Dialogue: Ensuring the safety of our patients
By Kathy Jenkins, MD, MPH, director of the Program for Patient Safety and Quality
What is Children's doing regarding patient safety and quality?
The biggest thing is that we're currently formalizing and integrating our efforts across the hospital under the new "Program for Patient Safety and Quality."
Program PSQ, as we call it, encompasses the traditional areas related to risk management, quality improvement and compliance, but we've also added a faculty component; a large measurement infrastructure made up of physicians, nurses and other scientists; and an administrative staff that includes biostatisticians and programmers.
We've also created two key committees: the PSQ Measurement Committee and the PSQ Implementation Committee.
What's the role of these new
committees?
The PSQ Measure Committee is a reworking of the Data Collection and Auditing Committee, but it's bigger now, with more people. It helps the hospital do the measuring we need, and want, to do at a very high level. The committee also ensures that the measures are good, valid, important and that we compare ourselves to other groups we believe we should be equivalent to or better than, whenever possible.
In terms of the PSQ Implementation Committee, one of the things we recognized was that, in the past, we were putting in a lot of effort to create really nice policies and procedures, but we were actually doing a poor job of rolling them out across the entire institution. So the PSQ Implementation Committee, co-chaired by otolaryngologist David Roberson and Vice President of Cardiovascular/Critical Care Services Patty Hickey, will develop an integrated strategy to prioritize and implement initiatives throughout the institution. It incorporates all the parts of the organization that we thought might be helpful in rolling out initiatives—Public Affairs, ISD, Pharmacy, and others.
What are the committees focusing their efforts on currently?
The PSQ Measurement Committee is creating a "Hospital Quality Dashboard," the highest level hospital scorecard for patient care. It is based on the six Institute of Medicine steps toward quality, which maintain that quality care should be safe, effective, efficient, timely, patient-centered and equitable. It is also based on Children's core mission to provide excellent patient care, research, teaching and service to the community. We're looking for excellent measurements in each of these areas that reflect how we're doing overall as an organization. And unlike a lot of quality efforts, which are really focused on measuring the process, we're looking at actual outcomes data wherever possible.
The PSQ Implementation Committee is focused on the hospital's overall success at meeting the National Patient Safety Goals. Achieving some of them is actually very simple; they just involve changing a few processes. But others involve changing behaviors, or practices like using abbreviations, or hand washing—practices that, despite their importance and their obvious link to safety, we just are not in full compliance with yet.
The PSQ Implementation Committee is also working on three major policies that were highlighted two years ago in the institutional response to the Department of Public Health investigation. The policies are all related to communication within our organization: the Associate/Attending Policy, the Change of Service Policy and the Consult Policy. The PSQ Implementation Committee will be rolling them out over the next year.
What can patient families do to ensure their children are receiving the safest possible care?
I believe that one of the best resources we have at Children's that's different than adult hospitals is that we have parents at the bedside who are naturally highly motivated to protect their children. And as of yet, we haven't completely tapped into that resource. Parents should ask questions of their child's caregivers if they notice anything that concerns them.
Are we mounting any formal efforts to hear directly from patient families about safety?
Yes. Lisa Horowitz, one of our faculty members, is designing a patient family version of Executive Walk Rounds. Implemented in 2003, Walk Rounds are a forum where hospital leaders hear about issues of safety and quality directly from frontline staff. They've been very successful, and now we'd like to extend them to parents and families to hear their safety and quality concerns. Lisa has already facilitated a focus group with some parents, and not only did they love the idea, they came out with patient safety concerns that perhaps staff might not have otherwise considered.
Also, as I mentioned before, one of the Institute of Medicine's steps toward quality is that care be patient-centered. At Children's, we define it as "family-centered." We feel it's important to track how we're doing in this regard, so we're going to be looking at satisfaction surveys in our inpatient and outpatient areas and in our ED. Some of these surveys already exist, but we're working to modify them to be more reflective of the overall hospital experience.
If all of these efforts come to pass the way we hope, we would achieve a pretty aggressive goal—to provide the safest possible care to all of our patients.
