Workforce Safety Means Patient Safety

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Tom Haederle
Hospitals and health systems never stop working to advance safety and quality around the patient care experience. Yet we know the best way to make care safer and better is not more regulation. Rather, it's the field's ongoing collaboration and innovation to drive safety forward.

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Tom Haederle
Welcome to Advancing Health, a podcast from the American Hospital Association. I'm Tom Haederle with AHA communications. Today's podcast is the first in a new series called Safety Speaks, a forum for hospitals and health system leaders to share their passion for accelerating patient safety efforts in hospitals and health systems across the country. Host Robin Begley, CEO of the American Organization for Nursing Leadership and senior vice president for Workforce with AHA, is joined by Dr. Tom Peterson, vice president and chief safety officer with Trinity Health, to share how Trinity's approach to both patient and workforce safety is paying off.

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Robyn Begley, RN
Hello and welcome to Safety Speaks, brought to you by the American Hospital Association's patient Safety Initiative. I'm your host, Robyn Begley. And today, like every day, we're dedicated to empowering patients and health care professionals alike. Our goal is to foster engagement in patient safety initiatives, bolster public trust in hospitals and health systems, and promote the uptake of evidence based measures to ensure the highest quality of care.

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Robyn Begley, RN
We concentrate our efforts on three foundational pillars: fostering a culture of safety, identifying and addressing inequities in safety, and enhancing workforce safety. We convene stakeholders and support our members as they continuously transform the landscape of patient safety. Joining us today for Safety Speaks to discuss workforce safety is Dr. Tom Peterson, vice president and chief safety officer of Trinity Health, a leader who has been instrumental in steering transformative safety initiatives across Trinity Health.

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Robyn Begley, RN
Tom, welcome to Safety Speaks. I'm looking forward to exploring your journey and discussing the impactful work you've been doing in patient safety and workforce safety.

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Tom Peterson, M.D.
Well, thank you for having me. Much appreciated.

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Robyn Begley, RN
Tom, can you start by sharing your motivation behind creating such innovative and strategic patient safety solutions at Trinity Health, and how your approach has evolved over the years?

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Tom Peterson, M.D.
Sure. Yes. I would say, quickly, in a nutshell, you know, as a pediatrician, I think I naturally have a lot of interest on the preventative side of the world. And I also have a significant interest in changing situations that need that I feel need big changes. So I've been involved with areas such as tobacco control for 30 years and safety work for 20 years.

00;02;59;11 - 00;03;22;14
Tom Peterson, M.D.
And I think these are really, focused on areas that you see, I see big changes needed. So that's been kind of my driving force. I think the big interest in my journey basically has been, over the last 20 years, I've been in four organizations building safety programs. It all started with a CEO at a children's hospital who said, I want to be the safest children's hospital in the country.

00;03;22;14 - 00;03;40;07
Tom Peterson, M.D.
And that was my deliverable I had to find for him, and we built a program, and that's kind of where it all started back then. This is when, soon after the safety efforts had just started, the HR rule thing was just coming into play. Lean management, all those things were just starting. So I've kind of evolved over the years.

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Tom Peterson, M.D.
I've kind of evolved and seen how, you know, the HRO thing I think is a little bit of a term, but I think the organizing process is really what we're always looking at. And driving towards zero is always a big focus. So I think it's evolved for me. But then a big evolution for me was, ten years ago at a place where I had an H.R. executive who really, was a passionate about the worker safety world.

00;04;05;22 - 00;04;22;25
Tom Peterson, M.D.
And I knew nothing about it at that time. Everything was just patient safety. We were clinical people. That's kind of the world we came from. And taking that on and finding out his one of his statements that's always stuck with me is you cannot have safe patients without having safe, employees We call them colleagues at Trinity Health

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Tom Peterson, M.D.
so you'll hear me say, colleagues - without having safe colleagues first. So that and also, it's a big issue with us being a leader in serious injuries to our employees or colleagues of all organizations in the country in health care. So that has been added into the journey and the focus as we've come in at Trinity Health.

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Chris DeRienzo, M.D.
Thank you for tuning in to this episode of Safety Speaks, the podcast series dedicated to patient safety, brought to you by the American Hospital Association. I'm Dr. Chris DeRienzo, the AHA’s chief physician executive and a champion of the AHA Patient Safety Initiative. AHA's patient safety initiative is a collaborative, data driven effort that lifts up the voices of individual hospitals and health systems into the national patient safety conversation.

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Chris DeRienzo, M.D.
We strive to catalyze and connect health care professionals like you across America in your efforts to innovate and improve, and to bolster public trust in hospitals and health systems by helping you share your successes. For more information and to join these 1500 other hospitals already involved, visit aha.org/patientsafety. Or, click on the link in the podcast description. Stay tuned to hear more about the incredible work of members of the AHA’s Patient Safety Initiative.

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Chris DeRienzo, M.D.
Remember, together, we can make health care safer for everyone.

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Robyn Begley, RN
Thank you for sharing your a little bit of your journey with us. Can you tell us about the Zero Harm program at Trinity Health and its impact on patient outcomes? You mentioned Zero Harm a little bit ago, and that was, you know, I think that's a natural next step.

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Tom Peterson, M.D.
Sure. I think these, you know, whatever term you use for me, zero harm, HRO, you know, whatever, ours is called Together Safe. That's the name that we gave the program. As I build these programs, I've always liked building it on the back about, the John Carter approach for change management, which is the eight step change model.

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Tom Peterson, M.D.
You know, you create an urgency. You get your leaders, you get your coalition built, you get your vision, you kind of you break down the barriers, you start building your army of champions and so on - your foundation/. And then you start showing short term gains, and then the sustainability comes after that. So that's always been kind of the backbone of how I've done this. I think for the work at Trinity, it's been, you know, obviously it's the biggest organization I've been at

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Tom Peterson, M.D.
so much of it has been very focused on since we have. And one thing that attracted new trainees is I knew the senior leadership was very committed to this, but also very committed to both the colleagues safety as much as the patient safety, which I think was, wonderful. But because it's so big in so many states and over 100,000 employees, etc. I've had a very focused effort.

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Tom Peterson, M.D.
Plus we've had years of Covid when it came to 2020. So it's been a focused strategy approach and that's what's really come with our colleagues' safety work, is we focus, we find 85% of our OSHA recordable are the serious injuries to our colleagues are from five areas. So that's really how we've driven our focused interventions and efforts in those areas to have the outcomes that, that we want.

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Tom Peterson, M.D.
I think it's one is a good approach. There's really no book on how to do this in health care for worker safety in my opinion that we've had yet. But I think it works very well, but also because it's such a large organization that's also been important.

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Robyn Begley, RN
You've had such an impact on so many people. You know, you call them colleagues and, you know, also patients. Very impressive. How have, your various initiatives? I know you've spearheaded the Smart Move program and the Workplace Violence five point plan as two examples. How have these contributed to Trinity's goals and patient safety?

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Tom Peterson, M.D.
Before doing any of it it's very important, in my opinion, to...I've always followed this three phase process where you have to really build the foundation. We've had over 100,000 people trained in safety behaviors, things like that. You have to have very good data to drive the efforts. You have to have leadership committed and the frontline commitment, etc..

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Tom Peterson, M.D.
And then as you build the colleagues safety efforts, and those are two of the efforts that have, I think, been quite, interventional. Nurses and CNAs are at the top of the list of strains and sprain injuries that put them out of work in the country, including all organizations. And, you know, that is to me not only an opportunity

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Tom Peterson, M.D.
but it is we have interventions like the bedside mobility assessment tool when it's used, and they use devices every time they move a patient when they should, you cut their injuries in half. So it has a huge effect on that as an intervention. But then as we started seeing falls and we're working on falls and we see the handling of patients and we see, worked with early mobility, the thinking was, well, let's put this together.

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Tom Peterson, M.D.
These all kind of overlap. So our falls work, our patient handling work and our early mobility work we put into the smart boots program that we're just kicking off right now as a focused effort. On the workplace violence side, it's been a very comprehensive - we have some of our regions that are ahead of other ones, but we have a very comprehensive focus.

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Tom Peterson, M.D.
On the prevention side, we use what's called the ??? score. So we want to have over 90% of all of our patients in the ER in the hospital scored. So they have the scored risk. And people can use this as a plan and make sure they have plans for them every single day. And the assessments [are] sent up to their tier three huddles, etc..

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Tom Peterson, M.D.
There's a three tier training program for everybody where we have from the de-escalation to the middle training to the more intense training. The policy piece, so the code of conduct that you've heard a lot about, and we have the zero tolerance, that is something we have in one of our regions. We're going to spread it to our whole, organization hopefully this year.

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Tom Peterson, M.D.
Strong responses from our leaders when people are injured or have a workplace violence injury, and also the data piece. So we now have developed, in our dashboard that I'm quite proud of, that we have, you know, a focused dashboard that focuses on metrics. We have six major metrics that every ministry - we call the hospitals ministries - every region,

00;10;39;03 - 00;10;56;14
Tom Peterson, M.D.
everybody can pull up any time and see where they're at in the journey. But we have a new one on workplace violence alone, where our focus is to get more and more events reported with less and less serious injuries to the colleague. And they have gone down about 10% in the last year.

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Robyn Begley, RN
So you're talking, Tom, a little bit about metrics. Are there some, specific data or metrics at a high level that maybe we could share with our audience that highlight the measured improvements in patient safety at Trinity Health as a result of all of these many comprehensive initiatives?

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Tom Peterson, M.D.
One of our things I think we did was, picking out some basic metrics that is so big and there's so many types, especially in the patient safety areas, you know, there are metrics galore. And so it was really focusing on certain ones, putting them in so everybody could have them. We have a six point scorecard that everybody can get and share to their executive leadership every month, etc..

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Tom Peterson, M.D.
And I think another thing it's really important is safety to me is you've got to have really good visuals. You got to have visual improvements to show in your huddles, to show to the leaders. And so that's a very big part of the metrics as well. But we have basically chosen the OSHA recordables. That's our rate that we follow.

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Tom Peterson, M.D.
That's the standard one that everybody in the country uses health care, non-health care. You can compare yourself with Amazon and Walmart if you want to because the metric is basically the same. And so, it's a it's a great metric that we can follow. And also, see where we are benchmarking with other hospitals in the country.

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Tom Peterson, M.D.
Our other one is we two falls. So we have serious preventable falls that we follow on there, as well as our all falls rate. Both of them have gone down significantly in the last two years, as well as our OSHA rate that's gone down. and then we have event reporting.

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Tom Peterson, M.D.
I still need a lot of work to do with that. It's gone up in the last couple of years, maybe 15% or so, but we want that to go through the roof with event reporting, especially at our unit level. And then we have surveys. So we do 4 or 5 questions on safety questions that come out of the HRQ.

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Tom Peterson, M.D.
survey. We do those three times a year to put those in, to see how people can follow, how they're improving and their safety culture work. And then we also have a focus on surgery events, because we had a big issue with those a few years ago, and that's had a huge, decrease of about 75% with our intervention, our six point surgery plan in the last two years, as well.

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Tom Peterson, M.D.
And finally, our last safety metric is a serious safety event, measuring preventable, serious harm events to our patients. We've dropped this one by about 40% in the last two years. Those are the basic ones that we have for the safety scorecard, the metrics that we use. Now, there are other metrics. There's HAI metrics. There's a lot of other census metrics other ones people follow and use, which we do too. But at least for our safety focus

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Tom Peterson, M.D.
those are the what our scorecard includes.

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Robyn Begley, RN
Wow. So you must have a team that helps collect all that data and, you know, present it in a manner that's meaningful for our clinicians and for our leaders.

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Tom Peterson, M.D.
The thing we've been lucky with is we have a big support from our senior leadership, as well as the, skills and the ability at all of our regions. So we try and standardize everything as much as we can. When I came in, there's a lot of variability in the safety program, and safety training and things like that.

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Tom Peterson, M.D.
So we tried to standardize everything, including the metrics. That was another purpose. I kind of saw this in a one-page report I saw from the V.A. system years ago. They did this really well. So that was kind of the idea. But they all tend to do this. We have a central place where they send it.

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Tom Peterson, M.D.
It's all tableau based, but we have a lot of, focused, skilled people that are in our regions and are in our hospitals as well.

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Robyn Begley, RN
So, wow, impressive. And, and really comprehensive work. Those are the words that keep coming to mind. And now I've got a question that is rather near and dear to my heart, being a nurse leader for so many years, considering the critical role of nurse leadership in shaping patient care, you know, how do your initiatives at Trinity Health integrate some of the nursing insights and leadership you know, to drive improvements in patient safety at Trinity?

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Tom Peterson, M.D.
Well, one thing I've learned over the years in health care is when you work in safety, whether it's with the colleagues safety or the patient safety, the nursing is an incredible backbone. I mean, it is a make or break kind of area because one, it is, so many of your of your colleagues, it's such a large, population.

00;15;13;24 - 00;15;32;28
Tom Peterson, M.D.
Secondly, they have such a hands-on to the day to day care, you know, with, everything from the falls to the pressure ulcers to the, you know, medication use, etc., etc. they're really a an area that you, have to have, as part of your safety work. and I think we've, done very well with that.

00;15;33;05 - 00;15;55;12
Tom Peterson, M.D.
We've had a lot of nursing focused areas on the safety. I would say from my perspective, the nursing has to completely support the Smart Moves and the Safe Patient Movement Program that is basically all nursing based. They're very engaged in the workplace violence advocacy because they are engaged with these patients every day, and they have to score them every day.

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Tom Peterson, M.D.
Sharps is a big one for nursing. We have a lot of, you know, contaminated sharps injuries, as they give, injections and medications and so on. And so they're, they're part of that is those teams that meet regularly. We have safety supported by a virtual nursing effort that our system is doing. All of our nurses went through the safety basic safety training that everybody did.

00;16;17;00 - 00;16;34;14
Tom Peterson, M.D.
And they will continue that as they're onboarded. So, I think they've been a a significant component. I think the other thing I like to say too, is safety if we do this really well, in my opinion, is it kind of is what I call it, you know, the rising tide lifts all boats, right?

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Tom Peterson, M.D.
So, the statement I like from one of my mentors at Alcoa, was, you know, if you do safety well, everything follows, or you do everything well, And that is a huge part in the nursing world of how we do this with safety that helps patient experience, that helps with turnover, that helps with the colleague engagement components. That helps with all the other aspects that we're trying to improve in our hospitals, in our centers every day.

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Tom Peterson, M.D.
So.

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Robyn Begley, RN
Well, thank you, Tom, any final words before we, we conclude?

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Tom Peterson, M.D.
Well, I would just like to say, first, thank you for having me. And thank you for, giving us a chance to talk about our safety work. Like I said, we have a great support from our leadership here at Trinity to do this. It's going to be a journey. It's going to go on for a long time, hopefully.

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Tom Peterson, M.D.
My big key is to build something that is sustainable and no matter who's here or who comes and goes, that's still there. Like you see in some of the other non-healthcare places where, they've had safety as part of their backbones for 30, 40 years. That's kind of one of my dreams with this process, as well as really trying to, you know, get some of these numbers to some of the best that we can get in the country.

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Tom Peterson, M.D.
I think there is a those are big opportunities.

00;17;47;00 - 00;18;18;22
Robyn Begley, RN
So I'd like to thank you, Tom, for joining us today and for sharing your valuable insights and experiences in advancing patient safety at Trinity Health. Your dedication and innovative strategy serve as an inspiration to all striving to improve health care outcomes with their respective hospitals and health systems. For our listeners, if you're interested in delving deeper into the topics discussed today, we have an expanded slide deck available exclusively for participating PSI members.

00;18;18;24 - 00;18;44;20
Robyn Begley, RN
If your organization is not yet signed up with the AHA Patient Safety Initiative, I highly encourage you to join us. By becoming a member, you gain access to a wealth of resources, collaborative opportunities, and the latest research aimed at fostering a culture of safety across health care settings. You can sign up and learn more by visiting the AHA Patient Safety Initiative webpage.

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Robyn Begley, RN
We thank you all for listening and hope you continue to engage with us. Together, let's keep the conversation going and work towards a safer health care environment for everyone.

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Tom Haederle
Thanks for listening to Advancing Health. Please subscribe and write us five stars on Apple Podcasts, Spotify or wherever you get your podcasts.