In yesterday's blog post (“Safety is always our top priority” – From lip service to daily practice?“), I challenged hospital leaders to back up the “happy talk” with real action and stories about putting safety first. It's easier said than done.
I wanted to share a story from Karen Kiel-Rosser, Vice President/Quality Improvement Officer at Mary Greeley Medical Center in Iowa. MGMC is a KaiNexus customer, they've recently received the “Gold” level recognition in the state Baldrige process, and she's an upcoming podcast guest (to talk about Baldrige).
Below, you can find a transcript and “bonus audio” that we recorded after the main podcast. She tells a story of patient safety trumping patient satisfaction. Doing the right thing for the patient might make the patient unhappy. Their survey scores might suffer as a result (which can have a financial impact). But they seem serious about doing the right thing.
Listen to Mark and Karen (Learn more about Lean Blog Audio):
Mark Graban: …Karen, there's one other bonus question I'd like to bring up around this idea of patient safety being a top priority. I cringe sometimes.I see, and it seems in every news story about a preventable medical error, there's always a spokesperson or an executive who says the same thing. “At XYZ Health System, patient safety is always top priority and blah, blah, blah.”
The follow up question that I would always want to ask one of those executives is, “OK, tell me about a specific story, a specific instance where a decision was made that demonstrates putting patient safety above speed, flow, or efficiency, or cost, or other factors.”
I'm curious, what are your thoughts on that issue? Do you have a story about how patient safety has been really demonstrated as a top priority?
Karen Kiel-Rosser: Sure, I can share. In our organization we always say safety trumps anything. Safety trumps privacy. Safety trumps satisfaction. Safety trumps almost anything. An example I'll use is our fall risk program.We have a new fall risk program. It's about a year old. We adopted it after many years of study, looking at some best practices, and really trying to get to zero falls. Our goal is zero.
Our goal is never to have a fall. We have a no fall risk assessment. Many times, I would say 80 percent of our patients, are on a fall risk. I bet, Mark, if you or I were in a hospital, we'd be a fall risk. If you're in the hospital, you're not quite yourself, and you could probably fall, possibly.
Our patients aren't always very happy with that. It means that they're going to have a bed alarm on. It means that when they're sitting up in their chair, they're going to have a chair alarm on. They're going to have to go to the bathroom with the assistance of someone else.
That's because we are so serious about protecting our patients from harm. Sometimes our patients don't like that. They'll tell their doctor they don't want that on there, or they'll tell, when we go out on rounds, they'll tell us that they don't like to have the chair alarm on.
We explain that it's really about safety. I can sight numerous stories where we hear that from patients or we hear that from a doctor that they're unhappy with that, but truly safety in that instance trumps their satisfaction or privacy.
There are many other ways that we can satisfy and make our patients satisfied with the care, the service. We really focus on the safety piece. Like I said, we say safety trumps you name it.
Mark: I like especially the part of the story where you talk about explaining why to the patient. That follows good Lean habits whether it's with employees, or with anybody.It's not just, “Well, do this because…” It's not a matter of, “Do this because we said so,” but, “Here's the reason why,” and try to help people understand.
If somebody were responsible for HCAHPS scores on patient satisfaction and that has an impact on reimbursements sometimes. If somebody says, “Oh, the care and this is really hurting our HCAHPS scores.” Your response would be?
Karen: My response would be our fall risk rates have dropped. We don't get the results that we are getting and we can statistically show that our fall rates are dropping with this new program in place.I've had that question asked of me, “What happens when we see our patient satisfaction scores? Our engaging scores go down and that's value based purchasing.”
We know where that goes and then we take a look at our fall rates. I can honestly tell you I‘ve had that conversation with our board and they agree. That's by far more important.
Mark: That seems like a really important part of the equation that the board supports this.
Karen: Absolutely. The board is very engaged in our safety initiatives. They see our preventable harm index every month. They know the initiatives. They set up some of the goals.They're with us and help us develop those goals. They know how important that is in the industry. They know how important that is for our patients. They support us in those efforts.
Mark: That's a great example. That really does bring to life the idea of putting safety first and illustrates the importance of I'll come back again to the idea from Dr. Deming, that quality starts in the boardroom. The same applies for safety. It's great to hear about that support.Karen, thanks for bearing with me asking that one more question, and sharing such a great story.
Does your hospital have a similar story of putting safety first? “Stopping the line” in the operating room when somebody has a concern about a potential risk — that's an example of putting safety first. What stories do you have or what would you like to see happening?
If you're an outsider to healthcare who is a patient or a family member, what's your reaction to the situations where safety is NOT a top priority? Please post a comment.