St. Bernard Hospital in Chicago achieved a remarkable feat by improving its patient safety grade from an ‘F’ to an ‘A’ in just under two years, a feat deemed by health experts as ‘extremely rare’. The hospital, which primarily serves an almost all Black patient population under Medicare and Medicaid, received the ‘F’ grade from the Leapfrog Group, a non-profit organization that grades hospitals on patient safety twice a year. This grade was a major wake-up call for the hospital’s leadership, as they had previously believed that they were doing a great job. Yolanda Penny, the hospital’s VP of nursing services, stated that they felt their impact in the community during the COVID-19 pandemic, but it did not reflect on paper.
St. Bernard Hospital’s journey to improvement began with the creation of a chief quality and patient officer role, filled by Michael Richardson. Richardson quickly mobilized a committee of key stakeholders, including nurses, pharmacists, and physicians, to identify the root causes of the hospital’s poor patient safety performance and develop strategies for improvement. One of the first challenges they noticed was safe medication administration, which was not meeting the required standards. The committee found that equipment failures, internet outages, and staff habits hindered clinicians from properly scanning patients’ wristbands and medications. To address this issue, the hospital retrained nurses, fixed malfunctioning equipment, and enhanced its Wi-Fi system. As a result, St. Bernard significantly improved its rate of barcode medication administration to around 98%.
Another area of concern was hand hygiene compliance. The hospital tackled this issue by implementing an electronic hand hygiene monitoring system. This system tracks the frequency of handwashing by staff members through a device that all employees wear. The device changes colors when a staff member leaves a room, reminding them to sanitize their hands. Since the implementation, the hospital has recorded over a million instances of hand hygiene opportunities, achieving a compliance rate of approximately 92% with a goal of 95%.
To foster a culture of safety, St. Bernard implemented a ‘just culture’ where staff feel comfortable reporting safety risks, and leadership analyzes mistakes and system issues to drive improvement. The hospital also made improvements in staffing ratios and infection prevention protocols. These efforts resulted in St. Bernard receiving a ‘C’ grade from Leapfrog in spring 2022 and an ‘A’ grade in spring 2023. Missy Danforth, VP of healthcare ratings at Leapfrog, emphasized that such a rapid improvement from an ‘F’ to an ‘A’ grade is exceptionally rare.
Despite the improved grade, St. Bernard acknowledges that there are still areas for further improvement. The hospital currently holds a one-star quality rating from the Centers for Medicare and Medicaid Services (CMS), attributed to extended emergency department wait times and a high percentage of patients leaving without being seen. Moving forward, St. Bernard aims to enhance its discharge planning process, educate the community about its services, and potentially hire a director of patient experience. The hospital also plans to utilize external services to improve patient follow-up after discharge. Additionally, St. Bernard has started including patient safety and quality costs, such as personnel, service fees, and equipment, in its budget, recognizing that the costs of poor quality care far outweigh the investment in safety initiatives.
Improving patient safety requires a comprehensive approach and a commitment to ongoing quality improvement. St. Bernard Hospital’s journey exemplifies the importance of coordinated leadership, collaboration among stakeholders, and targeted interventions to address specific patient safety challenges. By prioritizing patient safety and fostering a culture of continuous improvement, hospitals can achieve significant progress in delivering reliable, high-quality care to their patients.
Source: https://www.advisory.com/daily-briefing/2023/08/03/leapfrog-upgrade