Inside Vidant Health's High Reliability Journey: From Boardroom to Bedside

Added on Apr 21, 2016

Inside Vidant Health's High Reliability Journey: From Boardroom to Bedside
By Erin Graham
From Industry Edge April 2016

Vidant Health, a private, not-for-profit health system in eastern North Carolina, is vastly different today than it was 10 years ago, when it became one of the first organizations to undertake a systemwide quality transformation. From the boardroom to the bedside, the improvement in safety and quality is evident across Vidant’s nine hospitals, 70 physician practices and numerous ambulatory, surgery and home health services.

Since embarking on its High Reliability journey in 2006, the health system has seen the following:

  • An 85% reduction in Serious Safety Events
  • A 67% reduction in hospital-acquired infections and a 63% reduction in pressure ulcers (since 2009)
  • A 98% score in the Centers for Medicare & Medicaid Services (CMS) optimal care core measures
  • A systemwide CMS patient experience rating of at least 4 stars

A Need for Change

Early in its quality journey, Vidant Health partnered with HPI (Healthcare Performance Improvement, now part of Press Ganey) to use in-depth common cause analysis to understand what kinds of harmful events were taking place throughout its network. Soon after, a series of avoidable errors resulted in a patient death following a blood incompatibility event at Vidant’s academic medical center. This was pivotal in underscoring an urgent need for change. “It galvanized us to focus on patient safety, performance improvement and patient experience in a new way,” said Joan Wynn, PhD, RN, Vidant Health’s chief quality and patient safety officer.

Immediately after that event, Vidant Health engaged HPI to implement patient safety training throughout its system. This included educating 8,000 people in safety habits and error prevention tools, and conducting leader training in behaviors to increase situational awareness and sensitivity to operations—two signifiers of High Reliability organizations.

This systemwide training established the foundation for the transformational quality efforts that Vidant undertook during the next several years. “We accept that humans make errors—we needed to prevent these errors from harming patients,” Wynn explained.

A key element of this foundational work, Wynn said, was the creation of Safety Coaches. These front-line staff members work in lockstep with peers on their individual units to apply safety habits and tools each day.

In developing a quality, reliability and safety strategy for the network, Wynn’s team established priorities for patient safety, performance improvement and the patient experience and set quantifiable short- and long-term goals. These priorities were based on health industry best practices, with plans for continual review of tactics and strategies. “We set a long-range goal of zero events of preventable harm, 100% optimal care and exceptional experiences for every patient we serve,” said Wynn.

Her team identified four drivers that would serve as cornerstones in achieving these goals:

  • Board literacy in quality improvement
  • An aggressive transparency policy
  • Patient-family partnerships
  • Leader and physician engagement

Board Literacy in Quality Improvement

As a first step, the team developed a plan to ensure that the board of directors understood their role in leading improvement, nurturing a just culture, spearheading quality reporting and advocating for patient- and family-centered care. “The board’s understanding of reliability was critical, so they could ask for the right data, ask the right questions about performance and drive the will to improve,” Wynn said.

The following changes helped the board lead the transformation at the governance level.

  • Board members attend quarterly education sessions, including webinars, on-site events featuring national speakers and annual retreats focused on topics regarding quality.
  • Board members are involved in rounding on floors, hearing stories of harm from patients and celebrating successes.
  • In 2010, the board set a long-range quality goal that built on annual targets of incremental improvement and set the organization’s “true north” toward High Reliability.

Transparency Empowers Patients, Engages Providers

Wynn’s team pushed for an aggressive—and very progressive—transparency policy, showing clear, easy-to-understand reporting of process and outcome measures. This decision was based on the realization that transparency of quality data would be a key driver of improvement and that fully informed employees would be better equipped to make these improvements happen more quickly. Following are some of the organization’s transparency efforts.

  • In 2008, Vidant became one of the first health systems to post harmful-event data on its public website.
  • The organization created a Learning Kit designed for leaders to use in educating front-line staff on sharing data in an open manner, to bolster their desire to improve and elicit their ideas about how to do it.
  • All levels of the organization use a quality scorecard in staff meetings, medical staff meetings, department manager meetings and board meetings.
  • Leaders use reports of quality data to benchmark against high performers. This helps them establish aggressive, systemwide improvement targets each year, aimed at achieving highly reliable processes and major reductions in harmful events.

Building Patient-Family Partnerships

At Vidant, sharing stories about good and bad care experiences is a significant component of transparency. “We really believe storytelling connects people’s hearts and minds and keeps a laser focus on our ultimate goal of zero harm,” Wynn said.

For example, in 2007, a patient’s family member, who also happened to be an employee, shared her experiences with the senior executive team. The health system’s restrictive visitation policy limited the time her family could be with her brother in an intensive care unit, leading to limited access to information and heightened anxiety for the family. They felt that, because of the policy, her brother died alone.

This employee’s story resonated with the executive team and physician leaders, who committed to advance patient-family partnerships across the system—and to making this kind of story-sharing a prominent part of their safety, quality and reliability work. “Families are the ones who have the most at stake, and having them on the teams reminds everyone that it is really all about the patients,” Wynn said.

Today, more than 100 patient-family advisors work at every level of the organization—on performance improvement teams, in safety rounds, in quality improvement committee meetings, in interviews of candidates for key leadership roles and in the boardroom.

The system has also implemented additional patient-focused strategies. For example, an Office of Patient-Family Experience was established to educate leaders and staff on patient-family engagement and organize staff champions and patient-family advisors. Additionally, principles of patient-family partnerships were embedded in key documents, including Vidant Health’s strategic plan and long-range quality plan.

Engaging Leaders and Physicians in Performance Improvement

Building accountability with operational leaders and physicians, and actively engaging them in the work, has propelled performance improvement. Physician-executive leader teams sponsor each quality priority. An “Executive Sponsor Handbook” outlines their roles, responsibilities, rules of engagement and the basics of performance improvement.

Additional strategies include rewarding and recognizing leaders who are early adopters of new behaviors and skills by highlighting their efforts in videos and presentations; requiring leadership participation in safety and quality courses to help develop the necessary skills to lead performance improvement at the front line; and conducting annual, systemwide leadership development sessions to advance executives’ roles in overseeing performance improvement.

Change for the Better

Since 2012, Vidant Health has undergone numerous changes, the most significant of which were a name change, exponential growth in its physician practice arm, two CEO transitions and the addition of one hospital and two home health agencies. Throughout these transitions, it has remained a strong, viable organization of 12,000 dedicated individuals who continue to make High Reliability a priority.

This includes aligning new entities with its quality, safety and reliability processes. The organization sets the expectation from the start by building it into any new partnership agreement, Wynn explained. “If an organization wants to be part of Vidant Health, they need to buy into the whole philosophy—use our scorecards, establish physician-leader champions, get trained in doing common cause analysis a certain way, conduct safety reviews—we’re very transparent that this is our expectation, from the beginning.”

Partnership in transparency efforts is a two-way street: Wynn has found the perspectives of new staff to be useful, and hearing their ideas has led to further improvements. For example, when an audit of a hospital new to the Vidant Health network showed that staff struggled in articulating core safety habits, hospital staff came up with a simple way to remember them: CHATS (Communicate clearly, Hand-off effectively, Attention to detail, Think critically and Support each other). They have adopted the mnemonic systemwide, and it’s on everyone’s badge card, leading to an uptick in staff understanding of the core concepts.

Wynn noted that the strategic direction system leaders mapped out a decade ago produced a culture of quality and safety that has continued throughout the organization’s numerous transitions.

She also emphasized the importance of establishing, in writing, the ultimate goal of becoming a High Reliability organization. “As long as you keep everyone focused on safety and reliability, you will continue on the journey,” she said.

“You can never stop driving toward your true north and finding ways to embed that overarching goal into the fabric of the organization,” she concluded. “For Vidant Health, that means constantly focusing on our ultimate goal of zero events of preventable harm and exceptional patient experiences for every patient we serve.”