The Goal: Zero Errors

Goal Zero Errors

The RWJBarnabas Health System is on a mission to achieve the highest safety standards.

If a nuclear power plant has a serious accident, it’s big news. In large part, that’s because organization in this and other high-risk industries, where errors can be catastrophic, have developed robust safety policies to prevent mistakes from being made. In industry parlance, they’re what’s known as High Reliability Organizations, or HROs.

The parallels to healthcare systems with their high-stakes, highly complex operations, are clear.

“At RWJBarnabas Health, we’re on a journey to becoming an HRO,” says John Bonamo, MD, MS, FACOG, FACPE, Executive Vice President and Chief Medical and Quality Officer at RWJBarnabas Health (RWJBH). “There’s no end point, no HRO certification. Instead, being an HRO is a way of doing business. Ultimately, it delivers the highest-quality care and safest experience for our patients and for our employees.”

The aim of initiative, called “Safety Together,” is clear – and bold. “Our goal is zero incidents of preventable harm to patients and employees,” Dr. Bonamo says, “That’s it.”

The three-legged stool

“When people are interviewed in large-scale focus groups about what they want from a hospital, they tend to mention three things,” says Dr. Bonamo. “One is, ‘Help me’ – that’s about excellence in the quality of clinical care. The second is ‘be nice to me’ – and that’s about the patient experience, the communication and kindness.

“Then there’s ‘Don’t hurt me.’ That’s about safety, the third leg of the stool. For a long time, hospitals didn’t pay enough attention to that.

“Now, the best hospitals realize that you can have the most expert surgeon and the greatest bedside manner, but those things aren’t enough if a patient falls out of bed or gets an infection from a catheter.”

Over the past year, all employees at every RWJBH facility have received in-depth training in safety, error prevention and performance excellence. “We’re giving employees a new skill set so they can actively prevent harm,” says Dr. Bonamo. The goal of zero defects is seen as everyone’s responsibility.

Tools for success

To aid in this quest, staff members have a number of tools and techniques to use. They include:

  • Stopping the line: “In the past, if a staff member had a feeling something wasn’t right, he or she might have buried that instinct, thinking ‘I’m probably wrong,’” says Dr. Bonamo. “Now they’re empowered to say, ‘I’m not comfortable with X, Y or Z.”

Recently, he recounts, a nurse was preparing a young woman to go into surgery for gall bladder removal when the patient mentioned she had a “funny feeling” in her chest. The nurse called an EKG (electrocardiogram) tech and refused to send the patient to the OR until the test was done. As it turned out, the woman in the middle of having a heart attack, and the delay may well have saved her life.

  • Clarifying questions: If a staff member is not sure about something that’s happening , he or she can be comfortable asking for clarification. In addition, every order gets repeated back. If the dosage ordered is 50 milligrams, the pharmacist or nurse will clarify, “That’s five-oh, right?” If the verbal order is for a urology rest there will an alphabet check to be sure it wasn’t for a neurology test.
  • Cross-checks: “That means that if you see me making a mistake, you correct me or ask if I’m sure that’s right,” says Dr. Bonamo. “In the past, people were afraid they’d be told to mind their own business.

“But now we realize that if I have a 1 in 1,000 chance of making a mistake and you have a 1 in 1,000 chance and we cross-check each other, there’s a million in one chance of making a mistake. We’re realizing that healthcare is a team sport.”

  • Safety huddles: Every unit in every building has a stand-up safety huddle each morning to go over the previous 24 hours and forecast the next 24. An hour later, there’s a facility-based huddle, a larger gathering with the same purpose.

Many voices

“Each of our employees has a new voice, a chance to practice at the top of their skills and be heard,” says Dr. Bonamo. “We’ve made significant progress in our safety event rate, and we’re confident it’s going to continue to go down.”

Each RWJBH hospital has created patient-family advisory councils to get more insight into how they can improve delivery of care. In any circumstance, Dr. Bonamo says, patients should demand the highest-quality in their healthcare. “You wouldn’t take a flight on an airline that didn’t have the highest-quality standards and a great safety record,” he says. “It’s the same thing in healthcare. You should be seeking care in a facility that’s on a journey to becoming an HRO.”

The ABCs of becoming an HRO

At RWJBarnabas Health, all team members follow these principals of safety:

S peak up for safety.

A ccurately communicate.

F ocus on the task.

E xercise and accept a questioning attitude.

T houghtfully interact.

Y ou and me together.