Cincinnati 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.”
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