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How AdventHealth Achieves Optimal Patient Safety, Healthcare Quality

AdventHealth has recently been recognized as an exemplar in patient safety for its system for supporting all of its hospitals in healthcare quality improvement.

For AdventHealth, one of the biggest faith-based health systems in the country, patient safety isn’t just a tick-the-box metric; it’s essential to overall quality and patient experience.

In fact, patient safety fits hand-in-glove with healthcare quality and experience, according to William Scharf, MD, the executive clinical director of safety and quality for AdventHealth. When the Institutes of Medicine, now the National Academy of Medicine, broke ground first with To Err is Human and again with Crossing the Healthcare Quality Chasm, the healthcare paradigm shifted. It became clear through those seminal papers that patient safety is, in fact, a key component of quality healthcare.

And, in turn, it’s become a vital component of the patient experience.

None of that’s to say healthcare quality is the same as or defined solely by patient safety. There are many elements that constitute a high-quality healthcare experience, including good clinician bedside manner, clean facilities, and convenient care access. But those factors move the needle much if something bad happens, like a severe adverse patient safety event.

“Quality is the achievement of a positive outcome,” Scharf told PatientEngagementHIT in a recent interview. “Safety is the avoidance of a negative outcome, namely that of harm.”

AdventHealth isn’t just talking the talk on this. In an industry first, AdventHealth has received the first-ever Emerald Award for a health system from patient safety firm Leapfrog Group. The award comes after nearly two dozen AdventHealth hospitals earned an ‘A’ grade on The Leapfrog Group’s safety grades and 14 of the health system’s hospitals received the Top Hospital award, placing those facilities in the top 5 percent of patient safety.

Scharf said achieving high patient safety marks requires a coordinated effort across AdventHealth’s quality and safety team. In 2015, the health system set three clinical imperatives, first striving for every hospital to get a Leapfrog grade A.

Additionally, the organization set the goal of having each of its hospitals receive a four- or five-star rating from CMS and score in the top-performing quartile for the Premier observed-to-expected mortality ratio.

Scharf said those ambitions were purposeful and intentional, harkening back to the relationship between patient experience, quality, and patient safety. Although those three domains are distinct, a health system can’t have one without the other two.

Achieving those imperatives requires a serious team-based effort, Scharf added.

“We have a process within AdventHealth called the Clinical Excellence Review,” he stated. “My team meets with clinical and administrative leaders twice a year, and we review their data and their action plans to make sure that they're going in the right direction.”

Those plans are different depending on the hospital, Scharf pointed out, who himself works with about 40 hospitals. Every hospital has different skill sets and histories, so the quality and safety team needs to determine the appropriate type and amount of coaching required for clinical quality improvement.

Take, for example, a hospital that’s already hitting those three metrics—the high safety grades, the good CMS star rating, and the high performance on the Premier O:E ratio. Even though they're performing optimally, Scharf and his team can’t ignore these groups lest their ratings slip.

There are also more middling performers that might be scoring well in one of the three domains but are hovering closer to the middle in the others.

“We help prioritize and provide focus,” Scharf explained of these hospitals. “We've got dashboards on all of their results, both historical and most recent, and what they can do to improve. And to that end, it's just a little bit of providing insights, what they can do to help get that A grade.”

But perhaps most critically, there are the hospitals that need more extensive coaching to achieve good quality, safety, and experience. These are usually hospitals AdventHealth has recently acquired, Scharf pointed out. And considering prior research suggesting that recently acquired hospitals see drop-offs in quality and safety after the acquisition, Scharf said this group has become a top priority.

“It's almost like a couch to 5K program,” Scharf offered. “What is it that you need to do to get where you need to be? And as part of that, we will do site visits and we will go and visit some of the hospitals, meet with our C-suite leaders, just to help elevate their healthcare data literacy and help them understand what resources we have to help provide support for them so that they can achieve the clinical imperatives.”

This isn’t a quick process, Scharf added, and for some hospitals, quality and safety are still works in progress.

“We already have a couple of hospitals that we have acquired that have achieved the clinical imperatives, and we're working closely with those we have recently acquired,” Scharf said. “And that whole journey for them takes about really three to six years. So, we're in for the long run for these guys.”

But achieving those imperatives looks promising, especially for an Emerald Awardee. Taking the time to work toward quality, safety, and experience is a true investment, but it pays in dividends as the healthcare industry as a whole works toward the Triple Aim.

“This journey of safety and with the patient experience is this is not a sprint, this is a marathon that doesn't end,” Scharf concluded.

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