As more federal agencies adopt regulations and guidelines regarding the reduction of medical errors and the advancement of patient outcomes, many industry leaders have made implementing quality improvement infrastructure a top priority.
In September, the President’s Council of Advisors on Science and Technology published a report on patient safety advocating for more national oversight and public reporting of adverse care outcomes such as patient falls, misdiagnoses and wrong-site surgeries. The report also encouraged the Centers for Medicare and Medicaid Services to incentivize hospitals’ use of evidence-based solutions to prevent these high-risk harms, with penalties for not addressing harms in the right way.
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Angela Green, vice president of patient safety and quality at Johns Hopkins, joined Modern Healthcare to discuss how the health system is working to prevent adverse events through improved pathways of communication and the use of technology.
How does the national push for increased oversight of adverse events and patient outcomes align with what Johns Hopkins is working toward?
There is ongoing focus, both in the President’s Council of Advisors on Science and Technology report and within our health system, on evidence-based interventions to reduce patient harm. We employ strong national leaders in venous thromboembolism prevention and are using that expertise to implement [the recommended] evidence-based practices to eliminate that complication in our health system.
We’re taking very similar approaches across a number of healthcare-acquired conditions, such as central line-associated bloodstream infections and pressure injuries. Our nursing teams are also doing great work using evidence-based interventions to reduce falls.
I like a lot of the [PCAST] recommendations regarding interoperability of healthcare data. When we take care of patients within a health system and we all are on a single electronic health record, it really does help with continuity
of care.
What are some of Johns Hopkins’ main goals related to patient safety and care quality?
One key priority is having a culture where people speak up and where they report serious events and concerns, and [where] our response to any errors or opportunities for improvement [is] just and non-punitive. As we focus on being a learning health system where people will report events, we are prioritizing having a highly reliable structure—such as committees, tiered huddles and an event management system—for the flow of information.
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We are focusing this year on how we learn across the system. We’re asking how we leverage that learning in a way that reduces the likelihood that something that occurred in one place is going to occur in another.
We’re proud of the work that we’re doing on standardizing our event management processes, including a communication and resolution program through which we commit to transparency with patients and families after adverse events occur.
How are you using technology to help achieve these goals?
Our health system and patient safety team developed an event reporting software system, which made it easier for those who take care of patients to submit events. It also made it easier for managers to respond to events and created ways to collaborate and share information within the structure. The team that created the software … embedded the link to submit events in our electronic health record, so you don’t have to click out of the record and go into a different software system.
We also have a safety team-created app that helps us track our investigations and how we’re responding to events. Ultimately, if you have an event, you’ll be able to search and see if someone else has had a similar event and then look at what they learned and what they did.
What role does artificial intelligence play in this work?
That is the wave of the future. In our event reporting system, [we] have tons of narrative data that is impossible for a single human to process and turn into something that leads to action. There are machine-learning algorithms built in that tag events with indicators and help us leverage big data to improve in a more rapid way.
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How is Johns Hopkins staying on top of federal safety requirements and quality ratings, in addition to its own priorities?
A year ago, our data team developed an oversight dashboard that integrates data regarding external rankings with our internal improvement priorities. So I can go to one dashboard and see how [hospital] teams perform on Leapfrog and Centers for Medicare and Medicaid Services star ratings. I can click again and see each hospital’s performance on central line-associated bloodstream infections, readmissions and length of stay. That’s helped us survey how we’re doing on key outcomes and identify new areas for improvement.
Which safety metrics have been improved because of efforts like these at Johns Hopkins?
We’ve significantly improved our turnaround time for root cause analysis. The time between an event [occurring] and when actions are put in place to decrease future harm to other patients is critical, because the risks exist until you act to mitigate [them]. Across the system, some of the sites have seen incredible progress in shortening that time.
What advice do you have for other health systems working to create their own quality improvement processes and infrastructure?
Have clarity of purpose around what you’re trying to achieve and then be persistent. As I interact with quality leaders, we often talk about, “How do you ensure that you have collaborative relationships?” and “How do you develop those relationships to partner with those who deliver care?” Or, if you’re a system level leader: “How do you partner with those who are leading quality and safety at the entity level?” So much of this work is accomplished through how we work together as a team
