For the Crew Resource Management training, Gabbe says he tried to lead off as many of the training sessions as he could because it was important to explain why these safety procedures were important and why the employees should care.
“These are things that really have become part of our culture now,” he says. “And again, it’s that communication — emphasizing what our mission is and how what we’re doing supports that mission.”
Communication goes both ways
In addition to communicating why, it’s critical to adapt to feedback throughout the change process.
In order to improve their patient satisfaction scores, Gabbe says they identified the physicians who were at the 90th percentile for patient satisfaction over the course of a year. They then held a series of breakfasts to ask what these doctors were doing to make patients so pleased with their care.
“The one thing that came through loud and clear was: ‘It’s not me, it’s my team,’” he says. “So, we said, ‘Tell us who the key person is, the go-to person, in your practice that helps you get to these outstanding patient satisfaction scores.’ And then we met with those people.
“And from there again we had common themes of what our other practices could do to be as successful.”
In addition, Gabbe says they met with the physicians in the lower end of the patient satisfaction spectrum to ask what their challenges were, how they could help and offer suggestions from people who were doing this better.
“And, you know, like everyone else, physicians are very competitive. They want to do better. They want to be among the best,” he says. “It helped us learn from the people at the top of the scale, and it helped us improve the people who were not meeting our expectations.”
Developing expectations
In order to change the culture, it’s important to generate constant expectations, whether that’s through peer pressure or just reminding people.
Hand-washing is one of the most important things hospital staff can do to reduce infections — washing their hands before they go into a patient’s room and when they come out.
Across all Wexner Medical Center hospitals, the staff used to wash their hands only about 35 percent of the time. Today that compliance is close to 95 percent.
Gabbe says they used “secret shoppers” on all their floors, letting the employees know they would be watched. They also enlisted the patient’s families to remind the staff.
Another component of changing the safety and quality culture was decreasing the chance for patient falls, which can cause serious complications for patients who are on anticoagulants.
The Wexner Medical Center worked alongside a patient’s family to develop a color-coded falls wheel. These now hang on the outside of every door.
It lets the doctors, nurses, staff and families know what is the risk for that patient if they fall, Gabbe says. It’s easy to understand that if the wheel is rotated to red, everyone needs to make sure that patient isn’t getting out of bed alone.
And once again, he says the patients and families were enlisted to be part of the team working to improve the quality and safety of all their hospitals.
Success breeds upon itself
When you have transparency, ownership and communication throughout the change, success can lead to more success.
Gabbe says improving their quality and safety represented changes in practice patterns, but now that Wexner Medical Center has been named the third-best among all academic medical centers that make up the 104 school University HealthSystem Consortium everybody is on-board.
They also make sure to celebrate in order to encourage these behaviors to continue.
For instance, every month there is a leadership meeting on quality and safety, and at the start of the meeting exceptional nursing units are recognized.
“The folks at (University Hospital) East have gone hundreds and hundreds of days in their intensive care units without having a central line associated bloodstream infection, and that’s just meticulous attention to detail,” Gabbe says.
