March 13, 2017 | Every morning at 8:30 a.m., the UAMS Lobby Gallery is crowded with a mix of white coats, suits and scrubs as about 80 employees from all clinical and support units gather for the daily safety huddle.
The huddles, begun by UAMS in February at the suggestion of Richard Turnage, M.D., UAMS vice chancellor for clinical programs and CEO of UAMS Medical Center, are another big step towards improving patient safety across the institution.
They come just in time for Patient Safety Awareness Week, observed March 12-18.
“Safety is job one when taking care of patients,” said Stephen Mette, M.D., chief clinical officer of the Integrated Clinical Enterprise and executive associate dean for clinical affairs in the UAMS College of Medicine. “We have begun the journey to a true safety culture at UAMS, meaning that we will embrace a safe work environment where anyone can and should speak up if they have a safety concern,” he said.
Led by the National Patient Safety Foundation, a central voice for patient safety since 1997, Patient Safety Awareness Week is dedicated to raising awareness about patient safety among health care professionals and the public.
Patient safety is a public health issue. According to the National Patient Safety Foundation, one in 10 patients develops a health care-acquired condition during hospitalization. Recent research suggests that as many as 210,000 patients die each year as a result of preventable medical harm, and many others suffer significant and lasting quality-of-life implications.
UAMS added safety to its list of Core Values in February, illustrating the importance of a safety culture as UAMS strives to fulfill its mission. UAMS’ other core values are integrity, respect, diversity and health equity, teamwork, creativity and excellence.
“We have added safety to our Core Values because hospitals and medical care in the United States have unacceptably high risks of unintentional harm. We, at UAMS, need to commit to a relentless strategy to reduce avoidable patient and employee injury,” said Mette.
UAMS is also undertaking other efforts to underscore its commitment to safety, Mette said, including a review process of all patient safety events and an upcoming hand hygiene campaign.
It’s all part of creating a culture of safety, something Christopher Cargile, M.D., chief medical quality officer of the Integrated Clinical Enterprise, takes seriously.
In his office, Cargile has a six-foot-tall strategic plan covering a wall that reads: “Make UAMS the Safest and Most Effective Medical Center in the World.” It’s an ambitious five-year plan that starts with making UAMS tops in patient safety among the nation’s 6,000 hospitals.
“Everybody has two jobs: the job listed at the top of their paycheck, but also the job of constantly guarding against high-risk situations, both for patients and staff,” said Cargile.
Studies indicate that roughly 16 percent of health care expense in the United States is due to treating the result of medical errors or unneeded care. “It’s made the health care community as a whole, for the first time, exquisitely aware of the size of the problem,” said Cargile.
Since the turn of the 21st century, there’s been a significant effort nationwide across health care to identify the most frequent patient safety problems and how they can be prevented.
“Much of this isn’t about effort, it isn’t about being smarter – it’s about being constantly attentive to patient safety as an issue,” said Cargile.
Self-reporting continues to be the most reliable method of identifying errors for most hospitals, Cargile said. That’s where UAMS’ daily safety huddles come in.
Safety huddles include representatives of every clinical unit and support service. Every morning, the representatives confer as a group, led by Mette or another of the senior medical leadership team, in a stand-up meeting for about 20 minutes. As Mette ticks off a list, each unit reports any potential safety risk, no matter how small.
“The philosophy of the safety huddle is that there aren’t bad actors,” said Mette. “These are systems problems that need to be fixed, and we should all be accountable.”
Lower safety risks are resolved through education, by making sure that an oversight or misstep doesn’t happen again, said Mette. High-risk safety issues are resolved immediately.
“When we finish that meeting, we go deal with it,” said Mette. “It gets done right then and there whenever possible.”
There’s a huddle every morning, seven days a week – and that includes holidays.
Turnage, UAMS Medical Center CEO since December, is a strong patient safety advocate.
“Dr. Turnage threw down the gauntlet for patient safety when he came on as CEO,” said Cargile. “He said, ‘This will be a priority, and we will get this right.’”
In addition to the daily safety huddles, UAMS plans to publicly post its safety data in the hallways around the hospital as a way to promote awareness.
Both Mette and Cargile agree: transparency is the key to maintaining an effective safety culture.
“The mistake that many health care systems have made in the past is not being transparent, not letting the public know,” said Mette. “That erodes trust. I think that our communities, our patients and our employees will recognize and appreciate our transparency and the honesty that emanates from our approach to making health care safer. It’s important that we have the public’s trust.”
That includes making sure that everyone, from patients, visitors and their families as well as clinical and support staff, feels comfortable speaking up. An issue could be anything from a wet spot on the floor to a piece of loose equipment. If it’s a risk, report it, said Cargile.
“It’s not only okay, it’s expected and encouraged,” said Cargile. “If they see something that looks like it’s going to be a risk to people, we want them to raise their hands.”
Mette used hand washing as an example. “If we see that a physician or a nurse hasn’t washed their hands before entering a room, we need to remind them: ‘Dr. Mette, I’m sorry but I didn’t see you wash your hands before you came in, may I ask you to do that?’”
“We have to get everybody thinking, ‘Oh, I see a problem, I need to either fix it myself or get the right person to fix it,’” said Mette.
UAMS recently reduced its average patient length of stay by half a day. That’s significant, Mette said, because a patient is more at risk for injury and hospital-acquired infection the longer they stay in a hospital. Length of stay also refers to moving patients from the Emergency Department to patient rooms, as well as how many hospital-to-hospital transfers UAMS can make on any given day.
In other words, the more beds that are available, the more patients can be helped. So, the more that hospitals tighten up safety protocol, the less time patients will spend in the hospital.
“We have steadily, year over year, increased our awareness, our efforts and our commitment of resources to patient safety,” said Cargile. “It’s higher now than it’s ever been.”
“We are committed to doing whatever it takes,” said Mette. “If one aims for being average, one will always be average.”