review
task
MAR,
Labs,
Forms
Pt. Goal
Ask Pt
Daily
Bedside Change of Shift Report
Nurses will change shifts several times throughout the
day and night. During shift change, both nurses will see
you and the on-coming nurse will learn about your
condition and treatments. Because this is all about you,
the nurses value your input and the input from your
family members you choose to be present.
Bedside Report on this unit is done at approximately:
7am
3pm
7pm
11pm
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Bedside Shift Report (BSR)
5G ALOS
10.0
9.0
8.0
7.0
6.0
5.0
4.0
3.0
2.0
1.0
0.0
Series1
September
October
November
December
January
February
March
April
May
June
July
November
December
January
February
March
April
Linear (Series1)
• 6G Medical Unit BSR
Compliance and Resulting
Patient Satisfaction
Rankings
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EUOSH Patient Satisfaction Scores from opening to
end of year 2012
Average
Patient
Satisfaction :
96.4
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Challenges
• Lack of understanding of PFCC
• PFCC means “no limits”
• “What about confidentiality?”
• Changes in work flow processes and team dynamics
• Patients and families becoming a part of the team
• “What about our colleagues”… on our teams?
The Pledge
We will treat each other the way we want to be treated.
We will…
– treat everyone as professionals and with respect
and dignity
– greet each other by name
– welcome and encourage new team members
– be honest and open in all interactions
– be respectful of everyone’s privacy
– be culturally and racially sensitive
We will not…
– raise our voices in anger or use sarcasm or
profanity
– be passive-aggressive
– make culturally or racially derogatory remarks
– undermine each other’s work
– criticize each other and Emory in public spaces
We will cultivate a spirit of inquiry.
We will…
– ask “why” when we have questions or concerns,
especially about safety
– ask for a pause when we think someone is about
to make a mistake or do something unsafe
– thank each other for raising concerns
– declare our openness to the inquiry of others
We will not …
– respond with anger or sarcasm when someone
requests a pause
– intentionally belittle or respond in a threatening
or condescending manner when someone asks
a question
– tolerate rudeness
– stifle learning
We will defer to each other’s expertise.
We will…
– encourage each other to offer different
perspectives
– recognize that all members make important
contributions to the team
– seek help when we don’t know the answer
We will not …
– belittle or ignore the ideas and perspectives
offered by each other
– assume that expertise is overruled by age,
profession, or rank
We will communicate effectively.
We will…
– listen thoughtfully and ask for clarification when
we don’t understand
– check that others have understood when we say
something important
– remain respectful with our body language and
tone of voice
– remain calm when confronted with or responding
to stressful situations
– use scripts, read-back, repeat-back, or other
techniques where appropriate to reduce the
chance of misunderstanding
We will not …
– stifle clarifying questions
– interrupt our team members unnecessarily
– say “it’s not my job” or “it’s not my responsibility”
We will commit to these behaviors in support of Emory
Healthcare Care Transformation
We will…
– encourage and support each other
– hold each other accountable for the behaviors
identified in this Pledge
Improving Patient Outcomes
Improving Patient Outcomes
FY10-12 Outcomes:
Nursing Quality
Falls per 1,000 Patient Days
Hospital-Acquired Pressure Ulcers
4.05
4.29%
3.60%
3.64
3.12%
3.27
FY10
FY11
FYTD12
FY10
FY11
FYTD12
Note: Data includes EUH, EUHM, EUOSH, and WWH only
08/28/2012
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Improving Patient Outcomes
FY9-12 Outcomes:
Core Measures improvement
Core Measure Bundle
Acute Myocardial Infarction (AMI)
Heart Failure
Pneumonia
Surgical Care Improvement Project (SCIP)
Overall Core Measure
Q2 CY09 –
Q1 CY10
93.9%
76.6%
71.3%
81.6%
82.0%
Q2 CY10 –
Q1 CY11
96.6%
90.3%
91.5%
87.9%
90.8%
Q2 CY11 –
Q1 CY12
99.8%
96.6%
96.2%
94.4%
96.1%
EHC includes EUH, EUHM, EUOSH, and Wesley Woods Hospital (WWH); 100% is a perfect score
08/28/2012
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Lessons Along the Way
• Changing culture takes time and is hard work.
• Nursing and Nurses can play a pivotal role in changing culture.
• We continue to better understand the true definition of patient- and
family-centered care/Patient engagement.
• It is critical to tie metrics to evaluate the impact of process changes on
patient outcomes.
• New processes require ongoing reinforcement, refining and periodic
measurement to validate effectiveness.
• Leaders, staff and physicians require ongoing education, updating and
review of Care Transformation concepts.
• Continuously bring in new PFAs with fresh perspectives and ideas.
Improvements
Quality Leadership Award 2011, 2012
University Health System Consortium
• 2006 Rankings #63 EUH and #73 EUHM
• 2011 Rankings:
• #10 Emory University Hospital/Emory University Orthopedics & Spine
Hospital ranked
• #11 Emory University Hospital Midtown
ranked
• 2012 Rankings:
• #2 EUH !!!
• #6 EUHM!!!
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Questions?