Saving lives by working together

Children’s Hospital Solutions for Patient Safety (SPS) began as a partnership with the goal of improving the quality of care delivered to children in Ohio and reducing overall healthcare costs, as Nick Lashutka, SPS president explains.

An effort that began with a small group of hospitals in one state has now become an international movement that is saving children’s lives every day by preventing, serious harm in children’s hospitals across North America.

Launched in January 2009, Children’s Hospital Solutions for Patient Safety (SPS) began as a partnership between eight Ohio children’s hospitals, the Cardinal Health Foundation, and other members of the business community. The goal was to improve the quality of care delivered to children in Ohio and to reduce overall healthcare costs. Each of the participating institutions committed to complete transparency and data-sharing to foster an “all teach, all learn” culture for the learning network, meaning everyone has something to teach others, and everyone has something to learn from others.

"Partnerships have been key to the success of the network, including helping to drive change, while also providing vital resources."

Today, the original eight Ohio hospitals continue to work with the SPS network, which has grown to more than 100 children’s hospitals across the US and Canada, all committed to the goal of “working together to eliminate serious harm across all children’s hospitals”.

Since 2012, this international effort has saved 5,897 children from serious harm and led to an estimated savings of more than $109 million in healthcare costs, with a consistent reduction in harm occurring every month (as of December 2015). Results are updated quarterly on our public website: www.solutionsforpatientsafety.org

The SPS approach

Driven by the goal to create a universally safe and healing environment for all children who are in our care, the SPS network hospitals have united around the following tenets that guide our work:

• Leadership matters: Executive leadership is a critical aspect of successful improvement in pediatric patient safety. The SPS network has designed efforts to inspire and continuously develop the safety leadership skills of the executives who lead our network hospitals.
• Our mission motivates all that we do: We must act with urgency and discipline, focusing on outcomes through a combination of high-reliability concepts and quality improvement science methods. We learn through testing and partnering with families and front-line staff.
• Network hospitals will not compete on safety: The SPS network is built on the fundamental belief that by sharing successes and failures transparently and learning from one another, children’s hospitals can achieve their goals more effectively and quickly than working alone.
• “All teach, all learn”: Network hospitals must humbly share and gratefully learn from others. Accomplishing our goals requires focus on the detailed processes and cultural elements that lead to safer hospitals; guidance and support for hospital teams as they build the capacity for change; and facilitation of relationships within our network to broaden and accelerate learning.
• Network hospitals must commit to building a “culture of safety”: hospitals within our network employ the cultural transformation strategies of other high-reliability industries, to create a culture of safety within pediatric institutions, to significantly reduce harm.

Focused on reducing harm

The network is focused on reducing specific hospital-acquired conditions (HACs) by 40 percent, reducing readmissions by 10 percent; and to reducing serious safety events by 25 percent, all while creating a “culture of safety” within each hospital.

The HACs include:

• Adverse drug events 
• Catheter-associated urinary tract infections 
• Central line-associated blood stream infections 
• Injuries from falls and immobility 
• OB-AE*
• Peripheral Intravenous Infiltrates/Extravasations 
• Pressure ulcers 
• Surgical site infections 
• Unplanned extubations
• Ventilator-associated pneumonia 
• Venous thromboembolism

*The network will not be focusing on this after September 2016.

Importantly, the SPS network developed standard operational definitions for pediatric HACs, by using a participatory approach led by pediatric safety experts. Network hospitals rapidly adopted standard definitions and they have come together to develop evidence-based bundles in care delivery for each HAC. In 2014, our SPS network hospitals took the next step through the phased approach to continue to identify evidence-based bundle elements and eventually formalize pediatric prevention standards with the goal of spreading them across all children’s hospitals across the US.

In 2014, using data obtained from the SPS network as well as external evidence in medical literature, our network went through a process to identify protocols and processes within specific HACs that, when reliably implemented, are highly likely to result in decreased harm to hospitalized children. These protocols and processes are called a “bundle,” which is a small set of evidence-based interventions for a defined patient segment/population and care setting that, when implemented together, will result in significantly better outcomes than when implemented individually.

SPS has created two sets of bundles, which are available on our public website. SPS Prevention Bundles embody both standard elements that have evidence from the literature and our SPS data support as well as recommended elements that our SPS subject matter experts believe are the best practices to reduce HAC events. The other set of bundles are SPS Recommended Bundles. For these bundles, the SPS network is actively working to identify bundle elements based on the SPS data and medical literature.

A culture of safety

In order to achieve breakthrough safety results, the network hospitals employ cultural transformation strategies to significantly reduce harm—measured by serious safety events (SSEs)—in their institutions. These strategies include sensitivity to operations, preoccupation with failure, and reluctance to simplify.

Part of creating a culture of safety is employing principles of High Reliability Organizations, such as military operations, aviation and nuclear power. Focusing on high reliability requires in-depth evaluation and change in communication, team dynamics, and leadership. The basic culture transformation methods—including the adoption of the standard measure of SSEs and training in cause analysis, error prevention, and leadership methods—are essential in allowing all of our network hospitals to learn from each other’s successes and challenges.

Hospital leaders across the SPS network are committing personal leadership, hospital staff, and resources to drive a culture of safety. Additionally, patient families, as part of their children’s caregiving team, are helping to identify best practices, taking action to keep their children safe when visiting the hospital, and asking questions.

Partnering for success

Partnerships have been key to the success of the network, including helping to drive change, while also providing vital resources.

SPS works closely with the Children’s Hospital Association (CHA), an organization of more than 220 children’s hospitals focused on advancing child health through advocacy, quality and patient safety, data and analytics, and collaborative learning opportunities. As a champions for children’s health, CHA is aligned with our strategic mission and goal to eliminate harm and strive for the highest quality of care for patients being treated in children’s hospitals.

In 2013, SPS partnered with the Child Health Patient Safety Organization (PSO) to collaborate and align curriculum and methodology on high reliability principles. SPS members who participate in the Child Health PSO benefit from learning about national safety themes and trends and share SSEs with federal privilege and confidentiality protections to accelerate reduction of preventable harm in their hospitals.

Additionally, while each hospital pays a participation fee to be part of the network, these fees do not cover the full cost of the work. The network is funded in part by the Cardinal Health Foundation, CHA and the federal Partnership for Patients program.

The SPS network also receives funding from the Cardinal Health Foundation to organize the Cardinal Health Leadership Program, our SPS network’s hospital governance education program that is designed to improve the capability of each organization’s board to oversee quality and safety endeavors

Finally, the SPS network has been awarded funding from the federal Partnership for Patients (PfP) program. Over the last several years, the funding from this program has allowed SPS to aggressively grow and pursue its goals, which align with the Partnership’s goals to reduce preventable HACs across the country.

Looking ahead

While our achievements have been significant, we will not be satisfied until all serious harm is eliminated across all children’s hospitals. With this audacious goal in mind, we continue to expand our network, challenge our participating hospitals and transform pediatric health care all in an effort to save more lives faster.