Improving indicator results for patient safety

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New data from CIHI shows that the number of hospital deaths continues to decrease across the country. Out of 83 reporting facilities in Canada (outside Quebec), 47 have significantly improved on this measure over the last 5 years. See how 1 facility is raising the bar.

Southlake Regional Health Centre in Newmarket, Ontario, has achieved considerable success in improving a number of patient safety and quality of care indicators, most notably Hospital Deaths (also known as HSMR, for “hospital standardized mortality ratio”). Between 2009 and 2014, Southlake was able to drive down its indicator results for Hospital Deaths from 106 to 71—an outstanding achievement for the facility. We caught up with Southlake leaders to learn more about their success. From our discussions, it was clear that improving indicator results goes far beyond chasing numbers and Band-Aid solutions.

The Southlake Way

Addressing Hospital Deaths was a big task, explained Helena Hutton, Southlake’s chief operating officer and vice president of relationships, as there was not a single cause or simple solution to drive down the rates. Southlake began tackling its HSMR results in 2007. Rather than looking at the hospital as a whole, the management team examined data from each individual portfolio within the hospital to identify opportunities for improvement. Through this strategy, they were able to decipher what was and wasn’t working well in each portfolio.

From there, she said, it was essential to create achievable evidence-based goals for teams to work toward. Once the data started to change in a more favourable direction, the key to sustaining the momentum came through the promotion of core values centred on safety and quality.

“Culture and performance are the keys to success at Southlake. We do that by engaging our staff and giving them a voice to make change and be passionate about what they do,” said Dr. Dave Williams, Southlake’s president and CEO.

Creating a “high reliability” organization was the fundamental vision that Dr. Williams wanted Southlake to embrace when he joined in 2011. He did so by encouraging a culture in the facility that prioritizes 3 key elements: safety and performance, reliability and being driven by data. Staff at Southlake call this The Southlake Way.

Part of this approach includes encouraging hospital workers to speak up and affect the change needed to work more efficiently, something that’s a key component of Southlake’s success in a number of its quality and safety indicators.

Dr. Williams explained the importance of leadership that listens. “What is really important is to have a leadership team that seeks to empower front-line workers. They are the experts. They know what is going to make a difference to their patients.”

A number of practices have been put into place that give everyone, from nurses to physicians to hospitality service associates, the opportunity to speak up and discuss inefficiencies with senior leaders, including the CEO and COO.

Introducing team huddles and a huddle board to remind staff of safety and quality practices is another strategy Southlake put in place throughout the hospital. “Team huddles are voluntary and have become very popular and quite competitive among units,” said Dr. Williams. “Every clinical area takes 10 minutes each day—and sometimes twice a day—to talk about issues that are important to them and identify opportunities for improvement they want to focus on. Huddles have been so effective that the emergency department attributes its huddle board as the number 1 safety improvement initiative.”

Part of that strategy is making leadership visible to the organization. Dr. Williams and the entire senior team have weekly safety and quality walk-throughs, and once a month they host a 3C Rounds session, which stands for Culture and Conversation With the CEO—an informal roundtable discussion with the front-line staff to allow them to discuss issues that matter to them.

Knowledge through numbers

Understanding data is another integral part of the culture at Southlake. “When we say we’re data driven, we mean it,” proclaimed Dr. Williams.

“Transferring data into knowledge and knowledge into action is key,” said Ms. Hutton. “Otherwise, you’re just chasing numbers. We’re lucky to have people who are passionate about transferring data into knowledge.”

Southlake makes its data accessible to all employees so they can make data-driven decisions—an important driver for safety and quality initiatives. As a result of their innovation in doing so, the Southlake team was presented with the McKesson Distinguished Achievement Award for Clinical Excellence for its work on using a tool intended to help patient flow to include performance metrics. The result enabled staff to make data-driven decisions in real time.

Shockingly excellent experiences

Even though Southlake is among the top-performing hospitals in the country, work continues to identify issues and make improvements.

“Our commitment to quality and safety is a journey, not a point in time,” said Dr. Williams. “I’m very excited about Southlake because the culture is alive and we try to make it fun. Passion translates to quality and safety of patient care. We are thrilled that patients are excited to have a shockingly excellent experience.”

Results for the indicator Hospital Deaths are available in CIHI’s Your Health System web tool. Visit CIHI’s website for more on how hospital deaths are measured.