Transparency Initiatives Nurture Safety Culture at Providence St. Joseph Health

Added on Jan 24, 2019

Transparency Initiatives Nurture a Safety Culture at Providence St. Joseph Health
By Andrea Fitzgerald

A heightened focus on safety event reporting has dramatically reduced the rate of preventable harm within the Southwest Washington Service Area of Providence St. Joseph Health (SWSA). Since introducing daily safety huddles and summaries into its patient safety program in 2015, the organization has promoted transparency and safety event reporting and supported those who speak up for safety. As a result, safety event reporting has increased by 400% and the organization’s Serious Safety Event Rate has decreased by 59%.

SWSA’s journey to Zero Harm can be broken down into interdependent stages of implementation, education, influence, embedding and prevention, according to Jennifer Sipert, patient safety manager at Providence St. Peter Hospital, and Gerda Stafford, service area director of quality. During implementation in 2015, every leader went through two training modules—one specifically for leaders and one for every member of the workforce—on the High Reliability tones and tools established by Press Ganey HPI safety consultants, which include listening with empathy and intent to understand (tone) and practicing a questioning attitude (tool). The idea was to empower these leaders with enough education and training that they could teach these error prevention tactics themselves, according to Sipert. Within the next year, all staff members completed the High Reliability training module. 

Concurrent with the training dissemination, the organization launched a daily safety huddle which convened care providers from St. Peter Hospital, Centralia Hospital and Providence Medical Group in person and over the phone. At the time, Sipert and Stafford began sending Huddle Highlights—an email summary of the safety issues and events reported in the daily huddle—across the organization.

With this strong foundation of education, SWSA wanted to ensure that the safety awareness would be sustained. “Our top-of-mind concern was how we were going to take what people learned and embed it into their day-to-day,” said Sipert, who, along with Stafford, presented a session on SWSA’s safety journey at the 2018 Press Ganey National Client Conference. Many strategies were introduced from 2017 to 2018 to advance this cultural transformation, including reliability champions, multidisciplinary safety event review teams and a “great catch” program. The pair, along with other SWSA leaders, continue to develop best practices to engage the workforce in organizational safety efforts.

“The big questions we’re focused on now are how do we make the High Reliability tones and tools second nature to our caregivers, and how do we get to Zero Harm?” Sipert said.

Making Huddle Highlights a Reliable Process

At the forefront of these efforts is the Huddle Highlights communication, which has helped the not-for-profit organization sustain and advance its High Reliability journey. This communication tool has evolved almost as much as the organization’s safety culture, with many iterations and lessons learned since its launch in 2015, according to Sipert and Stafford.

Huddle Highlights is a two-page summary of great catches and safety events and alerts derived from the safety huddle that begins at 10:15 a.m. every day. It provides staff with the information they need to have a safe day. To create the summary document, which focuses on safety impact and learning rather than the error that occurred, Stafford, Sipert and their team take notes as leaders from 52 units and departments and 38 Providence Medical Group clinics run through their reports during the huddle. Then they spend 15 minutes debriefing to align and peer-check their interpretations. Their notes are transcribed and emailed to every employee before the end of the workday.

Since 2015, the team has never missed a day nor had a breach, complaint or issue related to sending the summary. Out of thousands, only seven have been sent after 5 p.m. This diligence is difficult to maintain but critical to their efforts, Sipert explained. “Particularly when the initiative is grounded in High Reliability, with consistency and transparency as core values, the logistics matter,” she noted.

Examples of the kind of information included in Huddle Highlights are flu outbreaks in surrounding communities, equipment that is broken, look-alike packaging and patient ID errors. Each event is color-coded according to priority: Safety alerts are gray, in-progress events are yellow and high-impact events that pose immediate danger are red.

In-progress and high-impact events are kept on the daily summaries to show action is being taken or needs to be taken. This helps drive accountability and communication across the organization, according to Stafford. “Some events have been on Huddle Highlights so long that we joke they should pay rent, but the point is that even easy fixes aren’t easy in such a complex organization and industry. Staff members appreciate that we don’t sweep these issues under the rug, and often engage us in a conversation about what obstacles we face in resolving the issue. In that way, Huddle Highlights offers an important feedback loop,” she said.

Although transparency is at the core of this practice and any High Reliability journey, some information is excluded or deidentified in the summary, either to protect patient privacy or remove bias and assumptions. “We want to emulate the appropriate use of the tool and underscore the safety impact,” Stafford said. For example, a leader might share that registration chose the wrong patient—one with the same name as another patient but a different date of birth—when checking her in, which caused delays. To take away the blame and keep the patient in the room, the leader will include in Huddle Highlights that there was a patient ID error due to two similar names and remind registration to use the STAR tool (Stop, Think, Act, Review) when checking an ID.

“When launching this initiative, our greatest concern was to prevent anyone from feeling ashamed or criticized when reading Huddle Highlights,” Stafford said. Rather, the objective of the summary and SWSA’s entire safety program is to communicate that every safety event is a learning opportunity, she explained. By upholding every report as an opportunity to reinforce education and improve the reliability of care, fear of reporting has dramatically decreased across SWSA.

Challenges Looking Back and Ahead

Sipert and Stafford have had their own share of learning opportunities along this journey. Two in particular helped strengthen the patient safety program and its commitment to transparency. When first launching Huddle Highlights, Sipert and Stafford only shared items that affected two or more units, departments, or clinics for the sake of brevity. “We quickly learned this was interpreted as censorship, hypocrisy and cherry-picking, and widened our scope to any event that had a safety impact or lesson,” Stafford said. Also, in the first few months, they sent Huddle Highlights to core leaders who would, in turn, send it to their teams with the idea of maximizing the engagement of both levels of the workforce, according to Stafford. However, with changes in leadership, reporting structures and vacations, some leaders could not send the summaries on a reliable basis. “We thought this strategy would build trust, but it was eroded because staff felt like leaders were withholding information,” she explained. Stafford and the team took on the responsibility of sending the report to all employees shortly after. 

The safety program also led to positive outcomes that the team did not anticipate. Chief among them is the sense of community that the daily safety huddle and summaries have fostered among leaders. “The huddle is only 15 minutes, but that’s a 15-minute opportunity for those leaders to come face-to-face with colleagues they might otherwise not see during the day or even the week,” Sipert noted. Similarly, the daily summaries, though brief, offer an unprecedented view into the challenges that units, departments and clinics across the organization are facing, which strengthens the sense of community while uncovering systemwide issues.

The partnerships that the team has forged with the Risk Management, Compliance, and Marketing and Communications teams are another major achievement. The leaders of each of these teams “had heartburn” about the idea of Huddle Highlights when it was first suggested, fearing widespread communication about patient harm, according to Sipert. But after years of collaborating, sharing events and peer-checking, SWSA’s safety team has created meaningful and productive relationships with these stakeholders.

Finally, although Sipert and Stafford continue to find opportunities to reinforce and model the High Reliability tones and tools, neither the huddle nor Huddle Highlights has required a reboot. “Leaders don’t miss the huddle. They show up on time. They meet reporting expectations. They use Huddle Highlights when rounding,” Sipert said. “And staff look for it, shooting us an email if it’s later than usual or if they don’t see their reported event.”

The fourfold increase in safety event reporting and the concurrent reduction in regional serious safety events represent great progress, but the leaders and caregivers at SWSA continue on their journey, knowing that the only goal can be Zero Harm, Sipert and Stafford concluded.