How Nationwide Children's Hospital found safety success in its PICU

Nationwide Children's Hospital is piloting new safety protocols in its PICU. (Nationwide Children's Hospital)

Nationwide Children's Hospital's pediatric intensive care unit was finding success in improving patient safety.

In particular, the PICU had found a way to better control adverse drug events. But hospital leaders wanted to understand the secret to success on that ward to see if they could replicate it elsewhere. 

"We were trying to do the same thing over and over again while expecting different results," said Thomas Bartman, M.D., associate medical director of quality improvement at Nationwide said in an interview with FierceHealthcare.


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So in the summer of 2016, the Columbus-based hospital conducted a series of focus group with PICU staff to determine what made the difference. What did they find? Staff were following a more flexible and proactive thought process when it came to approaching safety , according to a study published in Pediatrics.

RELATED: 6 patient safety improvement opportunities 

Defined by the Resilient Health Care Initiative, Safety I and Safety II are two different ways of thinking to approach patient safety. Safety I is a more traditional approach that focuses on examining mistakes for ways to improve, according to a white paper from the Agency for Healthcare Research and Quality.

But Safety II, a novel approach to patient safety, pushes providers to think beyond how safety prevention has failed and look at what has gone right—and what can be learned from those successes.

The focus groups identified several key areas where Safety II impacted the way PICU staff thought about safety, according to the study. For example, those surveyed said that having strong relationships with coworkers eased concerns about reporting medical errors, consistent with a Safety I mindset. But, they also said having those relationships allowed them to think more creatively in unplanned circumstances, which is consistent with Safety II, according to the study. 

One focus area identified in the study—which the researchers dubbed "innovative approaches"—was centered in the Safety II view. Some of the participants said they would apply steps that improved safety in other parts of the hospital, and emphasized teamwork in tackling new situations and risks, putting a greater focus on looking at what has been successful versus reacting to mistakes. 

"Safety II behavior in this unit was based on strong Safety I behaviors adapted to the Safety II environment plus innovation behaviors specific to Safety II situations," the researchers said. "We believe these behaviors can be taught and learned."

Researchers at Nationwide established where Safety II's approach may be most applicable and where it's already finding a footing to change the mindset on safety, according to the study, which is one of the first to examine how behaviors encouraged by Safety II can impact patient safety.

Simulations on using Safety II thinking in other units then began in December 2017.

RELATED: Diagnostic errors, opioid safety top ECRI's patient safety priorities for 2018 

Bartman said it was crucial for hospital leadership to make clear that these two approaches are designed to work together, and that they weren't tossing out the thought process behind Safety I because it is testing an expanded focus on Safety II. 

"We want to make sure that we sort of learn as we go how to identify when to switch," Bartman said. 

Bartman said that the positive response so far to the Safety II has led others in the hospital to push for more rapid change, but he said it's crucial that hospitals looking to implement the protocols not "put the cart before the horse" and overreach too quickly.

There are risks inherent to changing the way providers think about patient safety, so starting slow and taking time to pilot and test new models is key, he said. 

"I would encourage people ... to go slowly at first and really be very thoughtful about what you're doing and how you're going to see whether you're successful or not," Bartman said. 

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