In this section:

Texas Health aims to deliver exceptional care to improve health outcomes. We place particular emphasis on these areas:

Quality

Continuously delivering high-quality care – safe, effective, patient-centered, equitable, timely and efficient – is a key strategy for Texas Health to improve communities' health and well-being. In addition to the ways we deliver reliable and safe care, we:

• Design and deploy innovative models of care that measurably improve consumers' quality of care and reduce healthcare-associated infections.
• Engage multidisciplinary teams to integrate best care practices into standardizing care. For example, we collaborated to develop a surgical site infection (SSI) bundle containing evidence-based practices that streamline infection prevention measures before, during, and after surgery.
• Develop and deploy robust emerging disease screening and management processes and tools.
• Design interventions and evidenced-based processes that lead to positive health outcomes.
• Improve how we document and coordinate care and engage patients after discharge to monitor adherence to care plans.
• Monitor systemwide data readmissions, mortality rates, care transition management and social determinants of health to identify and address concerns and gaps in care equity before they escalate.

We participate in various regulatory and disease-specific accreditations that help us monitor and improve quality.

2022 Highlights

Since 2021, Texas Health has reduced inpatients’:

• Central line-associated bloodstream infections (CLABSI) by 41%.
• Sepsis mortality rate by 1.17% and sepsis observed-to-expected (O/E) mortality ratio by nearly 41%.
• Colon surgical site infections (SSIs) by 44% and abdominal hysterectomy SSIs by 11%.
• Overall mortality O/E ratio by 33%.
• Pneumonia mortality O/E ratio by 39.8% and readmission O/E ratio by 11%.

More data can be found in our 2022 Social Purpose Report Summary. Additionally, Texas Health:

• Received numerous care quality awards, including the 2022 Bill Aston Award for Quality, The Joint Commission’s Gold Seal of Approval® for Neurotrauma Certification and Magnet designation. Several nurses also were honored by the DFW Great 100 Nurses for nursing excellence.
• Had several entities recognized among the 2022-2023 Best Hospitals, top surgical centers, top physical rehabilitation centers and for excellence in cardiac care. Six hospitals also earned five-star ratings from the Centers for Medicare & Medicaid Services, the most in North Texas.

Snapshot: Cutting CLABSIs During the height of the COVID-19 pandemic, hospitals nationwide saw an increase in central line-associated bloodstream infections (CLABSIs) because of the number of high-acuity patients and longer lengths of stay. These can lead to an increased risk of death and excessive hospital costs. Texas Health enlisted an external consultant to assess central line insertion and maintenance at several hospitals, who found that most infections were related to line maintenance. We then assembled a work group of nursing and infection prevention specialists to recommend actions based on these insights. The group also conducted a gap analysis at each entity to assess if nationally recognized best practices were being followed and to identify and address areas of non-compliance. They suggested forming hospital vascular access teams of skilled experts to insert and maintain catheter lines. These efforts helped Texas Health reduce CLABSI rates by 41% in one year.

Reliability

Reducing unnecessary variation in care helps us save lives, reduce medical errors, deliver a better care experience and lower costs. Since 2015, we have been designing and hardwiring evidence-based best practices into our inpatient processes to deliver high-quality, safe care every time, in every hospital, for every person.

Many hospitals are implementing clinical redesign to improve patient outcomes. We go farther. Our Reliable Care Blueprinting™ (RCB) initiative aims to optimize and standardize our care processes and make it easier for our caregivers to consistently deliver exceptional care.

Our highly engaged nurses and staff, working with physicians on the medical staff, drive RCB design, deployment and adoption. They come together from many departments to develop and implement evidence-based and efficient care approaches.

To date, we’ve completed and deployed more than 60 care modules for improving a range of processes such as treating sepsis, rapidly identifying and diagnosing C. diff infection, screening emerging diseases and many more. Adoption rates for many of these modules have exceeded 95% systemwide. We won’t rest until we’ve optimized all our care processes.

As we create our blueprints for reliable care, we build tools and metrics to measure staff adherence and our progress in improving outcomes. To drive accountability, we’ve made RCB metrics a part of our key performance indicators. Each hospital reports its results quarterly.

2022 Highlights

Texas Health:

• Began developing a C-section Reliable Care Blueprinting™ module to foster the consistent application of evidence-based processes and reduce non-beneficial variability in the use of this procedure to improve maternal health.
• Continued to promote the use of an intensive care unit liberation bundle, a set of care processes that improve outcomes in severely ill patients.

Safety

Consumers count on us to deliver on our promise of safe, reliable care, so we continually raise the bar on error prevention. Texas Health believes in fostering an environment where care team members can speak up in the name of safety for consumers and one another. To reach our goal of zero preventable harm events, we:

• Use a comprehensive set of error prevention tools, which verify patient identity and medication, monitor gradual changes in vital signs or predict the risk of falling.
• Adhere to safety policies, processes and systems.
• Mandate that every care team member speaks up for safety by reporting unsafe behaviors and near misses. We then share management practices and alert system leaders when issues arise to mitigate risks that could occur elsewhere in the system.
• Conduct daily safety briefings at entities, weekly system safety briefings and departmental safety briefings at shift changes to address emerging concerns. Increasing the reporting of potential risks and near-miss events reduces actual serious harm events.
• Capture safety events and near-miss data to identify trends, accelerate improvements and monitor performance.

2022 Highlights

Texas Health:

• Improved understanding of each entity’s top three safety events, near-misses and barriers to safety reporting by conducting safety briefings. Each facility communicates its top three issues to leadership teams so they can address process failures and keep patients safe. These discussions help to discern the status of operations, identify problems, assign ownership for resolution and share a common understanding of the day’s priorities.
• Nearly doubled the reporting of near-miss events compared to 2021. This helped us reduce serious harm event rates – which examines how many potentially harmful events occur about the number of patients we serve – by 7.5%.
• Received the 2022 American Society for Health Care Risk Management Patient Safety Award for effectively sharing learnings about patient safety throughout the system.
• Received a grant from the American Excess Insurance Exchange to launch an executive rounding program that influences connection and commitment to zero preventable harm. Texas Health was one of two organizations in the nation to receive funding.

Snapshot: Virtual Care Companions Keep Patients Safe, Satisfied Texas Health deployed an innovative and affordable approach to help keep patients safe through its Virtual Patient Companion (companion) program. When a bedside nurse identifies a hospital patient at elevated risk for falling, the nurse can bring a camera into the room (with the patient’s permission). Once installed, the nurse contacts the companion – who works in our Dallas command center – and introduces the patient. The nurse and companion then use a technological tool to “draw” virtual side rails on the patient’s bed. If the patient attempts to cross these virtual side rails, the companion redirects the patient to remain in bed. If the patient is not redirectable, the companion can alert the nursing unit to dispatch a nurse who can intervene immediately. Companions work 12-hour shifts and can simultaneously monitor anywhere from 12 to 15 patients, providing a more efficient and cost-effective patient safety initiative.

Equity

Texas Health invests in ways to make care delivery and health outcomes more equitable to reduce health disparities and improve population health across North Texas. To advance health equity, we are:

• Systematically collecting data to identify trends and close gaps. When screening patients, our clinical teams capture 10 dimensions that impact health and well-being, such as their housing status or financial concerns. We add these responses to our electronic health record and color-code them based on the level of concern so we can connect them with resources and services to help alleviate these issues.
• Designing and funding tailored interventions for under-resourced communities.
• Delivering culturally sensitive care by training our workforce on inclusive practices and consulting with consumers in their preferred language.

2022 Highlights

Texas Health:

• Prepared to comply with emerging federal requirements to address social determinants of health (SDoH) at the hospital level. Multidisciplinary teams met to create SDoH screening mechanisms and standardize reporting templates that Texas Health hospitals will use to prioritize and address these risk factors.

Snapshot: Understanding SDoH to Advance Health Equity A systematic plan to help Texas Health’s patients go home to safe situations where they can get care and stay healthy — supported by healthcare teams that keep them connected to resources — is under development. To inform this plan, Texas Health's hospitals collect data on five social determinants of health (SDoH) — physical security and the availability of utilities, transportation, food and housing – from adults admitted for care. These insights help hospital leaders understand patients’ nonmedical conditions that influence health outcomes so they can refer those at risk to social services or community agencies that can help. The Joint Commission requires all U.S. hospitals to screen patients on SDoH factors upon admission and address at least one of the identified disparities starting in 2023. Additionally, the Centers for Medicare and Medicaid requires that hospitals submit two new quality measures starting in 2025: one measures how many adults were screened for SDoH factors upon admittance and the other measures the extent of conditions each patient had. The ultimate goal is to advance health equity and discharge patients into a better situation than they left. “Clinical care alone will treat a patient only to the extent that it can,” said Sunita Koshy-Nesbitt, M.D., M.B.A., Hospital Channel’s chief quality officer. “We must partner each patient’s social, mental and spiritual factors with the clinical to complete the healing process in its entirety. It is a critical piece of our overall unplanned readmission strategy and is vital to the health and well-being of all members of the communities we are privileged to serve.”