Committed to Perinatal Safety
Dignity Health, one of the nation’s five largest healthcare systems, is an 18-state network of 10,000 physicians and 56,000 employees who provide patient-centered care at more than 300 care centers, including hospitals as well as urgent and occupational care centers, imaging centers, home health operations, and primary care clinics. Headquartered in San Francisco, Dignity Health is dedicated to providing compassionate, high quality, and affordable patient-centered care with special attention to the poor and underserved. As part of this dedication Dignity Health has championed patient safety as a critical component of delivering excellent care. The system’s efforts are perhaps nowhere more clear that in one of the highest risk areas in healthcare – perinatal services.
A Four Phase Approach
In 2005, Dignity Health (operating then as Catholic Healthcare West) undertook an uncompromising approach to patient safety – starting with all 30 of its hospitals with Maternal Child Health Services. The focus on perinatal care included review of all adverse (or potentially adverse) events reporting and then fetal monitoring strip training, MedTeam training1 for every person working in perinatal services, executive “WalkRounds” requiring senior management to commit to executive rounding, and adoption of evidence based practices2. Spearheading this approach was Barbara Pelletreau, Senior Vice President of Patient Safety, who maintains a relentless commitment to quality and focus on patient safety. Further to the four phase approach she and her team made sure to implement effectiveness tracking, understanding that measuring the outcomes would be critical to defining success.
A National Stage
Dignity Health’s commitment to quality was recognized at a national level in 2012 when the health system was selected by the Centers for Medicare & Medicaid Innovation (CMMI) to be part of the largest federal hospital initiative tackling patient safety and quality of care: The Hospital Engagement Networks (HEN) project. As part of the national Partnership for Patients initiative, the HEN project aims, over two years, to reduce 10 hospital-acquired conditions by 40% and cut hospital readmissions by 20%, thus saving an estimated 60,000 lives over three years and conserving $50 billion in Medicare funding over 10 years. More than 3,900 hospitals in 46 states are participating through 26 HENs throughout the country, funded through $218.8 million by CMMI3. Contingent to this funding, HENs are required to file monthly, quarterly, and annual reports detailing progress on 10 clinical focus areas. As part of the HEN, Dignity Health is focused on eliminating early elective deliveries and ensuring frequent assessment of patients on oxytocin, a high risk drug used to induce labor.
APS for Perinatal Safety
A year before the HEN project was announced, Dignity Health began working with APS for perinatal content across more than 30 of its facilities, including APS’ Personal Proficiency Module to assess clinician performance. To date, nearly 100% of perinatal nurses have participated in the training, marking an extremely high adoption rate. With physicians and nurses combined, there are over 1,400 current users and Dignity Health maintains a performance dashboard to track individuals’ progress organization-wide.
By the end of 2013, Dignity Health will move to APS’ GNOSIS™ platform, citing the prioritized content in the universally understood colors of red, yellow, and green4 and the enhanced reporting features as major drivers for the upgrade. “The visibility and insights provided by GNOSIS are really exciting. Working with APS has made a great difference in the way we educate our June 2013 staff,” said Barbara Pelletreau. “As one of the many ways we provide ongoing education, we have found that the specialized training offered by APS is able to identify, prioritize, and tailor key competencies for individual staff’s continuing education – thus saving critical time and energy.” The administrative side of the tool, Pelletreau says, allows Dignity Health to benchmark performance across individuals, groups, hospitals, and system-wide, and helps the organization continue its mission to deliver quality compassionate care.
Broad Scale Implications
Dignity Health applauds APS for advancing their online training to a robust platform with detailed, pertinent information that combines knowledge and judgment. The system takes particular interest in the administrative dashboard feature in GNOSIS, which allows for intricate examination of data with broad- scale implications. Data from GNOSIS allows Dignity Health to:
– Identify performance trends not only within the system but also compared to similar organizations – Focus on the facilities that may need additional attention for specific learning objectives
– Inform operating decisions about allocation of resources, particularly with regard to training and
1MedTeams training is based on research in the field of aviation – a field, like medicine, that involves high stress, high risk, and dire
consequences should team members fail to communicate. For more information, contact the Agency for Healthcare Research & Quality at www.ahrq.gov.
2The WalkRounds concept was developed by Allan Frankel, MD. For more information, contact the Health Research & Education Trust at www.hret.org/walkrounds.
3“Hospital Engagement Networks: 10 Big Goals in 2 Short Years,” Hospitals & Health Networks, May 5, 2012, www.hhnmag.com/hhnmag/jsp/articledisplay.jsp?dcrpath=HHNMAG/Article/data/05MAY2012/0512HHN_FEA_qu
4APS content is associated with red, yellow, and green (universally understood as stop, pause, go) indicating content