The Pennsylvania system’s chief quality officer discusses how they saw significant improvements in patient safety, from empowering employees to improving processes.
The burst of confetti shows a celebration is underway.
But it’s not a birthday party or baby shower. At WellSpan Health, these celebrations take place to honor employees who flagged events that could potentially harm patients.
It’s a tangible way WellSpan aims to reinforce the importance of patient safety and reward workers for speaking up. It’s one of a host of efforts WellSpan has undertaken to reduce the risk of harmful events.
When WellSpan Health sought to improve patient safety, the Pennsylvania hospital system focused on getting buy-in across the organization. Michael Seim, WellSpan’s chief quality officer, explains that it isn’t just getting clinicians to focus more on patient safety. All employees, in every department, have a role to play in improving patient care and reducing the risk of adverse events.
“We have 20,000 problem solvers at WellSpan,” Seim says. “And those 20,000 problem solvers are close to the work that we do every day. So we as a leadership team really have to give them a pathway to identify a problem and to make sure that they're being heard.”
WellSpan spent months training its employees on patient safety.
“Whether you were in an executive role, or a frontline team member in a support service, every single person needs to understand our commitment to safety, our commitment to having a just culture and our commitment to being proactive in preventing harm from ever reaching a patient,” Seim says.
Now, WellSpan is seeing those efforts pay dividends. More staff members are flagging potential issues that could harm patients, and at the same time, the system is seeing fewer adverse events.
At WellSpan York Hospital, the system’s flagship hospital, both the open heart and surgical intensive care units have gone more than a year with a catheter associated urinary tract infection. WellSpan Ephrata Community Hospital and WellSpan Good Samaritan Hospital have both gone well over two years without infections associated with a central line.
In an interview with Chief Healthcare Executive®, Seim discusses the work to improve patient safety, including changes in organizational culture, improved processes, and the sense that safety is everyone’s job.
“Our team members really took to heart this idea that they own safety, and that safety is everyone's obsession at WellSpan,” Seim says.
(See part of our conversation with Michael Seim of WellSpan Health. The story continues below.)
Building a culture
Seim says the heightened focus on reducing patient harm was driven by WellSpan CEO Roxanna Gapstur and the board, and the message cascaded through annual planning goals and into meetings with staff.
In daily huddles, team members shifted focus from discussing adverse events that have already occurred to taking a more proactive approach. Employees were encouraged to look for potentially harmful events on their units.
Part of the effort entailed creating “a real sense of psychological safety,” Seim says.
WellSpan leaders acknowledged most harm events don’t occur because someone is being careless.
“We know in healthcare that the majority of problems that reach patients aren't because of a team member, but because of a poorly designed process,” Seim says.
In discussing ways to improve systems, Seim acknowledged the basic safety step of healthcare workers washing hands before seeing patients. But as Seim says, it matters if the sinks are near the entrance to the room and if foam dispensers are filled.
To encourage more people to come forward with concerns, WellSpan rebranded the safety reporting system to “Safety First.” Seim says it helped reinforce the shift from reporting on an individual to establishing safety as the first priority and creating a system to talk about potential problems.
WellSpan also works to make sure everyone in the health system knows that they are encouraged - and expected - to raise a concern about patient safety, no matter where they are in the organization.
That involves reassuring younger clinicians and employees in all areas that they need to speak up.
“We start on the very first day at WellSpan,” Seim says. “So part of our new team member orientation is really a focused discussion about the expectations of stopping the line, our commitment to safety.
“We want to build a culture where everyone speaks up at huddles, so that team members here, other nurses or other food service team members or housekeeping actually speak up,” he explains.
Supporting team members
If a safety concern is raised, WellSpan leaders focus on five key areas, Seim says.
How do we support the team member? How do we support the patient and family? How do we elevate it to the right people in the organizations? What stamps can be done immediately to decrease the risk to another patient? Is there any regulatory reporting obligation that must be followed?
Seim says it’s important to look after the individual staff member involved in a potentially harmful event.
“Everyone gets into health care, because they're passionate about helping people,” Seim says. “So we, as an executive team, have to have that same passion for our team members, and make sure that they're supported.”
For employees that raise a concern, Seim also stresses the importance of connecting with those workers and communicating about whether a change was needed.
“People want to be heard,” Seim says. “If they give input, they want people to listen, and to act on it. That doesn't mean you have to put it into place, but you have to look into it, follow up with them. And that's really kind of the principle of our huddle system is to give everyone a voice.”
Seim points to the growing success of people in the organization speaking up, including a contract nurse who was working with the system on a temporary basis.
“We actually highlighted that even more because she's coming to our culture as a traveler, or agency nurse,” Seim says. “And yet she exhibited the values that we have in the organization.”
Beyond the first explanation
When hospitals experience an event that harms a patient, Seim stresses leaders should ask many questions before reaching conclusions.
“Whenever a safety event happens, a lot of people are quick to make an opinion or judgment,” Seim says.
But he encourages hospitals to be curious about why the problem happened.
“Your first understanding or first impression of why an event happened … oftentimes is not the root cause of what happened,” he says.
“Don't stop at the first explanation,” he says.
To address the problem and avoid any recurrences, Seim says the key is
engaging team members.
“It's so critical for them to be part of the solution,” he says.
To reinforce the importance of people coming forward with concerns, WellSpan established the “Heads Up, Speak Up” awards to honor staff members who are raising an issue that could potentially harm a patient.
“We really started to celebrate when people actually do speak up,” Seim says.
Employees aren’t just recognized with a line in an email. They’re recognized in person and given certificates in fun gatherings.
While the events are fun, Seim says they serve a purpose. “ it just gives you that feeling of, ‘Yeah, they're serious about this,’” he says.
Employees who speak up are honored throughout the year. A few workers are honored at an annual event.
Team leaders surprise the workers who get the awards, which delight the employees.
Seim says it’s also satisfying for his team as well.
“I think my team has more fun doing it, to be honest with you,” Seim says. “It's the celebration of all the hard work you've done to make safety a priority for everyone. So I think that everyone feels it.”