the patient safety framework: how to hardwire the right...

© 2012 Kaiser Permanente1

The Patient Safety Framework: How to Hardwire the Right Tactics and Hold People Accountable

October 10, 2012

DEBORAH ROMER, Vice President, National Service QualityMICHELLE MUNN, Director, National Service Quality“DEXTER” JANET BORROWMAN, Principal Consultant, National Service Quality


A Patient Centered Journey Begins…

“Could someone tell me about this journey your facility is on, which creates this kind of environment/culture of communication-quality care?

It was the single best family member hospital experience of my life, even in the face of a very ill son (who is recovering nicely, thank you).”

~Quality/Baldrige/Coordinator


Our Markets and Membership: 9 million members

• 37 Hospitals• 454 Medical Offices• 15,000 physicians • 164,000 employees

(including 45,000 nurses)

Mid‐Atlantic Region

Georgia Region

Colorado Region

Ohio RegionNorthernCalifornia Region

Hawaii Region

Northwest Region

SouthernCalifornia Region


Compelling Case for Change

We are and have been a Quality Leader• TJC Composite exceeds national average (>99%)• All KFH facilities continue to be above the national average for the

overall TJC composite• Hospital Mortality Rate significantly lower than Medicare benchmark• Surgical Care Infection Prevention approaching 90th percentile (99.9)• Heart Failure Care >99% (TJC average 93.9)

Yet opportunity for quality, safety, and patient care experience continue …

“Always = Never”


Challenges

• 37 hospitals, 434 MOBs – bandwidth!• Consistent system wide spread• Multiple improvement frameworks• “Not invented here” culture


Driving Reliability Through a Culture of Excellence

Aligned Leadership(launching)

Sequ

ence

Tactics

Aligned Culture(engaging)

Aligned Behaviors(standardizing)

Aligned Processes(sustaining)

Leadership Alignment

Goal Cascading

Accountability

Excellence Teams

Leadership Development

Rounding for Outcomes

Recognition

Behavior Standards

Coaching for Excellence

Hiring & Onboarding

Communication Skills

Patient Rounding

Pre & Post Calls

Reception Area Rounding

Validation

Ongoing Reinforcement

Performance Coaching:‐High Mid Low

Coaching


Our HCAHPS Improvement Over Time


Change in Top Box Since 2008 -Kaiser Coached vs Non-coached Partners vs National Average

Source: CMS Hospital Compare


Change in One Year –Kaiser Coached vs. Non-coached Partners

.45

.71

.88

.83

.28

.83

.31

.87

.40

.99

2.52

2.68

3.40

1.88

1.92

2.44

1.20

1.00

2.00

1.80

2.25

2.00

3.75

2.75

1.50

2.50

1.25

.75

2.50

2.75

Room Clean

Responsiveness

Rate 9 or 10

Quiet at Night

Pain Management

Nurse Communication

Doctor Communication

Discharge Information

Definitely Recommend

Communication about Meds

Sunnnyside, Moanalua, Hayward Fremont, San Diego Change Top Box 4Q09‐3Q10 to 4Q10‐3Q11

Kaiser Non‐Partners Change Top Box 4Q09‐3Q10 to 4Q10‐3Q11

National Avg. Change Top Box 4Q09‐3Q10 to 4Q10‐3Q11

Source: CMS Hospital Compare


Culture of Excellence:Accelerators and Sustainers

• Expanded data and analytics• Deployment of Accountability Tools

Experiential learning through Simulation/Skills labsCoaching as an extension of training


Expanded Reporting and Analytics

Data reporting at Front Line Level:• Inpatient: HCAHPS unit level data• Outpatient: Department and individual level data

Internal evidence to support and monitor key practices:• Nurse Knowledge Exchange (bedside shift report)• Hourly Rounding• Nurse Leader Rounding on Patients


Nurse Knowledge Exchange = Safe Handoffs

Key Indicators

Shift change at bedside with introduction of oncoming nurseRegular updating of the Care BoardReviewed daily plan of care with patient inputValidating patient’s understanding of their plan of care


Nurse Knowledge Exchange Impact

By hospital and region


Hourly Rounding = Safety by Design

Key indicators

Nursing staff visited every hour or two to check on pain, positioning and personal needs during the dayNursing staff regularly checked in to ensure patient comfort at nightNursing staff regularly made sure the call light and other items were within easy reachNursing staff informed the patient when they would return to check in


Hourly Rounding Drives Perception of Care and Nurse Communication

75th PCTL (NC) 80.0

Nurse Communication Composite

Rate Hospital (9‐10)


Nurse Manager Rounding = Safety ValidationKey Indicator: A nurse manager or leader visited me daily about my care.

By hospital and region


Skills Labs

• Demonstration of “right”• Real environment• Real scenarios• Validate in real time• Video tape

“Yes, we’re doing that!”…“Now, what does right really look like again?”

Kaiser Permanente Garfield Innovation Center


Focus on Accountability and Coaching


Coaching for Excellence:Investment Coaching Model

Reconfirm the expectation

Provide objective example

Relate the impact

Provide recognition or align behavior

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Ask for a moment11 How can I help you be successful?

“Hi…could I have a minute of your time?”

“Remember the expectation / team agreement / standard that…”

“I heard / read / noticed that you …”

“The impact for…when you…is…”

“I wanted to thank you so much for your attention to … “ OR “How can I help you be successful?”

“Thank you for taking the time to talk with me about this.”


Coaching for Excellence:Expectations Coaching Model

Schedule a time

Reconfirm the expectation

Provide objective examples

Relate the impact

recognition Provide deeper recognition or re‐align a behavior(understand, reinforce, confirm)

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Help me understand…“Hi. Could we schedule some time to meet and talk? I would like to continue our conversation about…”

“As you know, our team agreed to…”

“Several times I saw/heard/read/ noticed that you…like when you (give a specific example).”

“The impact for…when you…is…”

“I wanted to take the time to sit down and personally thank you for…” OR “Help me understand what is preventing you from consistently meeting the expectation of….”

“Thank you for meeting with me today.”


Tips / Lessons Learned

• Maximizing Use of Data• Transparent and comparative KP data• Actionable data at unit level• Actively used for coaching opportunities

• Validating Through Skills Labs• Closes the knowing/doing gap• Reduces variation

• Standardizing a Model for Leader Coaching• Clarify and lead with expectations• Enhances coaching in the moment


Thank you

Kaiser Foundation Health PlanNational Service Quality1 Kaiser Plaza 18BOakland, CA [email protected]

Deborah RomerVice President, National Service QualityMichelle D. MunnDirector, National Service QualityDexter BorrowmanPrincipal Consultant, National Service Quality

the patient safety framework: how to hardwire the right...

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