Saint Luke's Health System President and CEO Melinda L. Estes knows providers across the country have seen an increase in hospital-acquired infections over the past year, mainly because of the quick changes made to care for COVID-19 patients.
"We saw an increase in catheters; we saw increases in central lines because we had an awful lot of sick patients; and because our staffing was stretched, and we had people in nooks and crannies that we might normally not have them in, we saw more incidents of C. difficile," Estes said. "All of our hospital-acquired infections went up."
Many providers moved patients from sitting upright, to lying on their stomachs to improve the patient's ability to take in oxygen and increase their blood oxygen saturation levels. But those changes made it harder to access catheters, and IV lines had to be strung up differently.
Now is the time to reflect on what could have been different, and to reiterate that safety and quality are top priorities, Estes told a virtual audience at the American College of Healthcare Executives' annual congress on healthcare leadership. That's what her team is doing at the 16-hospital system in Missouri and Kansas.
"[Quality and safety] really is essentially an issue of leadership, and not just the job of the people who have 'quality' in their job title," Estes said. "Leadership really needs to set that vision. And our employees need to understand the 'why' for what we are asking them to do."
It's also important for large organizations to bring leaders together from different departments to work on their mutual goals in areas including clinical, risk management and safety, according to Mike Slubowski, the president and CEO of 92-hospital Catholic system Trinity Health.
The pandemic was a wakeup call to many hospital executives that supply chain management is a crucial part of quality and safety.
"We had some product safety concerns — some very reputable suppliers, actually —g who'd certified that some of their gowns and things were FDA-approved," Slubowski said. "And when we tested them, they didn't meet FDA standards, and we've had to deal with that."
Trinity didn't deal with such severe shortages as many systems did, because it invested in a large warehouse to serve as a distributor of PPE and other supplies across the 22 states where it operates.
"We felt that there were economies of scale by having their own warehouse capability many years ago, and it was fortuitous that we did have that capability," Slubowski said.
Saint Luke's Health, meanwhile, created an internal website for employees with live information on what kind of N-95 masks were available on a given day or week, what supplies were in shortage and other crucial information that made the lives of frontline workers easier and a little less stressful.
That stress on care workers and potential burnout is a big concern for Trinity, which is experiencing significant nursing turnover.
"PTSD and burnout are something that we're really concerned about, because the risks are clear, both on their health, as well as what fatigue does in cutting corners in terms of care delivery and safety," Slubowski said.
Trinity's new internal staffing program has eased some of their hiring needs, and helped make sure that all care workers are on the same page regarding quality and safety. The system now largely avoids using travel nurses.
"Because we are able to recruit people that are colleagues who are familiar with our systems, technology, care protocols and provide quality services, [we] have people who are more aligned with us as a system," Slubowski said, adding that they have recruited more than 500 nurses who work part-time or in multiple settings, which alleviates some of their staffing shortage.
