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How to Use Teamwork to Create a Culture of Patient Safety

Patient safety efforts need to start for health system boards, but be carried out by senior leadership and sustained by frontline staff.

Mike Seim, MD, the senior vice president and chief quality officer at WellSpan Health, can hardly remember the last time some of the system’s hospitals had central line-associated bloodstream infections or catheter-associated UTIs. It’s been a long time since those patient safety events, he said, mostly because of WellSpan’s overall culture of patient safety.

It might seem obvious why a healthcare organization would want to address patient safety. Patient safety is one of the most paramount features of the patient experience. Patients go to the hospital because they are sick and want to get better, and when an adverse patient safety event occurs, it gets in the way of good outcomes and, in many cases, a good patient experience.

But despite that, patient safety can often feel elusive. In January 2023, Mass General Brigham and CRICO, the medical professional liability insurer for the Harvard medical community and its affiliated organizations, found that adverse patient safety events are still somewhat common.

Patient safety events occurred in a quarter of inpatient hospitalizations in 2018, the team wrote in the New England Journal of Medicine. Of those patient harms, 23 percent were deemed preventable, and 32 percent were marked with high clinical severity.

According to Seim, the problem isn’t that healthcare organizations don’t care about or aren’t trying hard enough to achieve zero harm. But reducing patient safety is a team effort, and it can be difficult to orchestrate a consistent strategy across an entire organization.

“In most health systems, everyone talks about patient safety,” Seim said in an interview with PatientEngagementHIT. “But how do you create that overarching strategy to actually achieve measurable outcome results?”

The Pennsylvania-based WellSpan knew a culture of patient safety was going to have to start at the top with buy-in from the health system’s board of directors and CEO. As a group, they developed a set of measurable outcome goals for the organization’s frontline staff to adopt.

WellSpan didn’t exactly reinvent the wheel when doing this. Like most organizations, WellSpan was concerned with measures like hospital-acquired conditions, falls with injuries, and other events linked to CMS and other regulatory agencies. The health system also used the Pennsylvania Safety Authority’s requirements for serious event reporting.

As those goals moved down the line to frontline staff, Seim said it was time to implement a new, leaner management strategy.

“Oftentimes, across larger health systems, one area of the organization may solve a problem, but it never gets disseminated or spread across the health system,” Seim explained. “Our approach was to really create a formal process to identify safety concerns, figure out what the actual true root cause was of the problem, then commit the team's talents and resources to solving the problem to root and, ultimately, to disseminate and spread across the organization.”

Seim and his team started with WellSpan’s safety reporting system, which they rebranded into a safety-first system.

“We focused on rebranding it to the concept of safety first so it didn't feel like a punitive reporting system,” he noted. “It was trying to change the mindset of being reactive, so responding to problems after they occurred, to encouraging team members to have the mindset of reporting anything that could cause a problem.”

The safety-first reporting system was the result of multiple listening sessions with team members who stated that the shift in mindset helped them feel psychologically safe in reporting events. After all, it can be difficult to report when you or someone else has made a mistake for fear of disciplinary action.

“We wanted to create a culture where people not only felt they could, but that they were expected, and it was a requirement of their job that they raise any potential safety concern or potential harm,” Seim said.

With that, the organization also implemented its six-tier huddle system. Starting at 6:45 a.m., frontline staff meet to discuss any potential patient harm that could fall down the line with the intent of putting an end to them before they begin. Those huddles work up the chain of command until the sixth and final one happens at 9:15 a.m. with participation from WellSpan’s CEO.

These huddles, plus the entire work to achieve better patient safety, don’t start and end with the clinical team, Seim clarified. Every team member in the health system is expected to participate in these patient safety huddles.

“Our goal is to link every single team member to safety,” he stressed.

Those in patient financial services, for example, are tied to patient safety because some folks might forego care if they don’t get the right information about billing.

“Every team, from food services, environmental services, and patient financial services to the care teams, huddle every day and raise any concerns that could contribute to a less-than-ideal experience and/or safety,” Seim added.

The huddles and the rebrand have had a significant impact on patient safety. WellSpan went from 20,000 to more than 41,000 events being recorded within the safety-first system. That coincided with a nearly 50 percent decrease in serious safety events. It’s been nearly a thousand days since the last central line-associated bloodstream infection in some facilities and nearly a year since catheter-associated UTIs in other ICUs, Seim added.

That’s not just because it’s easier and more psychologically safe for team members to report potential incidents. WellSpan has prioritized transparency and follow-through on the part of its senior leadership, Seim pointed out, and it’s provided a bedrock of support for frontline staff.

When a team member contributes to the safety-first system, it’s on the senior leadership to uncover what process issues may have contributed to the issue and how to revise that process to stop the issue from snowballing and prevent it again in the future.

“It also goes back to us talking regularly about most errors happen because, as a system, we didn't support team members with our process,” Seim stated. “We have to go back and be willing to listen to the frontline team members about why this process was set up to fail and what needs to happen to fix it as a team. It starts with a sense of humility and inquiry as leaders to really say, ‘how did we fail as a system to allow this mistake to happen to a patient?’”

This level of engagement and accountability from senior leadership has helped bolster the confidence of other frontline staff members. The more team members see they won’t get fired for a patient safety event, the more comfortable they feel participating in the safety first system, Seim said.

Moreover, WellSpan has gone to lengths to ensure team members receive praise when they stop the line of adverse events.

“Our desire is to really celebrate team members when they do stop the line, even if it doesn't turn out to be a problem,” Seim explained. “We have what we call our Heads Up Speak Up Awards, where we celebrate everyone who did stop the line or identified maybe even a potential problem.”

Of course, patients themselves are important members of the care team, Seim acknowledged. Shifting the culture of patient safety has also meant empowering the patient and their family members or caregivers.

“We do give our patients the opportunity to recognize team members. We have a very strong philosophy of disclosure,” Seim concluded. “You actually build more trust with patients when you're transparent, and so really engaging our patients and being transparent with either a patient or a team member, a patient team member or family member, whenever anything adverse happens.”

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