In 2010, leaders at The Ohio State University Wexner Medical Center, an essential hospital in Columbus, Ohio, decided it was time for a change—not just another project, but transformative improvements to patient safety and hospital culture.
Chief Quality and Patient Safety Officer Susan Moffatt-Bruce, MD, PhD, MBA, recalls that the hospital’s leaders knew “quality was going to become more and more important” in coming years. She remembers then-university President E. Gordon Gee, EdD, JD, saying, “We need to go from excellence to eminence.”
Taking the ‘Hard Route’
To realize those goals, Wexner deployed crew resource management (CRM) training in 2010 through LifeWings, a Memphis, Tenn.-based patient safety and process improvement consultant. CRM is designed to improve performance in situations where human error can lead to negative outcomes.
The training involved leadership development; physician engagement; team skills workshops; safety tools; and feedback and auditing. And it all started in one of health care’s most challenging environments: operating rooms (ORs).
“We had to make a decision of whether or not we were going to get an early, easy win or take on the tough challenge and build credibility,” Moffatt-Bruce says. “We decided to go with the hard route and go with the OR — the procedure area — because we thought it was going to be difficult, but if we made a change there and we made an impact, then other areas would fall in line.”
The next step was to engage key providers, including the chairs of anesthesia and surgery. Once those leaders were on board, “no reasonable person could push back on it,” Moffatt-Bruce says. The medical center’s board and executives also took part in training, she says, adding, “There was real buy-in there.”
Those who attended the training learned the importance of disseminating the purpose behind the team training, how to use scripted conversations to answer questions from other staff, and how to engage with physicians who might be skeptical of the program’s importance. Wexner then went to work streamlining its day of surgery checklist.
“That was the absolute first tool and I would say our flagship tool,” Moffatt-Bruce says. “The other tool that we built [was] the hand-off tool between the providers” across the whole continuum of care. Those tools gave providers practical tactics and engaged staff, she says.
Getting medical residents on board with the changes was key to moving forward.
“It was very hard for our faculty, when you have an enthusiastic resident, to not go along with that,” she says, adding, “I think we were strategic in getting residents to formulate what they thought would be the most helpful tools. [We got] the buy-in from them, and I think that really spoke to the faculty that this was going to be a really inclusive program.”
Later, LifeWings helped to prepare “master trainers” to assume responsibility for subsequent CRM training in other departments.
In the six years since Wexner implemented CRM, the medical center has trained 6,000 staff members in its use across more than 15 departments.
Wexner measured return on investment using the Agency for Healthcare Research and Quality’s surveys on patient safety culture before and after rolling out CRM across the organization.
“We looked at staff engagement, we looked at [hospital-acquired condition] score, mortality, and our patient safety indicator scores,” Moffatt-Bruce says. From 2011 to 2013, Wexner experienced 735 fewer avoidable patient harm events — including medication events with harm, central line-associated blood stream infections, and ventilator-associated pneumonia— than predicted, resulting in potential cost avoidance of between $12.6 million and $28 million. After accounting for the cost of CRM training, the organization saw an estimated return on investment of $9.1 million to $24.4 million, Wexner researchers reported in the American Journal of Medical Quality.
‘Consistency is Key’
Moffatt-Bruce points to consistent champions in each area as the key to success.
“You have to take the time to develop the tools and you have to be disciplined to continuing the leadership rounding,” she says, adding, “And you have to have consistency … when you have these long-term programs, consistency is key.”
Most of the champions are nurses who serve as CRM facilitators. The hospital has committed to supporting them by making this work integral to their job.
“You have to look at return on the investment,” Moffatt-Bruce says. Facilitators “might be taken out of circulation for four hours, but you are saving all of this potential ill effect or events by making this investment.
“We picked the right people who really wanted to do this, and I think that has been very helpful.”