Advocate Aurora Health: Patient Safety Is More Than Good Business

Added on Oct 18, 2018

Advocate Aurora Health: Patient Safety Is More Than Good Business
By Diana Mahoney

Patient safety is considered “a strategic imperative” in health care by leading organizations. However, Jim Skogsbergh, chief executive officer of Advocate Aurora Health, emphasizes its importance beyond just operational performance.

“Keeping patients free from harm is, first and foremost, a moral imperative,” Skogsbergh said during his keynote address at the 2018 Press Ganey Safety & High Reliability Executive Leadership Summit, which was held last month in Chicago. As a moral imperative, safety rises to the top of every health care leader’s list of priorities, and its consideration underpins every clinical, financial and operational decision they make.

The elimination of patient harm is not a promotional campaign or a stand-alone business strategy, Skogsbergh stressed. “The mission is much greater, and this greater mission has to be understood and embraced by every person in the organization.”

Fortunately, the preeminence of patient safety and the goal of achieving zero harm events are readily embraced. “It gets to the heart of the people who come to work every day to take care of patients. It resonates so quickly with staff,” Skogsbergh said. “And, importantly, when you make the safety imperative visible—once you state the case for it and name it—there’s no going back, because people respond to it so viscerally.”

At Advocate Aurora Health, as with most health care organizations, patient safety has long been a core value, but the deliberate, intentional effort to create a safety culture and drive to Zero Harm was sparked following a serious safety event in 2010: a preventable medical error that resulted in the death of an infant. The devastating event forced a fundamental mindset change, Skogsbergh explained, “from the idea that occasional errors and accidents are an unfortunate cost of doing business in health care, because these are human interactions and humans make mistakes, to the idea that even a single instance of harm is unacceptable and must be prevented.”

With the mindset shift came the realization that safety belongs to everyone in the organization—it’s not just the domain of the risk and legal departments—and it is the role of health system leaders to nurture an organizational culture built on that idea of universal ownership. “We brought our leaders together from across the organization and asked the question, ‘Is it possible to create a deliberate road map to eliminate serious harm?’ And the answer was yes.”

The road map that Skogsbergh and his team designed was based on six principles.

1. Have a strategy, keep it simple.
2. Establish a true north goal.
3. Engage the board.
4. Start with the leaders.
5. Act into a new, highly reliable way of being.
6. Build the foundation for a “sharp end” focus.

“Thinking about our approach in this manner has encouraged us to be mindful about leading to patient safety,” Skogsbergh said. In terms of strategy, for example, Advocate Aurora’s is based on four points, the first of which is summed up by the mantra, “We are, first and foremost, a safe clinical enterprise.”

“It was important for us to position patient safety as the foundation for all care,” Skogsbergh explained. “So every day we are beating the drum with this mantra. The thing I love about it is that people soon start to repeat it, and hold you to it. If there’s a decision or an issue, the reflection is, ‘Does this align with our commitment to being a safe clinical enterprise?’ and if it doesn’t, then we take another path. Those are the great conversations to have.”

The remaining three strategy points include leading to patient safety, which refers to the idea that leaders are accountable for modeling and spreading the safety culture (“We don’t assign it to a safety coach or someone else. It’s my job and your job every day,” Skogsbergh said); empowering and encouraging the front line to address safety issues and recognizing them when they do; and engaging patients and families in safety efforts by encouraging them to report safety concerns and involving them in care discussions so that they can verify the accuracy of pertinent information.

The true north goal for Advocate Aurora Health is the elimination of all serious safety events by 2020. “This is a long, continuous journey. With our recent changes [merging Advocate with Wisconsin-based Aurora Health Care in April of this year], our time frame has changed a little bit, but our true north has not,” said Skogsbergh.

Sowing the Seeds of High Reliability

Evidence of the organization’s continued commitment to this goal can be seen in its decision to relaunch its extensive High Reliability training initiative across the combined enterprise, and the Board of Directors’ support for that decision.

The training program, developed in partnership with Press Ganey’s HPI consultants, was delivered to every leader in the Advocate organization, from unit and department managers up to the executive team. The curriculum was delivered via 12 two-hour sessions that addressed various aspects of High Reliability leadership.

“Basically, we took all of our leaders back to school to teach them the Science of Safety. And it really is a science,” Skogsbergh said. “There was a mix of theoretical and practical content. Each session had assigned prereadings, homework and a tool or method, such as a daily safety huddle, that could be implemented so that we could visibly demonstrate safety commitment.”

The goal of the training is to provide leaders with the tools they need to sow the seeds of a safety culture throughout the organization. “We learned a lot throughout the course of the first rollout, including the fact that you can’t rush culture change,” said Skogsbergh. “We initially thought we would achieve this in 12 months. Ultimately, it took us 18 months, because along the way there were parts we had to circle back to. While it’s important to have a plan, it’s even more important to be agile enough that you’re able to deviate. The goal isn’t to just ‘get it done,’ it is to do it in a way that allows it to sink in.”

Since Advocate Aurora Health embarked on its deliberate safety journey, the culture shift there has been palpable. “Our executives have leaned into a new way of being. For example, where there used to be little executive awareness of daily threats to patient safety, we now come together for 15 minutes in a daily safety huddle to talk about what’s going on in the organization,” Skogsbergh explained. Further, facility leaders have embraced their role as chief safety officers, and they always lead with safety. “After the invocation, we start every meeting with a safety moment. It’s the first item on the agenda, reinforcing this as a priority,” he said.

Finally, according to Skogsbergh, safety events are shared openly in a blame-free environment where individuals are able to report errors or near misses without fear of reprimand or punishment.

Nurturing a Culture and Saving Lives

While Skogsbergh can describe the culture, “the numbers speak for themselves,” he said. Since 2012, the volume of reported safety events in the organization has almost tripled, rising from 41,600 to 108,866 in 2017 (before the merger), and the Advocate Hospital Serious Safety Event Rate® (SSER®) dropped 57.5% through the end of August of this year. In addition, the organization’s AHRQ Overall Culture of Safety percentile rank rose from the 52nd percentile in 2010 to the 84th percentile in 2017, with 90th percentile or higher performance on the composite measures for Organizational Learning, Feedback and Communication about Errors, Frequency of Events Reported, Non-punitive Response, and Communication Openness.

And while the safety improvements have led to significant financial savings (the organization’s actual insurance expense for 2014 through 2017 came in $433 million less than its budgeted expense), the most meaningful “win,” according to Skogsbergh, can be seen in the accounting of lives not harmed across all sites of care from 2014 through 2018 year to date. “Thanks to our safety culture and error and near-miss reporting, 85 deaths have been prevented, as have 16 instances of permanent harm and 302 instances of temporary harm. You cannot put a dollar sign on that.”

The future for Advocate Aurora Health’s safety culture looks bright, as the organization embarks on the next generation of its High Reliability journey, Skogsbergh said. “There’s no ‘end’ to the safety journey. It’s continuous, and it requires constant nurturing. Our goal now is to continue to adapt Advocate’s High Reliability journey for the new organization.”

The first item on the agenda is to pursue integration of the two organizations from a safety perspective by identifying best practices in each system and sharing them across the enterprise, relaunching the High Reliability leader series, modifying the organization’s High Reliability Units to align with its shared governance structures to improve and sustain integration, and identifying physician safety champions to help unify the medical staff.

“We are also making a significant investment in saving lives through the development of an aligned safety team,” said Skogsbergh. This team comprises 36 full-time employees, including a vice president of patient safety, seven patient safety regional directors, 20 site safety managers and eight site safety specialists. Together with a “safety army” made up of more than 1,600 safety coaches and more than 250 physician safety champions, Skogsbergh said, “we are building a strongly unified, agile program to ensure that safety is top of mind at all levels of the organization and across all sites.”