In 2008, SSM Health Care began an ambitious effort to instill across the organization a culture of patient safety. The effort, called Always Safe . . . Every Day. Every Way focuses on clinical care; communications; and the commitment of all employees, physicians and administrators to the goal: Do no harm, which means zero preventable deaths and zero medical errors.

Always Safe . . . Every Day. Every Way strives to make patient safety top of mind with every clinician, employee and administrator in the system – all the time. Along those lines, SSM Health Care circulates reports about specific sentinel and serious events – with their root causes and action plans to prevent similar situations from occurring again. In addition, safety is a standing agenda item at every hospital leadership meeting, as well as board of directors meetings.

A culture of safety is characterized by open communication, highly reliable processes, teamwork, the sharing of best practices, and accountability. Safety training is required for all employees, with an additional level of training for senior leaders, managers and physicians. By the end of 2009, every employee will have completed safety training.

A Just Culture
To be highly reliable, which means no errors over long periods of time, individuals must be willing to report errors and near misses to learn from them. An important element in the move to a safety culture is Just Culture training. A Just Culture is seen as a middle ground between a blame-free culture and a culture where people are disciplined for making mistakes. Just Culture promotes safe behavioral choices, and is built on personal and organizational accountability for those choices. All managers and supervisors in the system undergo training.

Clinical Collaboratives
Always Safe also includes the Clinical Collaborative work that SSM has been doing for years to improve outcomes for patients, as well as new team training in high-risk areas such as obstetrics, the emergency department and intensive care. The training focuses on communications, feedback, and learning among caregivers so the team that takes care of patients can provide the best and safest care possible. (Read more about our collaboratives below.)

Clinical Decision Support
To support physicians and clinicians in their jobs, SSM created a Clinical Decision Support department – at the corporate level. The department provides evidence-based medicine data to help clinicians ensure that they are using widely-acknowledged protocols. The department works with an outside firm to research the literature, summarize the evidence, and provide draft order sets. The system-wide implementation of the electronic health record further serves to create a uniform system for handling patient information.

Incident Intervention Teams
Incident intervention teams – or "no harm teams" – take less significant adverse events and near misses – potential incidents that could have happened but didn’t -- and review them after they occur. By doing this, these teams find ways to prevent potential errors. Teams work quickly to identify causes for potential adverse events and near misses and develop process changes to prevent them from happening. They share these prevention strategies across our health-care system.

Speak Up for Safety
Perhaps the most important part of Always Safe is the creation of a culture where everyone thinks about safety first. A safety culture means that everyone in SSM takes every safety concern seriously. All members of a caregiving team – along with all patients and families – are empowered to "Speak Up for Safety" -- to voice their concerns and have those concerns addressed as a priority. A safety culture means that all employees, physicians, administrators – along with patients and families – are encouraged to contribute their ideas and concerns about safety – and that, as an organization, we listen and make necessary changes. Finally, a culture of safety means that all proven safety procedures are followed – without fail. When we reach this point, we will be Always Safe – Every Day, Every Way."

Clinical Collaboratives

In 1999, SSM launched a series of Clinical Collaboratives across its 15 facilities. These teams, the cornerstone of SSM’s system-wide quality improvement efforts, were developed to improve patient care for specific clinical areas. Current collaboratives are:

• Achieving Exceptional Safety in Health Care (or reducing medical errors)
• Improving the Care of Patients with Congestive Heart Failure.
• Improving the Care of Patients on Critical Care Units.
• Surgical Care Improvement.
• Improving the Care of Patients with Pneumonia.
• Improving the Care of Patients Receiving Behavioral Medicine Care.
• Improving the Care of Patients with Acute Myocardial Infarctions.

Over 110 teams have joined the collaboratives, which consists of members from a broad spectrum of disciplines including physicians, nurses, pharmacists, infection preventionists, pastoral care and case managers. They share results in order to develop process changes based on best practices. For information, contact Shelley Niemeier (314) 994-7852, Eunice Halverson (314) 994-7747, or Dr. Andrew Kosseff (608) 239-1337.

Banding Together Safety Initiative

SSM Health Care hospitals in Missouri participated in a voluntary campaign to standardize the use of color-coded patient wristbands statewide in an effort to avoid medical errors. Other SSM hospitals also participated in their respective states.

The campaign in Missouri, by the Missouri Center for Patient Safety, was called “Banding Together – For Patient Safety” and set a standard for the use of red, yellow and purple wristbands for patients (pictured above). The bands give caregivers quick, visual “alerts” on a patient’s clinical condition.

At SSM, the campaign was led by the Achieving Exceptional Safety Clinical Collaborative and supported by the Quality Resource Center and Corporate Risk Services.

The Missouri Center for Patient Safety made several recommendations including:

• Standardized use of wristband colors in hospitals: red for allergy, yellow for fall risk and purple for do not resuscitate.
• Use of text on the wristbands in addition to the color.
• Removal of patients’ personal wristbands, like pink breast cancer awareness bracelets, upon admission to the hospital.

Additional information about the project is available at www.mocps.org and at SSM’s Quality Resource Center. For information, contact the QRC’s Shelley Niemeier at (314) 994-7852.