By Angela FitzSimmons
When it comes to making the grade, Kettering Health Network, a nonprofit healthcare system serving southwest Ohio, serves as a model of success. The organization’s long-term efforts illustrate how it achieves high levels of patient care and safety through a collaborative approach of regularly monitoring processes and implementing customized, corrective actions to address inefficiencies.
As a testament to Kettering Health Network’s performance, all of its eligible hospitals have earned A’s from The Leapfrog Group in its rating of how well healthcare facilities protect patients from preventable medical errors, injuries, and infections. The Leapfrog Group is an independent watchdog organization that assigns letter grades to all general hospitals nationwide every six months to assess healthcare quality and safety.
“Only a very select group of hospitals earn an ‘A’ Leapfrog Hospital Safety Grade across its entire network,” says Leah Binder, CEO and president of The Leapfrog Group. “Such success shows a sustained commitment to protect patients from preventable errors.”
In addition, Kettering’s hospital network was named a 15 Top Health System by IBM Watson Health for 2020, which recognizes health systems for achieving better risk-adjusted outcomes and higher patient satisfaction while keeping average per-patient costs down.
Making the grade with Leapfrog
To remain a high-performing healthcare facility, ongoing quality improvement is essential, and striving for respected industry recognition can help organizations raise the bar on quality care.
Kettering Health Network, for example, has maintained accreditation with HFAP since 2011, which complements the work it does to achieve high marks in the Leapfrog surveys. The evidence-based HFAP and Leapfrog standards both serve as road maps for establishing best practices and creating an organizational focus on patient safety and quality improvement.
“Our patients deserve the best care, so we are always working to improve our performance,” says Brenda Kuhn, PhD, RN, chief quality officer of Kettering Health Network, which also includes Kettering College and more than 120 outpatient facilities. “In alignment with our ‘One Best Practice’ mindset, we aim for all of our hospitals to achieve and maintain an ‘A’ grade from Leapfrog in order to create a culture focused on safety.”
Third-party assessments and validation help prepare an organization to evaluate itself not only against external standards, but also against its own internal policies and procedures, calling on all departments to work together with clear, consistent communication to meet requirements. Comprehensively, the goal is to identify opportunities for learning, implement protocols for ongoing improvement of patient care, and maintain a safe, efficient environment for patients and providers.
Benchmarking and identifying goals
Working with industry-recognized watchdog organizations like Leapfrog and accreditors such as HFAP can provide healthcare facilities with superior benchmarking resources to conduct a quality assessment, combat persistent performance issues, and guide the development of new policies and practices.
For example, one assessment tool that helped lead to immediate improvement at Kettering is the computerized provider order entry (CPOE) test provided by Leapfrog for electronic health records (EHR). The CPOE test validates that alerts in the EHR system notify providers of serious prescribing errors or problems due to factors such as drug and allergy interactions or the results of recent lab tests. Effective use of CPOE systems helps reduce the risk of adverse drug events and avoid problems caused by specification errors. As a result of the CPOE exercise, Kettering Health Network made modifications to EHR alerts that improved its medication prescription safety measures.
Using the Leapfrog survey as its criterion, Kettering Health Network conducted a large-scale gap analysis and developed an action plan to address inconsistencies in performance. Comparing internal measures to best practices laid the groundwork to achieve improved performance measures.
“Since we always strive for consistency, we develop systemwide goals and deploy actions across all our hospitals,” says Kuhn. “If facility-specific opportunities are identified, however, improvement goals and action plans are initiated at that facility to ensure network cohesion.”
By further benchmarking the metrics of its individual hospitals, Kettering Health Network identifies gaps in consistent performance, both internally across its facilities and externally against industry best practices. Following these thorough assessments, the team develops policies and procedures to meet agreed-upon goals and standards.
Empowered with valuable information and insight from HFAP accreditation and the Leapfrog grading system, Kettering Health Network developed strategies and structures to implement best practices across its facilities, from establishing a monitoring system to creating a collaborative culture.
The monitoring tool that the network created assigns accountability and identifies progress in completing the Leapfrog survey questions and optimizing standards. In particular, the tool proved very useful in detecting inconsistencies across the network, allowing Kettering facilities to better learn from each other in relation to the tracked performance measures.
Whether across a network or within one facility, collaboration is key to solve problems and implement strategies that boost outcomes and performance.
“At its core, accreditation is an assessment of an entire organization—from its governance structure to how it establishes clinical protocols and maintains its buildings—necessitating effective interdepartmental communication and coordination,” says Meg Gravesmill, CEO of HFAP. “One thing that really positions Kettering Health Network to consistently earn high ratings from Leapfrog is that everyone, including senior leadership, is involved in the quality improvement process.”
Kettering Health Network established teams to oversee the systemwide quality improvement initiatives, which included representatives from individual facilities and network leaders across several departments, such as nursing, pharmacy, medical, and administrative. Since these teams were established, they have done considerable work to build trust within the network, establish cross-functional communications, and adopt strategies that involve multiple departments.
An area of opportunity identified in the Leapfrog survey was the need for partnering with a Patient Safety Organization (PSO), and Kettering Health Network established that relationship in 2018. The PSO enhanced the network’s patient safety initiatives by reinforcing an open environment that encourages its providers to safely report and share information about vulnerabilities within Kettering’s healthcare system.
“The leadership of Kettering Health Network aims to be an approachable partner, especially in the process of quality improvement,” says Kuhn. “We empower our staff to report and analyze adverse events in order to proactively improve patient safety and identify best practices.”
A culture of teamwork focused on patient safety, transparency, and continuous improvement embeds the best practices of standards into daily policies and procedures—allowing facilities to continually enhance their quality of care and overall efficiency.
Working with HFAP
The HFAP accreditation process provides a foundational learning experience for healthcare teams through a consultative and educational survey. The approach is peer-based and interactive, paving the way for continuous improvement and industry recognition.
“HFAP standards support a process of continuous quality improvement based on a cycle of policy review, implementation, performance evaluation, appropriate change management, and effective communication to ensure that the focus is always on patient safety and quality of care,” says Gravesmill. “We create an open dialogue with our customers through which our teams can provide expert insight and ongoing educational opportunities to enhance an organization’s efficiency and growth beyond the survey experience.”
HFAP surveyors bring years of clinical experience to the accreditation process, empowering facilities’ staff to ask questions and establish a supportive learning environment. The thorough on-site reviews act as a self-assessment guide to help members develop a framework to boost survey performance, which leads to improved quality and safety across the organization.
“The collaborative spirit of the survey process along with the clear focus on consistent standard implementation are aspects of HFAP accreditation that we value the most,” says Kuhn. “We frequently reach out with questions or for guidance on the standards, and HFAP is very willing to share best practices to assist us in achieving our hospital accreditations.”
For facilities that maintain industry-recognized accreditation, continuous improvement becomes second nature, and it takes less time and resources to assess and maintain compliance. Continuous, small course corrections are easier than major overhauls when an accreditation survey or Leapfrog performance review is approaching. Ongoing evaluation against recognized national standards helps a healthcare organization achieve its maximum potential in environmental safety, quality improvement, and patient safety.
Angela FitzSimmons is director of marketing and communications for HFAP.