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A Tiered System of Safety: Committing to Zero Harm with WellSpan Health
Patient safety is a core principle of every health care organization, and hospitals and health systems are always striving for new ways to boost their patient safety missions. In this conversation, Carlos Roberts, M.D., urogynecologist and vice president and chief medical officer of the Women and Children Service Line at WellSpan Health, discusses the organization's commitment to zero harm, its innovative tier structure for daily safety huddles, and its fostered culture of continuous improvement and celebration of patient safety.
Transcript
Tom Haederle
Welcome to Advancing Health. WellSpan Health is a nine hospital system serving mostly south central Pennsylvania. Its 23,000 employees collectively serve more than 1.5 million patients per year, aiming every single day for a goal of zero patient harm. In this podcast, we learn more about how WellSpan relies on tiered daily huddles to provide the best patient experience possible. Not only clinical team huddles, but also frequent conferring among safety and security teams as well as cleaning staff.
::Tom Haederle
WellSpan's philosophy is simple: everyone has a part to play. Your host is the American Hospital Association's chief physician executive Dr. Chris DeRienzo
::Chris DeRienzo, M.D.
I'm Dr. Chris DeRienzo and I am super excited to be here in York, Pennsylvania. We are on site visiting with the WellSpan Health System. With me today is Dr. Carlos Roberts. He is a urogynecologist and he is the vice president and chief medical officer of the Women and Children Service Line. Carlos, thank you so much for joining the podcast.
::Carlos Roberts, M.D.
Thank you for having me today.
::Chris DeRienzo, M.D.
Well, thank you for having me. The reason I'm here in Pennsylvania this week is I get to join the award ceremony for your service line, and there is much to celebrate. We've gotten to tour the practices. We've gotten the tour of the hospital, and you have outcomes that just knock it out of the park on all manner and variety of fronts.
::Chris DeRienzo, M.D.
But the one thing that we really wanted to engage in the podcast today is about your safety huddles. As part of our patient safety initiative, we are identifying folks all around the country who have these leading practices, and doing the kind of tiered safety huddles that you lead at WellSpan is certainly one of those practices. Tell us about it.
::Carlos Roberts, M.D.
So we implemented safety huddles about three and a half years ago, and it was a way for us to work towards one of our most important initiatives as a health system, which is working towards zero harm for all of our patients and our team members. So the zero harm efforts are not just about patients, but it's also about harm to our providers and staff as well.
::Carlos Roberts, M.D.
Those tiered huddles are very structured and it enables us to one: identify any kinds of problems that we might have or opportunities for improvement. And two, escalated to the appropriate levels in the hospitals or the health system through this tiered structure. And we have several different levels of the tiered structure.
::Chris DeRienzo, M.D.
Let's talk about those levels because I got to join a couple of those today. But where do these huddles start out.
::Carlos Roberts, M.D.
So we have tiers one through six. And the very first level of the huddles - which is tier one huddles - occurs where the work is done with the providers and the staff. And what we do is we identify any opportunities for improvement, either with patient safety concerns or with processes. And then we then elevate that to the tier two level.
::Carlos Roberts, M.D.
The tier two level is the level where we have managers of those different sites involved in that practice or in patient facilities. Then, if there is something that needs to be escalated, then it's taken up to the tier three level. The tier three level is where we have the directors of operations. So the operational leaders, along with individuals like myself, engaged and hearing and understanding what the challenges are and then identifying things that may need some barriers to be broken down at levels above where I am.
::Carlos Roberts, M.D.
We then take it to the tier four level, where that's where the vice presidents of the service lines or the hospitals operate at. And we then share things through what we've heard from our tier three and tier two and tier one folks that need to be escalated.
::Chris DeRienzo, M.D.
Let's pause there for a second, because, through four tiers, we've now started, as you explained to me, you know, in the NICU itself on tier one or in an individual ambulatory practice or even other non-clinical team members in the hospitals and across the health system. Is that right?
::Carlos Roberts, M.D.
Yes, that is correct. And so one thing I want to share with you too. So in my role, and anyone who's in a similar role across the service lines or the entities or the health system, my first order of business as a chief medical officer is to look at what we use as Press Ganey and you see populated for you what has transpired over the last 24 to 48 hours.
::Carlos Roberts, M.D.
Okay. And what we get is sort of a report that allows us to identify if there's a serious harm event that we need to prioritize. Now, we encourage every team member to report. So we'd rather overreporting than underreporting. So once, so I already come to the huddles with some kind of understanding that there is some events that may have occurred, some more harm than others, some may be more or less concerning, but I already have some base knowledge.
::Carlos Roberts, M.D.
So once I come to the huddles, then I get the essence of all right, what is the OFI that has occurred? And what have we done so far to try and mitigate any further challenges?
::Chris DeRienzo, M.D.
OFI being opportunity for improvement. Everything that we do in health care is just driven by this relentless drive to improve. And, and again, so we've talked starts at tier one, goes up through tier four. I want to pause there for one more second though, because, these tier one huddles it sounds like, aren't just happening in in practices, in teams.
::Chris DeRienzo, M.D.
What are some of the non-clinical areas that are having same kinds of huddles.
::Carlos Roberts, M.D.
So our safety teams...you know, security teams, they have same type of structure.
::Chris DeRienzo, M.D.
Really?
::Carlos Roberts, M.D.
To ensure that they too are engaged with the entire platform to make sure that we are delivering care to our patients in a safe way, because the fact of the matter is, we're all together caring for our patients and team members in one way or another. Exactly. We even have it for our cleaning staff. So one of the things that we've done with our cleaning staff is ensure that they understand that their role is not about cleaning rooms, or about cleaning the hospital, or the elevator or the stairs.
::Carlos Roberts, M.D.
It's actually about decreasing infections. Yes. So when we change the perspective of how they view the job that they're carrying out, it allows us all to be aligned with reducing harm in the hospital and trying to achieve our goal of zero harm.
::Chris DeRienzo, M.D.
And when an entire team, from the folks who clean the rooms to the folks who are operating in the ORs are aligned in that way, there's some real magic that can happen. And you all are doing that at nine hospitals and countless ambulatory sites. But tier four is not where it stops. So what happens? We started, you know, early in the morning some places at 6:30, because that's when their team members come, some at 8:00.
::Chris DeRienzo, M.D.
So we're through tier one two through two, three, tier four. Now what happens next?
::Carlos Roberts, M.D.
So from the tier four level, that's where the most senior person at that level is someone like myself, a vice president and chief medical officer or a vice president of operations. Those individuals then go and participate in the tier five huddles, and we have to now bring information from the previous huddles that are important to share that level and what we have at that level now, the highest "ranking" person at that huddle is one of our senior vice presidents.
::Carlos Roberts, M.D.
Okay. And so after we share information at that tier five level, our senior vice presidents then take that up to the executive level.
::Chris DeRienzo, M.D.
So that's a tier six then. Yes. So what you're sharing is that, you know, something can happen at 4:00 in the morning somewhere. And by 9:30 a.m., the entire health system will have been briefed. And you can be taking action right away.
::Carlos Roberts, M.D.
Yes, absolutely.
::Chris DeRienzo, M.D.
That is spectacular. But it's not only and I think this is really important to remember, because the health systems like WellSpan that are so driven to improve, you know, if you don't remind yourselves of some of the things we need to celebrate, then you can lose the energy in that flywheel. And as I got to hear this morning, these huddles don't just focus on where can we improve.
::Chris DeRienzo, M.D.
They focus on what should we be celebrating. And so how do those celebrations translate all the way, all the way up to the leadership team as well? Yeah.
::Carlos Roberts, M.D.
So you know, just to give you kind of an essence of how we, we have that huddle structure. We always start with sharing our common goal. Our common goal is working towards zero harm for 23,000 team members and our patients. And it's an opportunity for us to work towards that zero harm and also to share things in an open way without concern about retaliation.
::Carlos Roberts, M.D.
So once we set that as our bar for operating, then everyone comes to the table sharing things. Then we kind of bucket things. We bucket things into: Do we have any safety events? Do we have any operational challenges, call outs or providers that are ill?
::Chris DeRienzo, M.D.
We saw that today. We happen to be in York, Pennsylvania, in the midst of a snow and ice event. And so there were some serious operational challenges as roads were iced and folks couldn't get places. But I got to hear you using those huddles to make sure that we're redeploying resources for calling patients. And when you serve a million and a half patients a year, that is a challenging process.
::Carlos Roberts, M.D.
Absolutely. Now, one component of that huddle is also celebrating the wins.
::Chris DeRienzo, M.D.
Excellent.
::Carlos Roberts, M.D.
So we encourage individuals to come forward with celebrations. And we don't just come forward with the celebrations. We then circle back with the people who we're celebrating and thank them for all the hard work that they're doing.
::Chris DeRienzo, M.D.
Closing that loop is so important, both when there's something concerning. If I'm a team member at WellSpan and I know that if I get this into to that reporting system, there's a cycle and a process where, we'll not only look into it but it can get escalated and then get brought back down with follow up.
::Chris DeRienzo, M.D.
And doing that on the celebration side is so terrific as well. You were sharing with me as we were walking through one of the elevators, the notes that you get to write, recognizing folks whose stories have been heard at the senior leadership team level. You know, it has been a privilege, Carlos, to get to spend some time with you.
::Chris DeRienzo, M.D.
Obviously you've got something very special going on here at WellSpan. If there's just one more thing you would want to leave our listeners with about what makes you all such a spectacular health system - one that AHA has recognized in our Quest for Quality process in years past - what would you want your closing thought to be?
::Carlos Roberts, M.D.
So what I would share with other hospital systems is that if you change your focus to the patient and working towards ensuring everything that we do for that patient results in them having the most favorable experience and outcome, then all of your work would be focused in that direction with all of your team members. And that in essence is what can give you the most reliable system that can deliver the highest quality care.
::Chris DeRienzo, M.D.
It is my privilege to get to visit hospitals all over the country. Carlos, you all and the team here at WellSpan clearly are spectacularly patient-centered in what you do. Thank you again for joining the podcast. And it's been a real privilege to spend time with you.
::Carlos Roberts, M.D.
Thank you very much.
::Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and rate us five stars on Apple Podcasts, Spotify, or wherever you get your podcasts.
