Do you know your hospital's bottom line in patient safety and quality? Tracking individual adverse event rates is important, but measuring a total patient harm rate is essential for hospitals and health care systems as they improve patient safety and quality. A total patient harm rate can be calculated and used to help connect the dots on improvement projects. Measuring total patient harm provides valuable information for the board as well as for quality committees, medical executive committees and nursing executive committees.
Executives at hospitals that are tracking and reporting this measure say it helps the organization to focus on quality priorities and increases accountability through transparency. To calculate an overall patient harm composite, health care organizations can aggregate metrics on the number of harm occurrences. These occurrences include: adverse drug events, catheter-associated urinary tract infections, central line–associated bloodstream infections, injuries from falls, obstetrical adverse events and early-elective deliveries, pressure ulcers, surgical-site infections, venous thromboembolism and ventilator-associated events.
Tracking patient harm and identifying opportunities for improvement forces hospital leaders and board members to have conversations about big strategy issues to reduce harm. In the following case examples, two hospitals improved communication and collaboration by adopting a standardized reporting format for discussing real-time data.
Ditching the Dashboard
When Frederick Goldberg, M.D., arrived at Nathan Littauer Hospital in Gloversville, N.Y., four and a half years ago as the new vice president of medical affairs and chief medical officer, he found that the information reported to the board of trustees on quality and safety needed more focus and clarity. The board had been seeing a dashboard with a large number of metrics shaded green, yellow or red to show progress toward reaching targets. "Lots of hospitals were doing [the same thing], and some still are," Goldberg says. "This is too much information. You get lost in the details … and cannot see what's important and where the greatest opportunities for improvement lie." Goldberg and his team developed a concise report on quality, patient safety and satisfaction — the QPSS report — to show organizational trends on risk-adjusted outcomes measures only. "Members of the board need to know if our patients are incurring unexpected mortality, preventable readmissions, dissatisfying experience or hospital-acquired harm — the 'big dots,'" Goldberg explains. "They only need additional drill-down to include process measures if we are not hitting our outcomes targets."
After hearing a presentation about measuring harm across the board, in July 2013 at the Health Forum–AHA Summit, Goldberg started making the HAB calculation: total harm events per 1,000 discharges per quarter. The hospital's total patient harm rate improved over 18 months: It dropped from 6.5 events to 1 event per 1,000 discharges. Last year, Goldberg added a second tier to the report called surgical harm across the board. Goldberg reports the information to the hospital's board every quarter, often sharing patient stories. He shares the same information with staff, managers and clinicians to be "totally transparent across the organization."
Goldberg says it's important for hospital leaders and staff members to remain "eternally" vigilant. "If you start resting on your laurels, people will get harmed. It's important how we measure patient safety and what we do to continually redesign our systems to mitigate the risk of harm." He adds, "It's fiscally important in terms of outcomes being increasingly weighted in the [Centers for Medicare & Medicaid Services] value-based purchasing program."
Good Data Improve Communication
Preventing patient harm is always top of mind at Yampa Valley Medical Center in Steamboat Springs, Colo. "As a rural community hospital, we take patient safety seriously," explains Glenn Sommerfeld, manager of performance improvement. "We care about our patients and want them to have the best possible outcomes. Hospital size does not matter when it comes to the prevention of patient harm."
About the time Sommerfeld was having conversations with colleagues on how to measure patient harm using evidence-based, standardized tools, he became involved with the American Hospital Association/Health Research & Educational Trust Hospital Engagement Network and learned about a new tool to measure harm. "This tool gives us something to measure and a communication measure that we can look at and use to set goals," Sommerfeld says. "Instead of separate spreadsheets for everything … I can open the summary page and see what is going on."
In an age of "big data and transparency," this tool is "progressive … helping us to become more transparent, starting with our staff and then with our community," Sommerfeld notes. Previously, harm events would end up in the risk-management department and be discussed behind closed doors. "Now we're looking at an adverse event and asking, 'What happened to the system?' We're looking to see where our systems might be flawed," he says. The medical center's total patient harm rate has decreased from a high of 9.6 per 1,000 patient days in mid-2013 to 3.6 in mid-2015.
The board of trustees at Yampa Valley Medical Center plan to make avoidable patient harm one of four overall metrics, under the "patient" pillar. Sommerfeld recommends finding a balance between timeliness in reporting to the board and having complete, accurate data. "Having a standardized format to talk about [patient harm] helps everyone to get through difficult conversations," he says. "By utilizing this tool, we can show where the data and the definitions come from." Sommerfeld adds that the process has encouraged better collaboration with the medical staff and board. "It is a lot of work, but so worth it."
Template for Tracking Harm
These hospitals are using the Eliminating Harm Across the Board template and improvement calculator developed as part of the AHA/HRET Hospital Engagement Network. With this tool, health care organizations succinctly can illustrate their progress toward eliminating harm by tracking the actual number of harm occurrences, spotlighting specific harm-reduction measures and sharing strategies for success.
As you work to improve quality of care and eliminate patient harm at your hospital or health care system, consult this checklist:
- Consider total patient harm as a bottom-line measure of patient safety.
- Measure and monitor a total patient harm rate each month.
- Discuss organizational strategies for improvement.
- Be transparent on the harm rate and the improvement strategies.
- Align leadership incentives to eliminate patient harm.
To access the template, improvement calculator and other resources on eliminating harm across the board, visit www.hret-hen.org.
Maulik S. Joshi is an associate executive vice president at the American Hospital Association and president of the Health Research & Educational Trust. Todd C. Linden is the president and CEO of Grinnell (Iowa) Regional Medical Center. Both also are members of Speakers Express.