Our Programs Achieve Critical Goals: Safer Health Care and Reduced Costs
LifeWings has had consistent, documented success helping clients achieve their improvement goals. Our programs are designed to provide optimal ROI and measurable, demonstrable, sustainable results.
Like many health care organizations, St. Francis Hospital in Columbus, Georgia, (SFHGA) knew that to ensure its sustainability with the torrent of changes in health care, it had to make safety a major priority. Although the hospital had a solid quality and safety record overall, less-than-optimal communication and teamwork in the OR had led to some negative outcomes.
Hospital leaders knew they had to move from good to great. So the CEO made quality and safety their top priorities and took the unique step of incorporating this mandate into the hospital’s strategic plan. The move worked. The results from their initial CRM implementation, started just a year ago, are remarkable.
In the fall of 2009, the leaders of St. Mary’s Good Samaritan, Inc. (SMGSI) committed to “reducing the incidence of preventable harm to zero” with improved teamwork and communications through use of the TeamSTEPPS program.
SMGSI, one of the largest systems in Southern Illinois, is comprised of two mid-sized hospitals: St. Mary’s Hospital in Centralia and Good Samaritan Regional Health Center in Mt. Vernon. SMGSI provides critical services to the area including emergency care, medical/surgical, oncology, neurology, mental health, obstetric, cardiology, orthopedic, pediatric, and rehabilitation.
The leaders at SMGSI realized that to fully address their weak areas and see real improvements, they needed more than just an out-of-the-box program. Their foresight resulted in several measurable improvements and a clearer path to greater safety in the future.
Training Magazine ranked Miami Children's Hospital as the 3rd top training organization in their renowned ranking of the best 125 training organizations in the US. The hospital ranked higher than Vanguard, the US Navy, Microsoft, Best Buy, and other world-class organizations. The Training Magazine report is the only report that "ranks companies unsurpassed in harnessing human capital." MCH was also recognized for having the highest scores in three application categories and overall qualitatively. Additionally, they received a special award specifically for the work they have done with their LifeWings CRM implementation.
For Miami Children's Hospital (MCH), winning awards is standard operating procedure. But its latest award, which acknowledges its outstanding training program on a national level, is an important affirmation of the remarkable results they have achieved from their comprehensive patient safety initiative. MCH was founded in 1950 and provides dedicated pediatric care in more than 130 sub specialties through its 650 attending physicians. But this year, for the first time, MCH has been ranked in the top five of the 125 companies selected for the 2012 Training Top 125– Training magazine's report on excellence in training and employee development. Miami Children's Hospital pediatric subspecialty programs have been selected among the nation's best by U.S. News and World Report since 2008 and the exceptional care at Miami Children's Hospital has garnered it the designation of Magnet facility by the American Nurses Credentialing Center (ANCC). The best organizations in the U.S. compete for high rankings in this report by providing information on their programs and results. In 2011, when MCH received an excellent ranking of 14– higher than Intel, FedEx Express, and McDonald's– the competitive field included medians of $1.2B in revenues and 6,000 employees.
A Level 1 Trauma Center hospital is saving an estimated $1.2M per year (or more) through their elimination of retained foreign object and their decreased expenses for travelling nurses. A surgical sponge can cost a hospital a few cents. But when it's left in a patient's body after surgery, the human and financial costs are crushing. When one major hospital in the west recognized the need to eliminate these types of errors, they acted swiftly and got bold results. The incidence of retained foreign objects (RFO) after surgery is so common that some malpractice attorneys specialize in providing services dedicated to that type of medical error. One report indicated that 1 in 5,500 surgeries resulted in an incidence of an RFO –— 68% of the time the object is a sponge.
The hospital was averaging several RFOs per year. In addition to being potentially life threatening, the errors were also damaging the hospital's bottom line. Hospital leadership knew that inaction was not an option. Due diligence on successful improvement programs convinced hospital leaders that a sound place to start their ambitious program was with crew resource management (CRM) training. Leaders reviewed proposals from several CRM providers and selected LifeWings because of the program's results and focus on sustainability. The results of the hospital's focus on this issue are remarkable; since the OR team has learned and implemented the communication, safety, and debrief tools taught in the LifeWings program and added the use of radio frequency-based scanning devices to help track sponges (this does not help with instruments), the hospital has had zero cases of objects retained.
In 2006 leaders at the largest provider of maternity care between Montreal and Manhattan decided to partner with LifeWings to uncover and fix potential problem areas in their state-of-the-art maternity center. Their effort worked. When the hospital implemented the Press Ganey Safety PerformerTM solution, an assessment of the hospital’s safety culture based on direct feedback from its staff, their percentile rankings compared to hospitals of all sizes, improved by 9%. Observational feedback from personnel at various levels confirms that staff morale is better, turnover is lower, teamwork dynamics and emergency response are better, and patient satisfaction has improved—all the intended results of a comprehensive improvement plan utilizing proven CRM methods.
To demonstrate the seriousness of their commitment to adopting CRM methods, leaders closed down the OR department for two days—a significant investment and one not done before—and trained more than 247 nurses, physicians, and staff. After the initial project, six other departments participated in the LifeWings CRM training. The use of CRM methods has made such a difference at the hospital that in 2010, the hospital created a position dedicated solely to improving safety. The Director of Patient Safety and CRM services and a graduate of the LifeWings Train-the-Trainer program, affirms that “We are on the forefront of CRM compared to our peers. We see daily how the teamwork principles are a part of who we are here; we say they’re in our ‘DNA’ and the maternity center is an excellent example of the potential results.”
- In a major academic medical center in Texas, we worked with the Medical Director, the Chief Nursing Officer, the Dean of Medicine, the Executive Director, and the Senior Director of Outcomes and Performance Improvement.
- One of their goals was to reduce incidences of retained objects from surgery. Lack of communication and teamwork between the physicians and nurses led to increased errors, including four incidences of retained objects from surgery in 7 months.
- Recognizing the need for improved quality of care, the hospital contracted with LifeWings to provide a series of customized, on-site training seminars and safety tools workshops. Lifewings was able to create specific safety tools based on the skills taught in classroom to allow for better teamwork and effective communication. By improving communication, team building skills, and creating more reliable systems in the operating room, the hospital was able to reach their goal.
- To date, the hospital has been able to reduce their incidences of retained objects from surgery by 75%.
A 55% Reduction in Patient Harming Perinatal Triggers And A Significant Increase in Days Between Serious Events
- In 2007 a client engaged LifeWings to help their staff and physicians implement teamwork and communications skills to continue their improvements in quality and patient safety. While the client was already performing well, they recognized the need for improved patient outcomes. We worked with them to develop a comprehensive plan that included management commitment, formal training, resources for implementation, and performance measurement.
- Two of the client-identified metrics to assess their success in making greater improvements in patient safety were: days between serious events – note that a serious event is more broadly defined than “sentinel events” in order to provide a metric with greater sensitivity, and IHI Perinatal Triggers – a tool used to indicate the rate of potential physical harm via a retrospective review of patient records.
- LifeWings provided the client a thorough risk assessment that revealed specific areas where patient outcomes were likely to be adversely affected; interdisciplinary collaboration, time-critical communications, and resilient “transfer of care” communications. We developed a training plan based on their specific needs and a Hardwired Safety ToolsSM implementation plan.
- The client has determined that their implementation of the teamwork and communications skills and Tools developed via the LifeWings® program has significantly improved patient outcomes:
- A reduction in the average number of perinatal triggers from 3.67 in 2007 to 1.67 in 2008. This approximate 55% reduction resulted in more patients being spared physical harm and most likely saved the client malpractice claims and insurance increases.
- An average increase of more than 180 days between serious events from January 1, 2007 (58 days) and May 15, 2009 (245 days).This significant increase in the number of days also provided the client a significant return-on-investment for their program.
Reduction in Wrong Surgeries: Achieving an Error Rate 10 Times Better than the National Average
- In a hospital in the Mid-south we worked with the Chief Medical Officer, the Chair of the Department of Surgery, and the Dean of Clinical Affairs. Their goal was to eliminate wrong surgeries by improving communication in the operating room. Both physicians and physician leadership were evaluated by the hospital based on the number of cases.
- There was tremendous pressure to increase throughput. The increased pace led to increased errors and a rise in claims, caused by a series of serious wrong surgery incidents (approximately one every 60 days).
- The leadership wanted a way to retain their hard-won efficiencies but reduce their medical error rates that were directly draining dollars off the bottom line. LifeWings created specific tools to allow for team building, a defined communication protocol between physicians and staff based on the aviation model, and Hardwired Safety ToolsSM that incorporated The Joint Commission Time-out briefing.
- The training and Hardwired Safety ToolsSM were successful. To date, the hospital, with our help, achieved an error rate of 0.15 per 10,000 procedures; a rate over 10 times better than the national average. We believe this reflects the results of an improved level of coordination and communication among the staff. The improved communication in the operating room and increased efficiencies reduced the amount of profit needed to pay claims and created a better place to practice medicine for the physicians.
- For an academic health center, we worked with the Dean of Clinical Affairs and his Project team. Their goal was to improve their observed-to-expected mortality figures. Their pre-project rate exceeded 1.0 and was a key metric in their drive to become one of the safest institutions in the country.
- The hospital leadership analyzed the factors contributing to the higher-than-desired number and decided they needed better teamwork, communication, and processes to lower the number and ensure the safety of their patients. They realized communication was the heart of every other process implemented to improve their score. As long as communication patterns were flawed, all other improvement processes would suffer.
- They needed powerful communication training for their critical care staff and physicians and system tools that would require and support the use of the new communication skills learned in the training.
- Our patient safety training provided both the targeted communication training and system tools they needed. Since implementing the communication tools, the hospital has experienced a 43% improvement in their observed-to-expected mortality figures.
- The President of a hospital called LifeWings to get help improving teamwork and processes with the goal of improving the rate of administration of pre-procedure antibiotics.
- Although the evidence is clear that the delivery of pre-procedure antibiotics has a dramatic effect on post-surgical infection rates, the hospital was having difficulty in getting compliance with the protocol. Post surgical infection rates were increasing.
- The leadership wanted a way to create specific tools and better communication patterns in the pre-procedure brief to improve the culture of safety among their clinicians and increase the compliance rate of antibiotic administration.
- Our compliance training and tools workshops delivered the results they sought. The hospital has achieved an increase in compliance, from 68% to 96%, and reduced post-surgical infections.
- In an academic health center we worked with the office of the CMO. The goal was to improve staff satisfaction. The staff realized that not only was turnover costly in terms of replacement and recruitment costs, their care-giving teams needed greater permanence to cut down on teamwork and communication errors.
- The leadership wanted teamwork training that fostered a sense of community among the staff and that would change the way the staff felt about themselves and the institution for which they worked.
- The LifeWings® teamwork training and tools implementation projects gave the hospital leadership the ingredients to meet their goal. The hospital found that employees (as measured by an Employee Satisfaction Survey) that attended the teamwork training and worked in departments using the Hardwired Safety ToolsSM had a greater sense of teamwork and satisfaction with their place of work than those employees that had not attended the training and did not work in departments using the Hardwired Safety ToolsSM.
- For a hospital in the Mid-west, we worked with the Chief Medical Officer and the director of Patient Safety and Quality. Their goal was to improve patient flow and the quality of care in the ICU. One of their ICUs had experienced several near misses and adverse outcomes, all related to teamwork and communication.
- The leadership wanted a way to create a hospital ICU improvement plan with specific quality improvement tools to allow for team building among the staff at the beginning of each shift, and a defined communication protocol between physicians and staff to ensure the most critical patients were seen first, followed by patients ready to be discharged to free critically needed rooms.
- LifeWings provided teamwork and communication training to all care givers and created a Pre-Shift Briefing format and guide to hardwire the communication and coordination skills into daily operations.
- Our training and quality improvement tools met the hospital’s need. The Briefing protocol has 100% acceptance and usage. Near misses have decreased. Patient flow has improved and the timeliness of critical care has improved. We believe these results reflect an improved level of coordination and communication among the staff as a result of the training.
- In a hospital in the central U.S. we worked with the Chief Nursing Officer to reduce nurse turnover in two of the hospital’s ICUs. Friction between physicians and nursing staff had increased dramatically due to poor communication styles and lingering resentments. Morale was at an all time low and nurse retention costs were at an all time high.Poor teamwork and physician and nursing communication had affected the quality of care and near misses and adverse outcomes had risen.
- The CMO and unit managers wanted to reduce turnover by creating a sense of teamwork among the staff and physicians. LifeWings created specific tools to allow for team building and provided focused communication training to improve information flow in a defined and precise way. Additionally, the staff was equipped with a system to provide for early detection of warning signs that coordination was breaking down.
- Our training and tools were successful. Turnover in the ICUs decreased by 23% and 35% respectively. The cost savings in reducing turnover provided a project ROI of over 223%.
- Specifically, in a hospital in the Midsouth we worked with the COO, the Director of the OR, and the Director of Risk Management. Their goal was to eliminate counts errors in the OR. Counts errors were increasing and costing the hospital in terms of increased procedure times, delays, efficiency, staff frustration, and patient harming errors.
- The leadership wanted a way to reduce the counts errors and thereby reap improvements in cost, patient safety, and quality care.
- Our team building training and tools provided those results. The teamwork and communication training improved the overall level of coordination in the OR, and the Hardwired Safety ToolSM created specifically to improve the counts process reduced the number of counts errors by 50%.
The results of this project appeared in a peer-reviewed journal. The reference is: RM Rivers and Diane Swain and Bill Nixon, “Using aviation safety measures to enhance patient outcomes,” AORN Journal 2003; 77:158.
- In a nurse-managed primary care clinic in Nashville, TN the leadership team wanted to improve their quality of care by building a more structured, time-efficient system. LifeWings worked with the clinical manager and director to decrease patient visit time and shorten new employee orientation time.
- To improve the flow of information and overall efficiency, LifeWings customized and delivered team-building skills training and safety tools. The project targeted training, task re-distribution and decision-support tool development in order to meet their goals.
- Daily, organized briefings, checklists and communication strategies were implemented into the organization’s every day routine. These tactics have instilled a sense of order that was missing prior to the implementation of the LifeWings® program.
- With the re-designed process in place, our training team was able to meet the clinic’s needs. Patient visit time decreased by 10 minutes per appointment and new employee orientation was reduced from several days of observation and instruction to a one-day demonstration and review. The staff evaluated the new process as highly useful and expressed gratitude for learning what is now expected of their performance.
- For an inner-city community clinic in the Midsouth, LifeWings worked with clinic leadership to improve new employee training, teamwork, and standardization with the ultimate goal of improving the diabetes care provided to its patients. The clinic leadership recognized that their recruitment and new employee orientation programs were not cost effective. In addition, their teams were providing less than optimal diabetes care due to limited resources and lack of teamwork.
- Poor adherence to diabetes care protocols carries an increased risk for serious, sometimes life-threatening, complications including blindness, amputation, and heart disease just to name a few. The community clinic leadership team wanted a way to implement specific communication strategies and safety tools in order to standardize and improve the quality of diabetes care in the clinic.
- The LifeWings® patient safety training program targeted specific communication techniques and Hardwired Safety ToolsSM in order to meet the clinic’s needs. Following the training and safety tools implementation, a formal study of 619 type 2 diabetes patients was conducted over a thirteen-month period. The study concluded that the LifeWings intervention resulted in improved diabetes care. In addition, the clinic documented a measured decline in nurse turnover rates, a decrease in patient visit time, reduction in new employee orientation time and an overall improvement in patient outcomes.
- View the complete formal study.
- In a large hospital in the Southwest LifeWings worked with the Chief Executive Officer, the Dean of Medicine, the Chief Nursing Officer, and the Sr. Director of Outcomes and Performance. The hospital was struggling with protracted OR turnaround times. OR personnel were able to meet their turnaround goals only 44% of the time.
- Hospital leadership realized the poor levels of efficiency increased staff and physician dissatisfaction, lowered patient satisfaction, and reduced profitability. Their goals were to dramatically improve OR turnaround times, while improving staff and patient safety and as a by-product, improve staff and physician satisfaction.
- To meet their goals, LifeWings provided a combination of teamwork skills workshops and implementation of customized Hardwired Safety Tools SM. The Safety Tools included checklists and standard operating procedures. Once the LifeWings® training and tools were implemented, the hospital experienced a 51% improvement in OR turnaround times. Both efficiency and patient safety increased as reported events of surgical error decreased. As a result, both physicians and staff reported greater satisfaction with their employment.
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