Our Reliable Health™ organizational capability aims to drive improvement in clinical performance – quality and safety – along with the consumer experience across the continuum of care. Optimizing and standardizing care processes makes it easier for our caregivers to deliver high-quality care reliably. Reliable processes are critical to moving Texas Health toward zero preventable harm events as it aligns best practices across the organization and disseminates shared learning.
Since 2015, we have been designing and hardwiring evidence-based best practices into our clinical teams' processes to deliver care across the system. This effort requires extensive research and the collective expertise of our administrators, clinical leaders, employees, and patient safety and quality improvement teams.
By standardizing processes and workflows, we eliminate unnecessary variability that increases the risk for errors and leads to injuries. We apply these processes broadly – from how we take a patient's vitals to processing lab specimens to treating sepsis. To promote ongoing improvements, we review industry benchmarks, share lessons learned and set aggressive performance goals.
We apply this same framework to enhance other processes, such as patient registration, safety measures, consumer feedback and making care more affordable. We're building metrics into all processes to measure what impact a new method has on the outcome. We have completed more than 60 “Reliable Care Blueprinting” modules to improve sepsis treatment processes, reduce healthcare-associated infections, screen for emerging diseases on admission, improve outcomes for hip and knee replacements, and more.
Consumers count on us to deliver on our promise of safe, reliable care, so we continually raise the bar on error prevention. Every member of our care team must speak up for safety to reach our goal of zero preventable harm events. We must adequately report unsafe behaviors and near-misses to reduce and eliminate potential risks.
To identify where adverse events occur and determine their root causes, we continuously examine data and analytics on the reliable health safety dashboard. This helps us to quickly make improvements or introduce more effective methods to reduce harm. To reinforce high reliability and patient safety, we coach and train clinical teams to:
- Use our error prevention tools.
- Deploy a reliability learning tool to accurately capture safety events and near-misses to identify trends and accelerate improvements.
- Adhere to our safety policies, processes and systems.
- Conduct morning safety briefings to address safety concerns.
- Share safe management practices and alert system safety leaders when issues arise to mitigate risks that could occur elsewhere in the system.
- Communicate with care teams to ensure they receive critical information.
By standardizing safety processes, introducing high-reliability processes and optimizing reporting tools and practices, we have reduced serious harm events by 40% since 2018.
Continuously delivering quality care is a key strategy for Texas Health. We design and deploy innovative care models that measurably improve consumers' quality of care and reduce hospital-acquired infections. Multidisciplinary teams collaborate to standardize care. They develop and deploy robust infection control processes, tools and evidence-based best practices to keep consumers safe and healthy. Our dedicated workgroups regularly monitor performance and design interventions that improve care delivery and outcomes.
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When Texas Health's leaders first became aware of coronavirus, they leveraged previous learnings and experience from prior emerging infectious disease events to stay at the forefront of the pandemic. They understood that while an initial plan was important, the system's ability to adjust and respond with agility as the situation unfolded would be more critical.
Multidisciplinary teams collaborated to develop workflows, tools and resources to protect patients and employees. They acted swiftly, from securing personal protective equipment to creating additional negative pressure care areas for COVID-19-positive patients. Additional efforts included:
- Requiring universal masking onsite. Caregivers also wear eye protection during patient care.
- Continually modifying processes to align with nationally recognized guidelines and utilizing our electronic health record to drive best practices.
- Creating automated and manual screening processes for all persons (healthcare personnel, patients and visitors) entering our facilities.
- Diversifying our suppliers of masks, shields, gowns, hand sanitizer and other personal protective equipment to reduce reliance on a single vendor or agency.
- Engaging ventilator suppliers to ramp-up production while safely transitioning anesthesia machines over to ventilators. This increased our capacity by more than 100 ventilators.
- Establishing COVID-19 hotlines that consumers and community clinicians could call with questions. The consumer hotline also facilitated scheduling of appointments for testing.
- Suspending elective surgeries and nonessential care to free up caregivers and beds to treat COVID-19 patients and others who needed emergent care.
- Expanding telehealth to deliver routine, preventive and other services remotely.
- Increasing our laboratory testing capacity to screen as many consumers as possible.
- Adhering to our existing safety protocols and reporting processes to mitigate risks.
Additionally, we established a System Virtual Incident Command Center to organize and coordinate our clinical and operational response. Recognizing that best practices surrounding COVID-19 were still evolving, we developed a clinical guidance manual so that our teams knew how to manage patients with the virus. The manual is a living document updated as the knowledge surrounding the disease evolves.
As new treatments and vaccines come to market, our infection prevention, infectious disease and pharmaceutical teams vet them to ensure their safety and effectiveness. The learnings about these therapies change continuously.
To allow entity leaders to monitor resources, we launched an online COVID-19 dashboard that shows each hospital's bed capacity, equipment availability, staffing capacity and supply usage for today and five to seven days into the future. This allows them to adjust during patient surges or respond quickly to anticipated staff or supply shortages.
Texas Health won the 2020 Texas Hospital Association's Bill Aston Quality Award for significant strides to improve patient outcomes in fighting sepsis. Sepsis is a life-threatening condition that occurs when an infection triggers a systemic chain reaction, causing tissue damage and organ failure. Texas Health intensified its focus on decreasing sepsis mortality since the infection claims the lives of one in three patients who die in hospitals nationwide.
To drive rapid improvement, we formed a Comprehensive Sepsis Workgroup of representatives from nursing, laboratory, pharmacy, physicians on medical staffs and other stakeholders. This team:
- Enhanced the order sets and processes already created in the Reliable Care Blueprinting process and further mobilized efforts to standardize sepsis care across the system.
- Met monthly to discuss all aspects of sepsis-related care. They reviewed best practices, cases, patient data and identified processes that had the most impact on patient outcomes, such as administering antibiotics.
- Designated a team member at each hospital to serve as a sepsis coordinator. Emergency Departments also implemented Code Sepsis, initiating a rapid response for patients suspected of having sepsis.
As a result, sepsis-related mortality at Texas Health decreased from 11.23% in 2015 to 7.12% in 2020, putting our system in the top 10% nationally for sepsis care.