The Last Word

Getting to Zero

with Lisa Paletta, RN, MPA, NEA-BC, FACHE, CNO, Intermountain Healthcare Urban South Region, Provo, UT; Rishi Sikka, MD, senior vice president, clinical transformation, Advocate Health Care, Chicago, IL; Brigitte McKale, vice president, patient services, CNE, Pali Momi Medical Center, Oahu, HI

Is it realistic to set a goal of zero harm? Here, several leaders share their perspectives on goal-setting and getting to zero.

There Is No Patient It’s Okay to Harm!

“Initially, we set our goal to be in the top decile for core measures, hospital-acquired conditions, and other publicly reported measures, while also aiming for zero serious safety events. We engaged staff with a theme ‘Getting to Zero: The Power of You.’

However, after I attended Studer Group’s What’s Right in Health Care Conference in 2013, it was painfully apparent to me that by setting our goal in the top decile, I was essentially accepting the fact that we would not deliver very best practice to a portion of our patients. I asked myself, ‘For which of our patients is it acceptable to deliver less than best practice?’ Clearly, not one of them! When we considered goals in this light, our team quickly accepted and adopted the goal of zero harm…not just for serious safety events, but for all best practice measures.”

Lisa Paletta, RN, MPA, NEA-BC, FACHE chief nursing officer, Intermountain Healthcare Urban South Region, Provo, UT

A Culture of Always

“Three years ago, we took a comprehensive look at safety in our 12 hospitals and in the practices of our 1,000 employed physicians and determined our approach to safety was very reactive. As a result, we developed a very deliberate and structured high reliability strategic plan designed to proactively eliminate all serious safety events by the end of the decade.

With our team, we express our high reliability journey as “Always”… Always mindful, Always executing, Always delivering, Always safe. We also use a diagram that shows the interdependency of the three things we need to deliver on: service, quality, and safety always. Safety is spotlighted at the top because it’s primary to any decision-making we do.

Staff and providers understand this is no flavor-of-the-month initiative because we spent two years to develop a cultural foundation that rewards safety and transparency through engaged leadership as the first steps in rolling out this multi-year strategic plan.”

Rishi Sikka, MD senior vice president, clinical transformation, Advocate Health Care, Chicago, IL

On Daily Huddles

“We set goals for zero harm. In fact, every 24 hours, all leaders come together for a brief safety huddle to review the prior day and look forward to the next day. This has proven highly effective in communicating safety events real-time and identifying issues that need to be addressed and reported back on.

We also do concurrent review of quality metrics and report concurrent data at medical staff meetings so we can review cases that are still fresh in everyone’s mind. Even if there’s no harm to the patient, every fallout in a core measure is a failure to our patient.

And finally, we have a multidisciplinary team that meets for daily Length of Stay (LOS) huddles to discuss all patients that are with us on Day 4 to 10 as well as waitlisted patients for alignment and timely interventions. In three months of huddles, we’ve noted a sustained drop in our LOS and better collaboration between nursing, rehab, respiratory services, and case management. The huddles move quickly with a ‘plan for the day, plan for the stay, and plan for the way.’”

Brigitte McKale vice president, patient services, CNE Pali Momi Medical Center, Hawai’i Pacific Health System, Oahu, HI