HCA Healthcare’s Chief Patient Safety Officer shares why safe care is the ultimate care

This year, as our patient safety team made plans to celebrate Patient Safety Awareness Week and the work we are privileged to lead, it occurred to us that the ultimate care is, ultimately, dependent on safety. And a safe care journey for our patients is everyone’s responsibility. As we work to help our nearly 294,000 colleagues provide the safest possible care across one of the nation’s largest health systems, we feel great responsibility for — and take great pride in — the many ways we engineer safe practices into all that we do.

Safety is foundational in healthcare because you can’t deliver effective, quality outcomes without it. At HCA Healthcare, we have long been committed to a culture of patient safety, even before it was recognized as a healthcare discipline. Today, we have quality and safety standards that set expectations across the industry. That said, high-quality, safe care doesn’t just happen; it occurs by integrating people, processes and technology into our care delivery. Good quality and patient safety are purposeful and realized through measured outcomes that reduce harm, prevent suffering and save lives.

Although progress has been made in patient safety across the industry over the past two decades, the Institute for Healthcare Improvement (IHI) cites estimates that medical harm is a leading cause of death worldwide. IHI has also declared that preventing harm in healthcare settings is a public health concern. While eliminating avoidable harm is a lofty goal, HCA Healthcare’s colleagues have a vision and passion for a mission much larger.

I am thankful that I work with a family of like-minded people who share my passion for patient safety. As we recognize Patient Safety Awareness Week, I want to express my gratitude to HCA Healthcare’s leaders and colleagues for your partnership in this work. Throughout this week we are highlighting efforts from across our organization that demonstrate how harm is being avoided, learned from and/or prevented, including how:

• The Agency for Healthcare Research and Quality (AHRQ)’s Patient Safety Survey helps us foster a culture of safety
• We prevent harm through our Patient Safety Organization and Good Catch Awards
• Our antibiotic stewardship work is setting standards to combat antibiotic resistance
• We collaborate with families to ensure patient safety

Related article: HCA Healthcare’s commitment to delivering safe, high-quality patient care

Culture of safety

Safe, quality care must be embedded into an organization’s culture. Across HCA Healthcare, patient safety and care experience teams are responsible for managing a federally chartered patient safety organization, and overseeing event reporting, patient experience, barcode medication administration and medication diversion prevention, among other programs. These teams also are responsible for clinical pharmacy surveillance software, implemented to prevent life-threatening medication errors, improve patient outcomes and reduce drug waste.

We leverage AHRQ’s Survey on Patient Safety Culture to help us sustain a culture of safety. This survey is an invaluable tool that helps drive our safety agenda and ensure that we are accountable for the care we provide to our patients. As we assess our anonymous survey results and candid feedback, we are able to draw insights into the strengths of our safety culture as well as our vulnerabilities. 

Patient Safety Organization

HCA Healthcare’s Patient Safety Organization (PSO) was established nine years ago and has seen significant growth. The mission of our PSO is to improve patient safety and the quality of healthcare delivery by partnering with its members to build systems, refine processes and foster a culture of safety. To fulfill this mission, HCA Healthcare:

• Established focused task forces to address patient safety concerns
• Actively looks for opportunities that allow our front-line experts to openly discuss, analyze and take action on patient safety concerns
• Conducts proactive risk assessments, process investigations and improvement initiatives
• Partners with clinical experts to disseminate “Calls to Action” regarding significant patient safety concerns
• Shares lessons learned from analyses of serious safety events in order to make improvements across HCA Healthcare
• Supports transparent patient safety event reporting and associated investigation and improvement

PSO protection for Healthcare Reporters (those who report concerns) is an often overlooked but powerful protection. It protects those who report adverse events and near misses. This includes events that were reported to them as well as events they witness. This protection is similar to whistleblower protections in that an individual cannot suffer disciplinary actions simply for reporting something to the PSO. Without the fear of reprisal, employees feel safe to report, and better reporting leads to better outcomes.

Good Catch Program

Creating a culture of safety where our colleagues feel empowered to speak up is a key component of our culture. Our “Good Catch” program encourages and celebrates the reporting of potential errors, adverse events and close calls regarding patient safety. Reporting of close calls allows facilities to intervene and correct weaknesses in processes or systems before harm occurs. We scale the learnings from these events across our organization to improve patient safety and the quality of healthcare delivery.

I encourage leaders to recognize colleagues when they make Good Catches and seek to understand how the issue occurred so it doesn’t happen again. As more Good Catches occur within our care settings, we will reduce these incidents, improve our processes and ensure a just culture.

Antibiotic stewardship

Antibiotics are medicines used to prevent and treat bacterial infections, which we rely upon heavily across the world. And while antibiotic resistance occurs naturally, misuse and overuse of antibiotics are accelerating the process. According to the World Health Organization (WHO), antibiotic resistance is one of the biggest threats to global health, food security and development today, and leads to longer hospital stays, higher medical costs and increased mortality.

HCA Healthcare’s antibiotic stewardship work, which began in 2008, has been designed to reduce overutilization through work with our infectious disease specialists. This includes efforts to ensure appropriate order sets, dosing and timing, and use of as narrow spectrum antibiotics as possible. We have worked to integrate pharmacists into our care teams to help our providers understand when to switch antibiotics or when to de-escalate.

In 2015, we formalized this work across our organization with the rollout of stewardship programs in all HCA Healthcare facilities to increase oversight and guidance. In accordance with The Joint Commission’s (TJC’s) national standards, we have been ahead of the curve for all TJC’s growing antibiotic stewardship requirements. Our ongoing clinical trials to reduce healthcare-associated infections as well as antibiotic resistance can be found in publications like The New England Journal of Medicine and The Lancet, and we continue to develop this body of research.

I am proud that HCA Healthcare is leading the way to drive meaningful change worldwide in appropriate antibiotic use, to curb resistance and improve patient safety everywhere.

Related article: HCA Healthcare’s innovative approach to surgical recovery promotes better outcomes, decreased opioid usage and faster recovery times for patients

Collaboration with family

An important part of HCA Healthcare’s efforts to foster a culture of safety is collaboration with patient families. We believe family is part of the care team and an important part of patient recovery, so we work hard to keep them connected to their loved ones. Even throughout the COVID-19 pandemic, we ensured that family members kept connected through telehealth and many other safety-first protocols, and worked to revise and relax those protocols as soon as it has been safe to do so.

Our infection prevention team works closely with other teams such as neonatal intensive care units (NICUs) and home health and hospice agencies to maintain family connections in difficult situations while ensuring compliance with safety protocols. Helping to keep patients and families as safe as possible is part of our commitment to caring like family.

With gratitude

Thank you to all HCA Healthcare colleagues for your partnership in our patient safety work and for your commitment to the care and improvement of human life. There is nothing more important than providing a safe experience for the people who entrust us with their care.

Karla Miller

Karla Miller, PharmD, BCPP, Chief Patient Safety Officer