Children’s Hospitals’ Solutions for Patient Safety is a massive collaborative effort among children’s hospitals to transform pediatric patient safety by eliminating serious harm. President Nick Lashutka told HRMR what the network has achieved so far.
Since the inception of Children’s Hospitals’ Solutions for Patient Safety (SPS), 4,746 children have been spared harm because of the network’s efforts. For SPS president Nick Lashutka, there is no better evidence of SPS’ success.
“That figure represents 4,746 kids and their families who have not had to deal with something that shouldn’t happen in healthcare—to me that’s one of our most proud achievements,” he says.
SPS started life in Ohio in the mid 2000s, when eight of the state’s children’s hospitals began working on patient safety projects. At the time this represented an unprecedented act of trust, with the hospitals sharing information about safety events as part of a commitment to prevent those type of problems occurring in other facilities.
“As that trust deepened and got stronger, we began to work more closely with the business community in our state—the large purchasers of healthcare—and that partnership grew into what ultimately became our commitment to eliminate all serious harm in children hospitals in the state of Ohio,” says Lashutka.
That effort began in earnest in 2009 as the network’s members began to achieve results not by competing, but by sharing insights on how to do better in caring for children. The network’s success has depended on a strong commitment from the leadership of each organization, says Lashutka.
“One of the key hallmarks for us is that we have extraordinarily strong leadership at the CEO level and also from clinical leaders—physicians and nurses—and from our individual hospital boards, who are very excited about enabling us to do the work,” he says.
SPS works to bring more business-oriented approaches to improvement in healthcare, learning from the high reliability approaches pioneered by the aviation and nuclear power industries.
“These industries have a very low tolerance for errors and a culture of safety, so we started asking how we could bring the learning from those industries into healthcare,” he says. “That is a key part of what has enabled us to be so successful.”
As word about SPS spread its membership grew from eight Ohio hospitals to nearly 90 hospitals, mostly in the US, but also in Canada. SPS is now in discussion with interested healthcare providers in the UK and other parts of the world.
Nurturing a safety culture
While there are other hospital engagement networks receiving federal funding in the US (the number stood at 17 in the most recent round of funding), SPS is the only one to be entirely focused on children’s hospitals. It has a very sharp focus on eliminating harm, and has seen some significant measurable successes, including dramatic reductions in several hospital-acquired conditions and in serious safety events.
“At the beginning, there were a lot of common problems: pneumonia, stroke events, pressure ulcers, urinary tract infections, and so on,” says Lashutka. “We have tried to instil rigor in our network: we get together for learning sessions, and we talk a lot with our nurses, physicians and network leaders about where they see harm occurring.”
"We may never get to zero but we have lots of hospitals that have gone more than a calendar year without a serious safety event."
Vital to the network’s success is a strong safety culture within the member hospitals.
“We spend a lot of our energy in making sure we are doing a good job in training our boards of directors,” says Lashutka.
Part of the aim of this is to ensure the individual hospital board members understand their fiduciary duty, and grasp the importance of everything from safety basics to how to instil a just culture within an institution, and how to delineate between the management and administrative sides of the operation.
“It’s vital that there is a culture piece. This is a journey, not a destination: we may never get to zero but we have lots of hospitals that have gone more than a calendar year without a serious safety event. These are institutions that just a few short years ago were having 20 to 30 serious safety events a year.
“That was unacceptable and this battle is never going to be over as long as we have the privilege of serving kids. That’s why cultural leadership, and being willing to learn from outside of healthcare from high reliability industries, are absolutely vital.”
Sharing with confidence
The involvement of risk managers has been an important part of the network’s success, but for risk managers and their colleagues to be confident in sharing information about safety events, it was important to establish that the information shared would not be discoverable in the event of litigation.
“At the beginning there were a lot of questions about exposure, a lot of questions about discovery, and questions about what the personal injury lawyers might want to do relative to this,” says Lashutka.
“We have been able to set up a framework where the lawyers and the risk managers recognise the importance of what we are doing and our work can be conducted in a manner that is going to help us achieve our goals.
“For example, in Ohio we have fairly robust peer review protection laws for individual clinical leaders but there is some question as to whether those statutes provide protection for collaborative networks doing the same kind of work, so we worked with our elected policy leaders and our governor to make sure the Ohio law very specifically protected the work as it occurred inside our state borders.”
As SPS has grown it has also strongly encouraged its member hospitals to be engaged in its partnership with The Child Health Patient Safety Organization (PSO).
“This not only alleviates some of the concern from the risk and legal side but also generates an enormous amount of data and information that we can share.”
The ground already gained as a result of these efforts is enormous, but SPS is not about to slow its pace. While Lashutka is rightly proud of the lives saved as a result of the network and the barriers it has broken down, he is hungry to see it achieve more.
“We operate in very complex environments that are by their very nature dangerous and we need to do a much better job of putting in place systems that would enable our people to be successful.
“We’re excited about what we’ve been able to achieve, we’re proud of it, but we’ve got a long way to go and I feel we have an obligation to make sure we continue to drive this agenda and make our work available to people who have the privilege of caring for kids.”
Children’s Hospitals’ Solutions for Patient Safety, Nick Lashutka, US
