Nurturing a Culture of Patient Safety on a Daily Basis

“At Cleveland Clinic Children’s, we are preoccupied with failure,” says Vera Hupertz, MD, Cleveland Clinic Children’s Vice Chair of Quality and Patient Safety. “One child experiencing a serious safety event due to failure of a safety process is one child too many.”

This preoccupation with failure has led to a documented change in the safety culture, she adds. Over the past two years, the Quality and Patient Safety team has nearly doubled the number of low level safety events reported while decreasing the number of serious safety events in Cleveland Clinic Children’s inpatient settings. “We encourage reporting of near misses and precursor safety events, as these help us identify and fix gaps in the system that could lead to serious consequences if left unfixed,” Dr. Hupertz explains. “The goal, of course, is zero children harmed.”

The mission of Cleveland Clinic Children’s Quality and Patient Safety team is to facilitate standard-setting performance in safety, quality and patient experience by creating and sustaining a culture of safety. “Every caregiver attends error prevention training designed to provide simple tools for promoting and reinforcing behaviors that lead to consistently safe performance and high reliability,” says Amrit Gill, MD, Cleveland Clinic Children’s Patient Safety Officer.

Setting the tone with daily safety briefings

For more than a year, Cleveland Clinic Children’s leaders have held a daily phone “huddle” for a multidisciplinary safety briefing. The huddles focus on problem awareness, identification and resolution. Operational leaders in areas ranging from emergency departments and operating rooms to food service, security and clinical risk take part in the calls, which lasts an average of 10 minutes.

Since the daily safety briefing started, it has expanded to include several community hospitals as well as Cleveland Clinic Children’s Hospital for Rehabilitation. “We look back over the previous 24 hours to review events that may have threatened safety and look ahead to anticipate anything new or different that may increase the chance of an error,” Dr. Gill says. “This exercise encourages situational awareness that has led to several great safety catches and averted errors that may have occurred had problems not been anticipated.”

Getting parents’ perspective

In an effort to include patients and family members in decisions that impact the safe delivery of care to children, Cleveland Clinic Children’s Quality and Patient Safety team has enlisted parents of patients in an advisory capacity.

“Our goal is to be consistent with our family-centered care philosophy and use a parent advisory council to maintain focus on what matters — the safety of our patients,” Dr. Hupertz says. “We realize that parents can be excellent advocates and evaluators of healthcare, and we want to use this parent advisory council as a vehicle for organizational transformation.”

Knowing when and how to escalate

Prompt escalation of safety concerns is critical to preventing serious safety events. Cleveland Clinic Children’s has developed escalation guidelines as a resource for caregivers. In addition to knowing when to escalate care concerns, knowing how and to whom to escalate those concerns is critical.

“When in doubt, it is acceptable and highly encouraged to escalate a situation,” Dr. Gill says. “It is the responsibility of those receiving the concern to thank others for involving them in patient care and safety concerns.”

Simple changes, major returns

Sometimes simple changes in safety practices can result in major payoffs. One such example is Cleveland Clinic Children’s success in reducing central line-associated bloodstream infections (CLABSIs).

“Most pediatric central line infections are related to the care and maintenance of the line, and the single most important part of the maintenance bundle is to scrub the hub properly,” Dr. Gill says. “By focusing on these simple measures, we have seen a 70 percent reduction in CLABSIs in our pediatric ICUs.”

Taking safety to the front lines

On weekly safety rounds, Quality and Patient Safety team leaders talk to front-line staff, patients and their families about safety concerns. The focus is identifying threats and finding solutions.

“During these rounds, it is clear that safety is a team effort,” Dr. Hupertz says. “Success comes from having an abundance of dedicated caregivers who know that safety begins with them.”