Innovating to Align Safety and Experience in Care Delivery

Added on Nov 6, 2020

Innovating to Align Safety and Experience in Care Delivery
By Lauren Keeley

For the past three years, the acute care division of Ohio-based ProMedica has been on a mission to link its safety error prevention techniques and patient experience always behaviors. The goal of this effort is to achieve zero harm and a reliably excellent patient experience, and their work to date appears to be paying off, as evidenced by a 51% decrease in SSE-1 and SSE-2 Serious Safety Event Rates and above-target patient experience performance.

Extending High Reliability to the Patient Experience

The idea of aligning safety and patient experience improvement began when ProMedica leadership looked at the safety gains the organization had made in its high reliability work with Press Ganey HPI and wondered if there were lessons that could be applied to the patient experience domain.

“We started to think about how we could take the same concepts, consistency, and rigor we used in our safety work and apply them to experience,” said Leslie Meyer, director of ProMedica Experience. “That’s when we began looking at our experience data and developing our always behaviors.” It is also when the functional silos across the 12-hospital system started coming down.

To jumpstart the process, the safety and experience teams held a daylong retreat with ProMedica’s Press Ganey team to brainstorm and solidify common concepts between safety and patient experience, discuss how to build on them, and identify gaps in care delivery that they could fill in.

The result was a list of patient experience always behaviors—behaviors that everyone in ProMedica always demonstrates—that stem from Press Ganey best practices and align directly with ProMedica’s existing high reliability framework. For example, staff’s commitment to communicating clearly is exercised in one of the fundamental always behaviors: owning and escalating problems. This aligns with the SBAR (Situation-Background-Assessment-Recommendation) and ARCC (Ask a question, make a Request, voice a Concern, and use the Chain of Command) error prevention techniques, explained Chris Barfield, patient safety specialist at ProMedica.

Escaping the Idea That Safety and Patient Experience Are Mutually Exclusive

After more than a year of behind-the-scenes work, one of the first systemwide coming-together activities was an Escape Room team-building initiative during which participants work together to decipher clues, solve puzzles, and complete tasks in order to reach a specific goal and escape the site in a certain amount of time.

Inspired by another organization’s use of an Escape Room activity to creatively engage its workforce, the safety and experience teams reached out to an Escape Room vendor that provided the format for the activity. The vendor also worked with the safety and experience teams to alter various artifacts and language to reflect the goal of aligning safety error prevention techniques and patient experience always behaviors.

Multiple Escape Rooms were set up across ProMedica’s northeast Ohio and southwest Michigan footprint over a three-week period, and every acute care leader, from hospital presidents to front-line leaders, was invited to attend. Of the 600 leaders invited, 452 attended.

The first 10 minutes of the activity were spent reviewing error prevention techniques and always behaviors. Then the participants had 40 minutes to solve the puzzle and “escape the room,” followed by a 15-minute debrief conducted by safety and experience leaders. Upon leaving, each participant was asked to commit with confidence to use and teach the error prevention techniques and always behaviors with their departmental teams.

“We could see the lightbulbs going off in people’s minds when we started the activity,” recalled Diane Dunne, patient satisfaction specialist at ProMedica. “We heard participants talk about where they saw themselves, or their co-workers, using error prevention techniques and always behaviors to solve the puzzle, where they saw them intertwined, and how they could take this knowledge back to front-line staff.”

Before and after the activity, Dunne surveyed participants to measure their confidence in demonstrating the error prevention techniques and always behaviors and observed the following improvements.

  • I feel very confident with the use of error prevention techniques and always behaviors: from 36.4% to 55.7%
  • I have a strong understanding of the interconnectedness between error prevention techniques and always behaviors: from 40.2% to 68%
  • I feel very confident modeling the error prevention techniques and always behaviors: from 28.1% to 59.8%
The team was particularly excited about the rise in the last item. “Modeling behaviors by sharing stories and experiences makes it easier for staff, especially those on the front line, to see the connection between safety and experience in their daily work,” Dunne emphasized.

The key to the success of the activity has less to do with the format and more to do with the organizational commitment to consistently reinforcing the universal skills and behaviors that improve the safety and experience of care.

“Every facility has to find their fun and creative way to keep these concepts alive in their departments,” said Dunne. And with the movement of staff to adjust to the operational changes that have occurred during the COVID-19 pandemic, embedding these concepts into the culture has been key, she said.

Supporting Interconnectedness Through Leadership Alignment and Team Convergence

Executive leadership support has been pivotal to deploying the safety and experience initiatives across ProMedica’s system, said Meyer. Shortly after the Escape Room activities launched, ProMedica decided to merge its safety and experience leadership teams, Barfield said. Both teams report up to the president of acute care through the chief nursing officer, who recently took on the role of senior vice president of experience, quality, and safety. This leadership adjustment has helped strengthen the links between functional domains and created more synergy in care coordination, Meyer said.


ProMedica also started cross-pollinating its teams: Safety is now a part of patient experience team meetings, and vice versa, and ProMedica’s safety coaches are now paired with patient experience connectors. Safety coaches are front-line staff who volunteer to be advocates for safety and service excellence, observe and recognize their co-workers’ safety behaviors, and teach and model the error prevention techniques. Patient experience connectors are individuals across the organization who champion the always behaviors.

The safety coaches and experience connectors gather for a virtual event two times per year to talk about the convergence of their roles and responsibilities. During their most recent meeting, they explored how ProMedica’s brand ties to the continued safety and experience integration efforts.

To keep the error prevention techniques and always behaviors at the forefront, ProMedica posts weekly stories on its intranet about how safety incidents and safety wins always tie back to always behaviors, and vice versa. Leaders also use Journey of Excellence boards in every department to display the key metrics they track in ProMedica’s strategic plan, two of which are safety and experience. The boards serve to guide huddle discussions and are a daily visible reminder of the importance of the interconnectedness between safety and experience.

In addition to the 51% reductions in SSERs noted earlier, ProMedica’s composite inpatient experience scores have steadily increased from 71% to 74.3% since the launch of these initiatives.

For 2021, the safety and experience team hopes to define, record, track, and embark on process improvement around emotional harm, creating an even more robust toolkit of error prevention techniques. The team also plans to extend the work done in acute care to other divisions across the system, including post-acute care.

“We are still at the beginning of our journey and there is room to grow our high reliability culture. Regardless of the format, we are committed to making both safety and experience nonnegotiable elements of care delivery,” Meyer said.