Patient Safety First

Purpose:
Despite on-going quality initiatives, safety indicators remain below national benchmarks. In response, Boulder Community Hospital structurally integrated continuous improvement, regulatory sustainment and culturally integrated safety awareness resulting in a patient safety–centered organization.

Significance:
Healthcare reform has created a dynamic and competitive environment regarding quality improvements and quality based reimbursement. Recent performance puts seven figure reimbursement at risk. A reactive culture also lacks the ability to identify safety issues before the patient is affected.

Strategy and Implementation:
As a result, Boulder Community Hospital has reallocated resources to create a culture of safety. The Hospital's Mission was reviewed and updated to reflect safety as the primary organizational focus. Statistically relevant metrics were developed to internally benchmark serious safety and precursor safety events. The organizational chart was redesigned and the Division of Organizational Excellence was created to centralize and subsume continual regulatory readiness responsibilities; data governance; process improvement and safety culture education. Nursing staff are now engaged in nursing practice decisions through the initiation of Shared Governance and in process improvement through the commencement of a Lean program. To further promote buy-in, organization-wide education on safety behaviors and methods to proactively manage the risk for human error began. Transparency has been heightened by increased quality reporting directly to staff and on patient safety boards in clinical areas.

Evaluation:
An organizational safety culture survey shows an increase in favorable responses to key questions. For example, 94% of staff have incorporated safety behavior into their daily practice. Internal metrics reflect fewer serious safety event; more reporting of errors; and improved Core Measures.

Implications for Practice:
By improving the ability of nursing staff to identify safety issues; increasing ability to influence systems and modify personal practice with best practice are the implications for individual practice. Creating the structures to support these efforts are the organizational implications.