In a presentation at the American College of Healthcare Executives (ACHE) Congress, Joint Commission president and CEO Mark Chassin, MD, MPP, MPH, made the case that creating a high-reliability organization with zero incidents of patient harm shouldn’t be seen as an abstract, aspirational goal.
Chassin said no one in healthcare is happy where the industry is on quality improvement, despite seemingly never-ending improvement initiatives leading providers to complain of “project fatigue.” The high-reliability, zero-harm philosophy, however, shouldn’t be seen as another project in Chassin’s opinion.
“It requires a very careful attention to process, to culture, to leadership focus,” he said. “It’s not a project. It’s not something you, as leaders, delegate to somebody else. It becomes the way you work.”
The Joint Commission has been advocating the idea of healthcare adapting methods from high-reliability organizations in other industries, like air travel, nuclear power and amusement parks, for several years. Their circumstances may not be directly transferable to hospitals and health systems, but general principles can be absorbed from those industries, Chassin said, such as having leaders taking full responsibility major changes like zero harm and valuing when errors are identified.
Such a culture change doesn’t come easy, Chassin said, though the Joint Commission has resources to encourage healthcare organizations to make the leap, like self-assessment tools, training for what it calls Robust Process Improvement (RPI) and change management and working with state hospital associations. Current methods, he emphasized, like initiatives that settle for “30 percent good outcomes, 70 percent failure” or that see improvements melt away after a specific project has been completed, won’t be enough to meet that zero harm goal.
Houston’s Memorial Hermann Health System was one of the first to take on this challenge. Judging by their hand hygiene compliance rate, the Joint Commission’s “targeted solutions tools” worked. Across its 11 hospitals, the compliance rate went from an average of 58 percent—with lots of variation between different inpatient units—to 96 percent compliance. One reason high-reliability initiatives can be more effective, Chassin said, is they don’t rely on “one-size-fits-all” best practices, but identify what a hospital is specifically doing wrong rather than “solving problems they don’t have.”
The improvements continued from there for Memorial Hermann. By reaching 96 percent hand hygience compliance, hospital-acquired infections “plummeted” through 2017, reaching zero instances of harm on measures like ventilator-associated pneumonia and surgical site infections.
“Memorial Hermann’s goal is zero,” said Michael Shabot, MD, the system’s chief clinical officer. “And I know that sounds like an aspirational goal, like get there someday. Several years ago, our board made that the actual goal and that’s in the incentive plan for 26,000 employees and, at a more significant level, for all the executives in the organization.
Shabot said the system hasn’t hit its goal of being a high-reliability organization yet, but has taken many steps to get there. It doesn’t come cheap, with Shabot saying it cost $18 million just for “safety culture training” for all 26,000 employees, though some of the changes have been small ones, like making safety reports the top agenda items at board meetings.
Those seemingly tiny changes matter as part of the broader strategy. Gary Yates, MD, a strategic consulting partner at Press Ganey, emphasized that buy-in from leadership wouldn’t be enough. In his words, executives and board members need to “own,” not just support, the culture change in their facilities.
“You need to move from safety as a priority to safety as a core value which just can’t be compromised,” he said.
John joined TriMed in 2016, focusing on healthcare policy and regulation. After graduating from Columbia College Chicago, he worked at FM News Chicago and Rivet News Radio, and worked on the state government and politics beat for the Illinois Radio Network. Outside of work, you may find him adding to his never-ending graphic novel collection.