Inspira Health: Building an Enterprise-Wide Safety Management System

Added on Sep 19, 2019

surgeons_outsideOperatingRoomInspira Health: Building an Enterprise-Wide Safety Management System
By Debra A. Shute

When leaders of Inspira Health met to discuss their annual work plan for 2015, patient and workforce safety was already a top priority for the network, which had been formed in 2012. Two of its three New Jersey hospitals had previously achieved ISO certification (the third achieved ISO certification in 2018), and all three had earned a Leapfrog Hospital Safety Grade of “A.”

The question on the table was how to bring the network to the next level, said Paul Lambrecht, Inspira’s vice president of quality and patient safety. “As a newly formed health network, our initial strategic plan had a focus on quality and safety as a key strategic indicator, and we wanted to define Inspira as the consumer’s choice for safe, quality health care,” he said. “Setting out to transform our network into a High Reliability Organization was quickly identified as the path to reduce preventable harm and strengthen both our quality and safety management systems.”

Aligning across Entities

Inspira embarked on its journey toward Zero Harm with advantages as well as challenges. In the plus column, the organization had already been introduced to the concept of High Reliability during a previous medical staff leadership retreat. “Our medical staff leaders had been exposed to this kind of thinking, so we began to have physician leaders on board before we jumped into the pool, so to speak,” Lambrecht said.

However, there were challenges in rolling out the work consistently across Inspira’s more than 150 access points, including its acute care hospitals; urgent care; outpatient imaging and rehabilitation; numerous specialty centers, such as sleep medicine, cardiac testing, digestive health, and wound care; and more than 30 primary and specialty physician practices throughout southern New Jersey. “It was our desire to consider the nuances of our various entities while maintaining a standard look and feel to the program that was consistent across all care delivery settings,” said Lambrecht.

With just three acute care hospitals in the mix, it took some time for the focus to shift more to the ambulatory setting and for the staff to appreciate the relevance of hospital-based safety practices to their own work. “There are similar kinds of things that can go wrong,” Lambrecht noted. “What we’re teaching the hospital employees about error prevention really does have an application in the physician’s office or urgent care.”

To help this philosophy take hold, the network provided its ambulatory leaders with additional resources and education. The effort was successful in elevating the ambulatory team’s understanding of and commitment to organization-wide safety, Lambrecht said.

Building on a Strong Foundation

“As ISO 9001:2015–certified hospitals, we had in place a strong quality management system that linked continuous quality improvement across the entire enterprise,” Lambrecht explained. “Working from that foundation, we set out to develop and implement a similar structure for our safety management system, developing a system that would link our culture of safety work across the enterprise.”

Solidifying a culture of safety was closely intertwined with employee engagement, Lambrecht stressed. Specifically, 2018 engagement survey results demonstrated that highly engaged employees were four times as likely as disengaged employees to rate overall safety as an “A”—which also translated into more than 80% of respondents indicating they would speak up if they observed something negatively impacting patient safety.

This willingness to speak up is at the heart of High Reliability care, according to Craig Clapper, Partner, Press Ganey ​Strategic Consulting. “Whenever we, as caregivers and safety leaders, ask a question or challenge a decision, the reliability of care delivery is multiplied,” he explained in a blog post. “For example, the probability of a human error occurring during a routine action in a familiar environment is 1 in 1,000. But in organizations where a colleague speaks up for safety, the probability of error in care delivery is reduced to 1 in 1,000,000—simply because someone said something.”

Transparency and Communication

Inspira had already established quality and safety as a core value, and the board had prioritized achieving Zero Harm. With this focus front and center, leadership introduced a number of concepts and tools to improve safety across the organization and further develop a safety management system.

Transparency was a cornerstone of success, said Lambrecht, but it did require an adjustment period. For example, the daily safety briefing—the first visible High Reliability tool that Inspira implemented—caught on slowly before taking the network by storm. “Although we were concerned about folks being comfortable with transparency and speaking up, it quickly became the staff’s way to get issues addressed,” Lambrecht said. Whereas potentially dangerous situations might have lingered for weeks or months previously, the daily safety briefing gave staff an avenue to raise concerns and see prompt action take place. “Roughly 98% of the issues that were brought up on the daily safety briefing were resolved the same day.”

What’s more, the team adopted a framework to make all communications among colleagues more effective. In particular, “clarifying question” became a helpful and popular term. “You couldn’t go into a meeting or have a conversation without somebody saying, ‘I’ve got a clarifying question,’” Lambrecht said. “It became a natural part of conversation and really put people at ease, because they could ask for clarity without casting judgment or blame.”

The goal of creating a just culture was also paramount, as was facilitating it with tools that were meaningful. “We taught leadership the concepts of a just culture, but we also engaged our human resources team very early in the process,” said Lambrecht. “This strategy allowed HR to participate in developing the tools and educating leaders about how to use them.

“The realignment of our cause analysis process, the engagement of our human resources business partners, along with a focus on executive and leader rounding have promoted a just culture,” Lambrecht stated. “Leader behaviors and staff error prevention tools were taught to all employees and physicians through a four-hour program or 90-minute CME program.”

Additionally, the team developed a number of “artifacts” to help reinforce what everyone had learned, said Katy Perez, coordinator and data analyst for Inspira’s quality and safety department. Examples include the following.
  • Badge ​buddies: For easy reference, badge buddies attach to employees’ name badges and have Inspira’s safety tools listed on the front and code of behavior described on the back.
  • Safety tool of the month: To keep employees’ skills fresh, leadership and safety coaches promote and highlight a single tool each month, including some of those noted above.
  • Employee recognition: Inspira acknowledges top performance in promoting safety with formal awards as well as “on the spot” recognition cards and e-cards.
  • Safety coach program: More than 200 front-line employees with special training serve as safety coaches for their own departments. They participate in monthly meetings in which they discuss rates of serious safety events and the outcome of rounding activities. Coaches also facilitate learning demonstrations around safety issues such as hand hygiene.
Measures of Success

With the focus on transparency, the reporting of serious safety events at Inspira had reached a peak in November 2016, Lambrecht said, prompting the system’s partnership with Press Ganey for safety improvement and reversal of the trend. “Between then and August 31, 2019, we’ve achieved an 80% decrease in serious preventable harm,” he said. “What’s really important is that the people who have trusted us with their care were kept safe and had positive outcomes.”

Employee engagement and safety culture have also improved. As of September 2018, more than 63% of engaged employees graded overall patient safety as an “A,” with an additional 33% grading it as a “B.”

“For the culture of safety specifically, 38.4% of hospital respondents ranked overall patient safety as excellent (“A”), which was just shy of the AHRQ 75th percentile,” Lambrecht noted. In total, 79.5% of respondents ranked overall patient safety as either excellent (“A”) or very good (“B”). In Inspira’s medical office setting, 20.9% of respondents ranked patient safety as excellent, up from 15.4% in the prior survey, and 55% of respondents ranked patient safety as either very good or excellent.

Sustaining the improvement trend requires ongoing effort that includes real-time communication up and down the organization, from the front line to the board. Much of this interaction occurs within the existing meeting structure and during executive patient safety rounds, where staff discuss what’s working to improve safety and where there are opportunities for improvement.

“We just kicked off our employee engagement and culture of safety survey for this year, and we’re anxiously awaiting the results to tell us how we’re doing—and more importantly, where we go next with our work,” Lambrecht said.