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.

The grade covers six areas: medication safety, inpatient care management, infections, maternity care, inpatient surgery, and pediatric care. Promoting a culture of safety in your organization will positively 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 five 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.

The manager 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.

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

2. Use Stories to Get Buy-In

Change is hard for many people. It will be easier to get staff to do things differently if you 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.

Takeaway: 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, but it’s also 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 underreported, 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 question:

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

●      Lack of time

●      Complicated reporting system

●      Concern that the report wouldn’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 publicize all the details.

4. Adopt a Root-Cause Attitude

Many organizations use a Root Cause Analysis (RCA) to respond to healthcare-related errors and adverse events. The purpose of an RCA is to identify what happened, understand why it happened, prevent a future event, and improve patient safety.

While typically reserved for serious events, an RCA approach can certainly be used to analyze smaller problems, too. Train and empower leaders to adopt a root-cause approach to solving the more common 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.

5. Use Education to Make Your Patients Allies in Their Safety

Teach patients how you keep them safe. Enlisting them as an ally in their care adds another set of eyes to the safety team and encourages cooperation and patient engagement.

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.