Maine-based EMHS recognized for creating system-wide culture of safety

National Business Group on Health and the VHA Foundation Looked Across Country to Identify Healthcare Leaders Creating Safer, More Transparent Environments for Patients

A poor economy in a rural area might seem like overwhelming obstacles to creating a sophisticated culture of safety in a health care system that serves the largest aging population in the country, but leaders at Eastern Maine Healthcare Systems (EMHS) beat those odds in 2009. Delivering safer care, not just in a single location, but across their seven-hospital system, Brewer, Maine-based EMHS was given the National Health System Patient Safety Leadership Award for creating a system-wide culture of safety from the National Business Group on Health and the VHA Foundation.

Ten years after the Institute of Medicine issued its landmark "To Err is Human" report, the U.S. health care system continues to be plagued by medical errors. Finding and highlighting examples of leaders who are turning the tide on patient safety, experts say, is essential to improving our nation's track record as a whole.

"To truly move the needle on safety, we can not rely only on new technology and the latest interventions," said Colleen Risk, executive vice president of Clinical Improvement Services of VHA Inc. and executive liaison to the VHA Foundation. "Safer care is developed in carefully-cultivated environments, such as the one created at EMHS, where leaders promote shared values, attitudes and behaviors across an entire system allowing employees to work with common purpose to improve safety."

EMHS was chosen from a nationwide pool of applicants by a panel of judges representing corporations, patient safety and government organizations. Applicants were selected based on a set of criteria designed to measure the ways a health care system's leadership created safety-centered cultures including: system-level commitment; board and senior leadership involvement; system-wide alignment of patient safety resources and goals; improved patient outcomes; and transparency in public reporting.

"Thousands of lives and billions of dollars are lost each year to medical errors," said Helen Darling, president of National Business Group on Health. "It is time for health care leaders to learn from exemplar systems. Our hope is that this award will show other leaders that it is possible to create safer patient care by creating a shift in their organizational culture, including during a recession and in challenging environments."

Highlights of EMHS leadership practices that underpin its operations, performance and outcomes include:

• Setting a Transformational Goal: EMHS leaders set a goal of becoming the country's best rural health system in America by the end of 2012. To drive towards this goal, the leadership team instituted and has played an essential role in the Zero Defects Initiative, a system-wide program to eliminate errors in key areas in all of its hospitals by 2012. The leadership team notes that by setting zero as the target, it has changed how the organization and staff think about improving safety. It has challenged them to think about what they can do to completely eliminate errors. To meet this goal, EMHS has dedicated the staff and budgetary resources needed to meet 5-year plans set by each hospital.
• Walking the Walk: Executive compensation is directly tied to quality and safety outcomes. All executives - not just clinical leadership - are accountable for EMHS performance in patient quality and safety.
• Being Transparent: EMHS leaders feel strongly that open and clear communication with patients is essential to safety. Leaders at EMHS were the first in the state to institute a full disclosure, apology, support and resolution policies for patients and families. In place for nearly two years, the policies were established before it was required by state and other regulatory bodies. The system's hospitals were also some of the first in the nation to share quality data with patients by posting Centers for Medicare & Medicaid Services core indicator data on its member hospital Web sites, including the psychiatric hospital Web site.
• Educating the Board: The EMHS board helps to set its strategic vision for safety and holds leaders accountable for achieving goals. EMHS provides personal training sessions on safety and quality to more than 150 individuals who serve on its volunteer boards so they can better understand patient safety and the Zero Defect project.
• Making the Patient and Family Part of the Safety Team: The leadership team has initiated the use of signage and patient literature throughout the system to encourage patients and families to step forward if they have concerns including questioning a doctor about handwashing or to learn about the medications they are taking. The system also has a rapid response team to allow families or patients to initiate an assessment of a patient if they have concerns.
• Sharing Knowledge: EMHS leaders feel that it is important to share their knowledge with others in the health care field to improve safety. For example, EMHS is one of the founding partners of a new, statewide coalition of all Maine hospitals dedicated to reducing the risk of hospital-acquired infections (HAI). The coalition members share learnings to speed the elimination of HAIs across the state.
• Building Safety Into the System: Since error can not be stamped out of human beings, EMHS leaders have decided to hardwire some safe actions into processes. For example, EMHS modified its computer admission system so that the admission process can not be completed unless the deep vein thrombosis risks for patients are filled out.

"At EMHS, transparency isn't just a policy, it's a way of life driven by the type of care we would want for our own families," said Michelle Hood, FACHE, president and chief executive officer of EMHS. "We are honored to receive this prestigious National Health System Patient Safety Leadership Award and are inspired to keep advancing the cause of safety in our system, across the state of Maine and the entire country."

"At a time when the nation is looking to overhaul its healthcare system, nothing could be more vital than patient safety," said Representative Mike Michaud (D-ME). "Reducing hospital efforts is key to improving care for all Americans, and driving greater efficiency in our system. All hospitals and healthcare groups should strive for the standard that EMHS has established."