NAVIGATING PATIENT SAFETY IN THE RURAL HEALTHCARE LANDSCAPE

by David Allison, CPHRM, System Patient Safety Director, PeaceHealth As those who work in them know well, running a rural healthcare facility can pose unique challenges. Transitions of care such as helicopter transfers and pathways to access are of extra importance, with long distances and waterways separating patients from treatment centers. Critical access hospitals, ambulatory settings, and outpatient clinics in remote regions must think critically about how to meet complex patient population needs often while facing provider shortages and competition from large urban facilities. PeaceHealth has the distinct challenge of running not one, but a whole system of facilities in rural communities spread across the Pacific Northwest, from the small historic town of Cottage Grove, OR, all the way to the shores of Ketchikan, AK. David Allison, CPHRM, PeaceHealth’s Director of System Patient Safety, shares some of the work he and his team have been implementing to address these unique rural needs. About PeaceHealth: A Truly Regional Health System PeaceHealth includes 10 hospitals in Washington, Alaska, and Oregon – 6 of them being critical access hospitals. Also included in the system are 60+ ambulatory clinics with 800+ physicians and allied health providers. Patient Safety is a department within the Quality Division, led by a physician Patient Safety Officer and a Patient Safety Director; my role. Hospitals and the Medical Group are served by Chief Medical/Patient Safety Officers, or other Medical Staff Leaders, and Patient Safety Consultants. Tailoring Patient Safety Structures That Work for Your Setting In the PeaceHealth System, we have been focused on building functional patient safety structures in our critical access hospitals and in the medical group. In doing this, we have found that a patient safety program and structure based on the function and resources of large, acute care hospitals does not serve the needs of critical access hospitals and ambulatory clinics – as many of us know, these programs are not one size fits all. To address this, PeaceHealth patient safety leaders have met with leaders from all our critical access hospitals, and with medical group leaders, to assess whether the needs and proposed structures were in harmony. The feedback we received from these leaders is what has enabled us to adapt and improve on these structures, ultimately making them more functional. For example, our critical access hospitals do not have Chief Medical Officers. We agreed to ask the Chief of Staff or other medical...

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CHAMPIONING SAFETY AFTER A SERIOUS ADVERSE EVENT

by Jacqueline Valentine, Director of Patient Safety,  Seattle Children’s A behind-the-scenes look at what one hospital has done to turn tragedy into an ambitious opportunity to build a stronger base of safety culture into their organization with the goal of zero preventable harm. About Seattle Children’s Seattle Children’s is an independent children’s hospital founded over 100 years ago by Anna Clise, whose vision stands firm today: to provide care to provide care for all children in our region, regardless of their family’s ability to pay. Operating in the WAMI (Washington, Alaska, Montana, Idaho) region, we offer tertiary and quaternary care and have c over 8,000 staff and faculty members. What is the patient safety concern you or your organization is aiming to address? In our last five-year strategic plan, safety was specifically called out as a goal for the first time. This was following our tragic and publicized safety events, when in 2010 an infant died from an adverse event related to an improper medication dosage. Wanting to do everything possible to prevent such an event from reoccurring, the board set the audacious goal of eliminating all preventable harm. At the same time, a group of leaders from high-reliability organizations like nuclear power, military and aviation industries, came together to form the HPI (Healthcare Performance Improvement) consulting team, now owned by Press Ganey. High-reliability organizations are industries that operate under highly complex and risky conditions, and experience less than their fair share of safety incidents. The HPI consulting group was gaining national momentum in working toward building the same reliability seen in their own industries into healthcare. Seattle Children’s contracted with HPI, which now has over 900 institutions on the same journey as us: to build reliability within our processes, our people, and our organization. We are fortunate to have also joined the Children’s Hospitals’ Solutions for Patient Safety National Children’s Network (SPS for short), which is dedicated to eliminating harm across all children’s hospitals. This network has also partnered with HPI in their initial development and is using the same principles of safety culture and process reliability. The information and data we are gathering from these resources is helping us support the evidence base we need to get both the process and culture change necessary to reach our goals. Describe the challenges your team or organization has faced, and how have you overcome these barriers? There are several tactics...

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PROMOTING SAFETY & QUALITY IN SKILLED NURSING & ASSISTED LIVING FACILITIES

by Elena Madrid, Director of Regulatory Affairs, Washington Health Care Association How can a state organization help promote patient safety for elderly communities? Elena Madrid shares her experiences from inside the WHCA and the work they do to sustain quality in these indispensable facilities. About the WHCA The Washington Health Care Association (WHCA) is a statewide non-profit organization representing over 400 assisted living and skilled nursing facilities. WHCA’s mission is to promote quality long-term and post-acute health care and services, while serving as an advocate for providers, staff, and the patients and residents they care for. Association members provide health and personal care, social support and housing to 25,000 frail, elderly, or disabled Washingtonians each day. About 25,000 employees work for member facilities. Through its leadership and engagement with federal and state quality improvement initiatives, WHCA and its members are committed to healthy, affordable, and ethical long-term care. In keeping with the continuous evolution of long-term healthcare, our quest for sustained quality improvement in this arena is achieved through active engagement with all stakeholders. Applying the Baldrige Performance Excellence Framework The Washington Health Care Association works in conjunction with America Health Care Association (AHCA)/National Centers for Assisted Living (NCAL) to focus on its Quality Initiatives.  Our current focus is challenging members to apply the Baldrige Performance Excellence Framework, an approach which was the foundation of the 2015-2018 AHCA Quality Initiative, to meet measureable targets in eight areas with three key priorities focused on improvement in: organizational success short-stay/post-acute care long-term/dementia care WHCA also works directly with our assisted living and skilled nursing facility members to pursue the AHCA/NCAL National Quality Award Program. The program provides a pathway for providers of long-term and post-acute care services to journey towards performance excellence. It is based on the core values and criteria of the , employing the above framework. Member facilities may apply for three progressive levels of awards: Bronze—Commitment to Quality, Silver—Achievement in Quality, or Gold—Excellence in Quality. In 2015, six Washington WHCA LTC facilities received the AHCA/NCAL Silver Quality Award and 29 received the Bronze Quality Award, placing Washington in the top five states in the nation for Bronze Awards. Target Goals: Reducing Readmissions and Antipsychotic Use One of our target goals is to safely reduce the number of hospital readmissions within 30 days during a skilled nursing center stay by an additional 15% or achieve and maintain a low readmit rate of 10%...

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