Reaching zero

Kathy Evans, director of risk management at Paradise Valley Hospital in Phoenix, Arizona and treasurer of the Arizona Society for Healthcare Risk Management, has helped to slash safety events at her hospital, achieving 18 months and counting without a serious safety event. She told HRMR why she has found her niche.

Eighteen months without a serious safety event is an impressive track record—and for Kathy Evans, director of risk management at Paradise Valley Hospital, it’s proof that the hospital’s commitment to becoming a high reliability organization (HRO) is paying dividends.

“It’s not my achievement—it’s the nurses, technicians and physicians who all play their important roles in getting us to that elusive goal of zero harm to our patients,” she says. “Our parent company, Vanguard Health Systems, supports us and it really helps us achieve that goal. I’m really very proud to say we’ve gone this long without a serious safety event.”

A small community hospital located in Phoenix, Arizona, Paradise Valley Hospital is part of Abrazo Health, which is owned by Vanguard Health Systems of Nashville, Tennessee. Vanguard owns 26 hospitals throughout the US and recently went into an acquisition process with Tenet, the second largest for-profit health system in the US—so the whole organization is in a state of change.

Meanwhile, Evans and her staff are continuing their work on maintaining their hospital’s outstanding safety record.

“We started our journey to being an HRO about three years ago,” she says. “It’s been important make sure the staff understand what we mean when we speak of an HRO and what we’re talking about when we talk about a culture of safety.”

Increased staff awareness of patient safety is the biggest change Evans has experienced during her nine-year career as risk manager at the hospital.

“We’ve put safety in the front of their minds and made it the capstone of our organization,” she says. The process began with what Vanguard calls ‘safety for life’ training, a four-hour training session designed to introduce staff to safety tools and the concept of being an HRO.

“When we started this journey, 30,000-plus employees went through a four-hour training session. That’s a huge commitment on the part of the company to take the time and the money to train existing staff and new employees in this concept.”

The main change she has seen as a result of the training is a growing sense of responsibility by all the staff for keeping patients safe.

“More and more, the entire staff has put on a risk manager hat,” she says. “They understand it more, they understand what an HRO is, they recognise the errors, they recognise near-misses—we call them ‘good catches’ here—and are much more willing to report them.

“Near-misses—an error that would have reached the patient had someone not stopped it—are caught by staff using one of the safety tools known as STAR—stop, think, act and review—which helps prevent the error from reaching the patient.”

Evans has worked in healthcare since the age of 17, starting out as a certified nursing assistant (CNA) and going on to take various roles in healthcare, including a role as supervisor in admitting and working in human resources for a healthcare system, before moving into risk management at Paradise Valley nine years ago. The role suits her well, she says.

“I like it when people give me a problem and ask me to do what I can do to solve it. I was attracted to the challenges I could see in a risk management role—the investigative element of root cause analyses and working with the team to try to help staff with process improvement. It’s helpful to show the staff that most issues are with the processes: no-one comes in to a hospital in the morning thinking, ‘I’m going to hurt someone today’.

“I have always wanted to help people and this role gives me that opportunity; I always feel rewarded when I know I’ve helped someone.”

She says the biggest challenge of the job is keeping all the balls in the air at the same time, making sure patients are safe and satisfied with the care they are getting while trying to keep the liability of the hospital under control.

“Sometimes it seems as though they are competing goals but as we are working towards being an HRO we’re preventing those untoward events and that leads to decreased claims and lawsuits—so it all meshes together. The challenge is to help the staff understand and see how it all works.”

In addition to all this juggling, Evans has the role of treasurer for AzSHRM (the Arizona Society for Healthcare Risk Management). One of the society’s main functions is to help its members with their ongoing education by holding four sessions a year which will count towards their continuing education (CE) units in order to keep their Certified Professional in Healthcare Risk Management (CPHRM) certifications current.

“As risk managers are wearing more hats these days and have more diverse roles, it’s good to have one place where we can not only network with other risk managers but also know we are going to learn something and get our CE units as well,” she says.

“It’s a very diverse group—some are from physician practices, some are from hospitals and so we have to try to cover everything, and of course there is always the matter of trying to keep up with healthcare reform.”

Asked about her priorities for the future, Evans says she is committed to continuing her hospital’s patient safety journey.

“We need to keep current and make sure we never stop thinking about safety—we won’t let it take second place, ever,” she says. “Even though we haven’t had a serious safety event for 18 months we still have a lot of work to do to make sure we’re not causing harm to our patients. If we had no harm, if we had no errors, then how much easier would that make my job!”

Despite—or perhaps because of—the challenges, Evans is confident that she has found her perfect role.

“I really enjoy helping the staff and the physicians understand what we are trying to do and how they can help us do it. I love working in small hospital, and we have the advantage of having the support of a larger organization. I’ve found my niche as a risk manager, and I really feel I am fortunate to go home at least some nights knowing in my heart that I’ve made a difference that day.” 

What is an HRO?

A High Reliability Organization is an organization that has succeeded in avoiding catastrophes even though it functions in a high risk and/or complex environment where accidents might be expected. Typical examples include air traffic control systems and nuclear power operations, but increasingly healthcare organizations are seeking to achieve HRO status.

Researchers have found that successful organizations in high-risk industries have certain characteristics in common, including

•  Preoccupation with failure;

•  Reluctance to simplify interpretations;

•  Sensitivity to operations;

•  Commitment to resilience; and

•  Deference to expertise.