5 Ways to Improve Your Leapfrog Hospital Safety Grade

Build a culture of safety to make an impact throughout your organization

The Leapfrog group assigns hospitals letter grades based on safety outcomes. The grades are an easy way for patients to choose one hospital over another and can be directly tied to reimbursement through Leapfrog’s Value Based Purchasing Program.[1]

The grade covers 6 areas: medication safety, inpatient care management, infections, maternity care, inpatient surgery, and pediatric care.[2] Promoting a culture of safety will impact all areas.

A culture of safety is the combination of the safety interventions you do, your staff’s knowledge of them, and their buy-in. Here are 5 steps you can take to reduce errors and build a culture of safety.

1. Examine Error Hotspots to Focus Interventions

Safety events happen at some points more than others. Recurring incidents can provide a clue to your hotspots. For instance, infections may point to a problem with hand-washing, surgical prep, or sterile processing.

Hotspot: hand hygiene

In one organization, a manager identified problems with hand hygiene after cleaning instruments. The correct process involved transporting instruments in a covered container, putting on gloves to clean them before sealing them for transport, and performing hand hygiene after glove removal.

But staff rarely followed that process. They carried instruments across the clinic in a single gloved hand and gave them a cursory wash before dropping them into a bag that was left open all day. It was common to take off the glove and go on without any hand hygiene.

As a result, their hands would easily get contaminated, and the instruments wouldn't get cleaned well. Leaving the bag open also let instruments dry out, which interfered with sterile processing later.

First, the manager investigated the root causes. No one wanted dirty hands, but they thought what they were doing was fine. Glove boxes were often empty, and the closest hand sanitizer was in a different nurses’ station.

She added hand sanitizer to the area and implemented a restocking routine to check all gloves in common areas daily. Staff then performed the procedure with simulated “organic material” that would glow under a blacklight. They were alarmed at the extent of contamination. The result was cleaner instruments and much better hand hygiene rates.

When you identify gaps, your goal is not to see who isn’t washing their hands. Instead, look for workflows that make good hand hygiene difficult.

2. Use Stories to Get Buy-In

Resistance to change is universal. Telling staff to do things differently doesn’t usually work if you don’t also get their buy-in on a new process.

One great way to get buy-in is by demonstrating the impact of a change through safety stories. A clinic used this story to highlight the importance of labeling laboratory tests in front of the patient:

Two patients had biopsies for cervical cancer. The samples were mixed up because of a labeling error. One patient had an aggressive form of cancer, and one did not.

The patient without cancer was told she had cancer and underwent months of surgery and treatment before the mistake was uncovered. Meanwhile, the patient who desperately needed treatment was unaware of it, and her cancer progressed unchecked. By the time she learned about it, it had metastasized to other organs.

This labeling error resulted in significant harm to both patients. Staff who heard this story reported that it had a lasting impact on the way they practiced.

3. Follow Through on Incident Reports

Not only is incident tracking and reporting required by state, federal, and private agencies including The Joint Commission,[3] it’s one of the best ways to identify safety shortfalls.

Most hospitals follow standard incident reporting best practices — making it widely available and non-retaliatory. Despite this, incidents are still severely under reported, limiting potential insight into safety events.

There are many potential reasons for low reporting, such as lack of time to complete reports, fear of blame, and cumbersome systems. One of the most impactful is a history of inadequate follow-up.

If an incident has been reported before but nothing was done to correct the underlying issues, staff will not see the point in reporting the same type of incident again. Having no visible follow-up makes staff feel like their concerns are not heard.

To address this in your organization, ask your staff if they feel this way. An anonymous, one- question poll sent through employee email could give you a gold mine of information.

Sample poll

What would prevent you from reporting a safety incident? Rank in order of impact:

●      Lack of time

●      Complicated reporting system

●      Feeling it won’t be followed through on

●      Not sure it is my responsibility

●      Other:

If your staff doesn’t believe you will follow through, communicate your commitment to change. Next, show them your actions. Share what you can even if you can’t make all the details public.

4. Adopt a Root-Cause Attitude

Many organizations use formal Root Cause Analysis (RCA) investigations to respond to sentinel events — those that cause serious harm. RCA investigations are not unusually retaliatory. But if they are only connected to the worst incidents, they can be perceived that way.

This can be a significant barrier to incident reporting and sets up the RCA for failure. Participants approach it like they are on trial and spend the time defending themselves.

Formal RCA investigations have their place but should not be the only place an RCA approach is used. For better success at solving problems based on root causes, make the practice of acting on them part of your daily culture.

Train and empower leaders to adopt a root-cause approach to smaller problems they encounter — like the manager who addressed her clinic’s hand-washing gap. Provide training to help employees use RCA when they solve day-to-day problems too.

5. Use Education to Make Your Patients Safety Allies

Teach patients how you keep them safe. This adds another set of eyes to the safety team and encourages cooperation.

For example, a patient may not understand the importance of an updated medication list that includes over-the-counter medications and supplements. High-quality education will help them understand how they can contribute to avoiding medication errors, interactions, and adverse events.

Conclusion

A culture of safety is worth striving for. A safer organization will save lives, reduce readmissions, and create better outcomes for patients. To build a culture of safety, investigate root causes, optimize procedures, share stories, and involve your staff in creating solutions. With a cultural shift, you will see positive changes throughout your organization.

References:

[1] Leapfrog Value-Based Purchasing Program. Leapfrog. Published March 24, 2016. Accessed February 22, 2024. https://www.leapfroggroup.org/VBP-Program

[2] Leapfrog. Competitive Benchmarking Report: Sample Hospital. 2023. Accessed February 22, 2024. https://www.leapfroggroup.org/sites/default/files/Files/2023%20Leapfrog%20Competitive%20Benchmarking%20Report%20Sample.pdf

[3] Institute of Medicine (US) Committee on Data Standards for Patient Safety, Aspden P, Corrigan JM, Wolcott J, Erickson SM. Examples of Federal, State, and Private-Sector Reporting Systems. National Academies Press (US); 2004.