President’s Visit Highlights Role of Children’s Hospitals in the Community
June 28, 2010
Posted by chcablogadmin in : Community Benefit, Healthcare Reform
Nationwide scored a coup last week when President Obama visited Columbus. Steve Allen gives us the inside story of his visit and how the President is looking to children’s hospitals to serve as leaders in improving the health of their communities in the coming years. — Don
by Dr. Steve Allen, CEO
Nationwide Children’s Hospital
Steve Allen, M.D.
Last Friday, Nationwide Children’s Hospital welcomed President Barack Obama to Columbus for the 10,000th transportation project awarded under the American Reinvestment and Recovery Act of 2009. It was for a road expansion project and urban rehabilitation plan that Nationwide Children’s is spearheading in a neighborhood that borders our facility, in advance of our new pediatric hospital opening in 2012.
The President’s visit brought focus to work being performed by Nationwide Children’s outside the four walls of our hospital, in support of our vision to create optimal health for every child in our community. Neighborhood revitalization is not something for which hospitals have historically been recognized—but as America works to implement the landmark new health reform law, the role of hospitals is undergoing a quiet revolution that could transform our industry, our economy, and our country.
From 2001 to 2006, the U.S. economy added zero private sector jobs. By contrast, our health care economy added 1.7 million jobs. In many states like Ohio, which has seen the loss of hundreds of thousands of manufacturing jobs the past decade, lab coats are replacing hard hats as a symbol of jobs and growth. In Columbus, for example, Nationwide Children’s is one of the fastest growing employers in the region. Our expansion and the project for which President Obama came to Columbus will add over 2,300 jobs.
The President’s visit also highlighted the responsibility we are taking to improve the communities that we serve. We are past the days when public health officials alone can handle the flood of public health challenges facing America today, from obesity to diabetes to low birth weights. Pediatric institutions are stepping up as conveners and collaborators to address these issues in the community. At Nationwide Children’s, we’re also going beyond the traditional boundaries of health care to focus on ways we can partner with our neighborhood to improve the basic supports that enable children to reach their full potential—housing, education, safety, and economic development. Amidst the construction equipment last Friday that focus on children and families got the national attention it deserves.
add a commentCincinnati Children’s: The RACE for Results Goes On
June 28, 2010
Posted by chcablogadmin in : Innovation, Quality
Steve Muething muses in his video that his hospital’s participation in RACE for Results isn’t about the trophy. It is about finding and sharing among his peers so he can keep more patients safe at Cincinnati Children’s Hospital Medical Center. We hope you enjoy Steve’s story about how you have helped the hospital in its journey to becoming a high reliability organization. — Don
by Steve Muething, M.D., Assistant Vice President for Patient Safety
Cincinnati Children’s Hospital Medical Center
Steve Muething, M.D.
What makes a hospital a High Reliability Organization (HRO), and what does that have to do with CHCA’s RACE for Results and keeping patient safe?
That’s one of the questions we asked in 2006 as Cincinnati Children’s Hospital Medical Center started the RACE for Results journey. For our effort, A Program to Reduce Serious Safety Events at an Academic Hospital, we realized that even though we had significantly reduced hospital-acquired infections and implemented evidence-based and family-centered care, we needed to learn from HROs by adapting and adopting key concepts.
HROs achieve a new level of safety by adopting a culture, structure and operating principles that are different than non-HRO organizations. We started down the path to becoming an HRO while working to lower our rate of Serious Safety Events (SSEs). To do that, we needed to become a high-reliability organization and change our culture by establishing a clear message that patient safety is a pre-condition to achieving exceptional outcomes.
To reduce SSEs, we used the HRO model, which prompted major operational and cultural changes. We focused on failures in our care delivery processes, leveraging the information that “near miss,” “precursor” and “serious” event failures provide about our systems. We analyzed these failures and identified opportunities for action to improve our systems and patient safety.
Lessons Learned
One HRO concept, “deference to expertise,” is based on the concept that the expert in any case is often not the highest-ranking staff member. This has been one of our biggest lessons learned and means that when something goes wrong, the person closest to the problem – often the front line staff – probably has the clearest view.
Our front line is committed to keeping patients safe. By supporting them in speaking up for patient safety, we’ve changed and continue to change our culture. All employees are encouraged to stop the line whenever they feel something might be wrong – whether it’s a tangible potential threat or a “gut feeling.”
Together we’ve developed patient safety focus areas, common terminology and systems for escalation of concerns so we’re all speaking the same language and doing the same things. Two key concepts explained below are among the tools we’re using on our safety journey.
Situation Awareness: This involves identifying the risk faced by each patient, mitigating or lessening risk and reliably escalating patient concerns until they are addressed.
Engaging Families: We took a program developed in our Regional Center for Newborn Intensive Care designed to involve families and encourage them to ask questions about all aspects of care and spread it house-wide.
Cincinnati Children’s has benefitted from the RACE for Results program as we’ve been able to share ideas and data with other hospitals, and learn from what has worked for them. This has helped us keep more patients safe.
But the RACE for Results is not over. At Cincinnati Children’s, it’s part of our ongoing quality and safety journey. Michael Fisher, president and CEO at Cincinnati Children’s, has made our mission clear.
He says, “Our goal is to be the safest children’s hospital in the world. That means we’re all responsible to speak up and take action for the safety of our patients, to assure patient safety first in every thing we do, every day, for every patient.”
add a commentMoving the Big Dot – Mortality Trends at LPCH
June 13, 2010
Posted by chcablogadmin in : Industry Trends, Innovation
CEO, Lucile Packard Children’s Hospital at Stanford
Chris Dawes
In 2003, a white paper from the Institute for Healthcare Improvement identified remarkable variability in standardized mortality rates across US hospitals. A recent study confirmed the same phenomenon exists within CHCA hospitals. At Lucile Packard Children’s Hospital at Stanford, we track mortality rates as a Board of Directors Quality Indicator and have seen consistent annual decline despite an increasing severity of illness. Researchers from our hospital (led by our Chief Patient Safety Officer) previously demonstrated that implementation of rapid response teams was significantly correlated with mortality rate improvements (Sharek et al., JAMA, 2007), and another group (led by our Chief Medical Information Officer) has now found that our computerized physician order entry (CPOE) rollout was also significantly associated with decreased mortality rates (Longhurst et al., Pediatrics, 2010). Health information technology has been widely touted as a tool to help improve quality and patient safety, and while a retrospective correlation does not prove causation, this is one more piece of evidence suggesting that CPOE is the best way to provide high-quality care for our pediatric patients.
add a commentOvercrowding at Children’s Hospitals Can Be Overcome
June 13, 2010
Posted by chcablogadmin in : Innovation, Quality
A study of 39 children’s hospitals revealed that few have a real understanding of how to resolve overcrowding — issues that can lead to impaired patient flow, inefficiencies and an increased potential for adverse events. The study, which analyzed PHIS data, found that children’s hospitals commonly function at high occupancy, but used limited corrective measures. Responses to overcrowding, such as small and counterintuitive measures, included releasing non-critical patients to decreasing length of stay.
According to the study’s senior author, Samir Shah, M.D., a pediatrician and infectious disease doctor at Children’s Hospital of Philadelphia and an assistant professor at the University of Pennsylvania School of Medicine, children’s hospitals should focus on identifying methods to reduce crowding. “It is important from both from a quality improvement and business case standpoint,” he states.
The study, published in Pediatrics, outlined recommendations for reducing overcrowding, including:
- schedule elective admissions during times of lighter emergency volume;
- make greater use of weekend options;
- create units that offer extended-care ED or short-stay inpatient care;
- expand hours at primary care practices, and
- create areas for lower-acuity patients.
Learn more from Dr. Shah in the video.
The CHCA research group, which conducted this study, brings together 10-20 CHCA doctors for each project and utilizes PHIS data for analysis. Current and recently published research includes shunting, comparative effectiveness of drugs, implementation of CPOE and mortality (see this week’s blog entry from guest blogger, Chris Dawes), and the impact of H1N1 on the E.D.
For more information about any of these projects, please contact Matt Hall (matt.hall@chca.com).
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