Health Performance Improvement (HPI)

Healthcare Performance Improvement (HPI) provides healthcare organizations with methods to improve safety and quality while lowering costs. The HPI approach and methods, currently being implemented at over 100 hospitals across the country, are based on the knowledge, learning, and best practices of high-reliability organizations such as nuclear power, aviation and manufacturing. These healthcare systems have achieved up to a 91 percent reduction in the rate of preventable serious safety events that harm patients, while at the same time result in significant positive financial benefits – up to a $21 million savings in three years.

While healthcare has historically focused on traditional process improvement as a means to better outcomes, high-reliability organizations recognize that optimizing outcomes requires a concurrent focus on and integration of process design and human behavior accountability. Building behavior accountability is as complex, and perhaps more challenging, than process design improvement. While process design focuses on detecting and correcting weaknesses in systems, behavior accountability focuses on the prevention of initiating human errors that can lead to events of harm or untoward outcomes.

The HPI approach is a highly structured methodology that defines actions by staff, physicians, hospital administration and medical staff leadership to minimize error and profoundly change culture. Based on an in-depth safety culture diagnostic assessment interventions are tailored to the individual organization. These strategies include several complementary efforts:

• Leadership Method – Learn adopt and practice proven leadership skills for building and sustaining a reliable and safe culture that results in performance excellence. For example, daily check-in, walking rounds and pre-task briefs.
• Error Prevention – Implement safety behaviors and error prevention techniques for physicians and staff targeted at common causes of previous performance problems. For example, team member checking and coaching, self-checking using STAR, and formalized communication and handoff techniques
• Root Cause and Common Cause Analysis – Implement state of the art cause analysis capabilities to identify and resolve root causes of avoidable events and establish an early warning system by identifying common causes of precursor and near miss events.
• Lessons Learned – Implement a transparent and robust process to learn from serious safety events, success stories and best practices from other industries.
• Safety Metrics – Establish a comprehensive performance monitoring system that employs leading, real time and lagging indicators.

A strong accountability system drives individual compliance across the organization and to the front-line depths of each department. Elements of accountability systems include aligning goals, metrics, and performance incentives to reinforce behavior changes; ensuring an environment of fairness that reinforces behavior expectations without punishing people for unintended errors and other programmatic reinforcements such as front-line safety coach programs, sharing of safety success stories, and creation of visible reminders of behavior expectations such as badge cards, newsletter articles, and department posters.

The process of building and sustaining a culture of reliability is sometimes described as a long distance marathon. Each of the following healthcare organizations is at different stages in their journey of transformation and recognizes that these improvements are an early sign of success that nonetheless requires continued application of the methodology described above to continue to sustain those gains.

Results:

• HPI organizations have achieved up to a 91% reduction in the rate of preventable serious safety events that harm patients, while at the same time result in significant positive financial benefits – up to a $21 million savings in three years.
• Sentara Healthcare, an integrated health care system in southeastern Virginia, has reduced the number of serious events of harm to patients (Serious Safety Event Rate?·) by over 60%. Through December 2008, SNGH has demonstrated an 80% reduction in serious events of harm since it began its efforts in November 2003. There has also been a 90% reduction in ventilator associated pneumonia and a 70% reduction in blood stream infections.
• Community Health Network, a four-hospital system in Indianapolis, realized a 70% decrease in the Serious Safety Event Rate, and in early January celebrated 365 days since their last Serious Safety Event.
• WellStar Health System, an integrated health care system located in the northwest metro Atlanta area and a recent HPI client, has already seen the near elimination of ventilator associated pneumonia and central line blood stream infections.

***Submitted by Shannon M. Sayles, RN, MS, MA, Consultant, HPI, shannon@hpiresults.com

Published: January 26, 2009