When it comes to hospital safety, no leader ever feels their work is complete.

There’s not a hospital leader in the country who has achieved all there is to do in the realm of quality improvement and patient safety.

A session at last week's National Patient Safety Foundation's Patient Safety Congress brought two health system leaders — Charles Stokes, executive vice president and chief operating officer, Houston-based Memorial Hermann Health System, and Gary Kaplan, M.D., CEO of Virginia Mason Health System in Seattle — together to share how their systems are moving toward achieving a higher standard of quality and safety.

Memorial Hermann Health System’s journey toward high reliability

When Stokes got to the system nine years ago, only about 15 minutes of each board meeting were spent on quality and safety. Today, almost 50 percent of the time is spent on the topic, he says.

Stokes credits the beginning of the change in culture to making quality and safety part of the system’s core values, not merely a priority.

The 17-hospital system has devoted many resources to that value as a result. Nearly 27,000 employees and 4,000 physicians have received quality and safety training as part of the system’s BIPS (Breakthroughs in Patient Safety) program.

The transparency on all safety issues with the board members has been crucial as well, says Stokes. A physician council, co-chaired by Stokes, meets with one of the four physician board members each quarter to discuss safety concerns that they believe need to be addressed, which will be shared with the entire board.

Quality and safety initiatives are now embedded into the system’s culture, such as its Red Rules, a three-step observation process built into all situations. If a rule is observed to have been broken, a member of the C-suite is contacted and leaves whatever he or she is doing to intervene in the situation, said Stokes.

“It’s about setting behavioral expectations on how we expect our staff, physicians and leaders to behave and be educated,” said Stokes.

The results speak for themselves. Memorial Hermann’s high-reliability, Certified Zero Award was created for hospitals that go a year or longer without adverse events in federally defined categories. Since its creation in 2011, the system has given out more than 100 of these awards to hospitals in its system.

“We should not be willing to settle for anything less than zero patient harm,” emphasizes Stokes.

Virginia Mason Health System applies the Toyota production system

When Gary Kaplan became CEO in 2000, he quickly realized that the processes at the system were based around clinicians, not patients.

After looking for an effective management system, a leadership group, including Kaplan, toured a Toyota manufacturing plant in Japan. There they noticed that each worker on the assembly line had a cable to slow down the assembly line, or stop it completely, if the work couldn’t be completed, thereby embedding quality into the process.

Since that time, Virginia Mason has been on a journey to implement safety measures into its own culture, beginning at the top.

Every board meeting begins with a patient story with the patient in the room. Now, at the request of the board, more than 50 percent of the stories are negative — to better understand how to improve quality culture at the system.

Its patient safety alert system has tallied several hundred alerts a month. And before a red safety alert event, which is a serious safety event, is closed, it must be reviewed by the quality oversight committee of the board.

“It’s helped to evolve and change our culture,” says Kaplan. “What I’m most proud of is that we are building the capability and becoming a learning organization. It’s not about figuring things out, it’s about creating an environment and culture that will allow us to continue to survive into the future.”