Press Ganey Launches Zero Harm 24/7 Initiative

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By Jay Kumar

Harm prevention requires leadership, which is why Press Ganey this month launched its Zero Harm 24/7 initiative. The effort calls on healthcare CEOs and boards to commit to working to eliminate preventable harm using shared best practices.

Participating health systems will work to address the top 10 barriers to optimizing safety in healthcare by driving system change and elevating patient safety to the highest levels of strategic planning, resource allocation, and performance oversight.

“I’ve been working in patient safety for over 25 years and I was reflecting on where we are today and then where do we need to go to accelerate progress,” says Tejal Gandhi, Press Ganey’s Chief Safety and Transformation Officer. “I started thinking about what are the 10 barriers that we constantly hear about from organizations that are preventing us from accelerating progress? And then what would it take to get past those barriers and really starting with the importance of leadership and boards and CEOs and what they need to do. But then, throughout the organization, what needs to happen. So that turned into this framing around 10 critical commitments that organizations need to do to get past these barriers.”

Top 10 barriers

Press Ganey has identified the following barriers that must be overcome to achieve zero harm:

  1. Boards assume that healthcare is safe and CEOs delegate the responsibility for safety.
  2. Safety is treated as a project and exists as silo.
  3. We know and tolerate variation in operations within organizations and across the industry.
  4. We permit and even promoted wide variability in leadership knowledge, skills, and behaviors.
  5. We don’t measure safety well.
  6. We undervalue the input of patients and families.
  7. We are blind to harm other than physical harm.
  8. We are reactive, not proactive.
  9. When events occur, we still blame and shame, and we let lawyers deny and defend.
  10. We don’t learn from failures or successes, and we don’t improve.

10 critical commitments

Zero Harm 24/7 participants will commit to the following, in alignment with the CMS Patient Safety Structural Measure:

  1. Establish and visibly demonstrate safety as a core value.
  2. Drive safety integration across the organization.
  3. Require a high reliability operating system to ensure that performance is as intended consistently over time.
  4. Require consistent leadership structures and behavior expectations to drive safety performance.
  5. Optimize safety measurement and monitoring.
  6. Partner with patients and families to embed their input into all levels of safety strategy.
  7. Ensure both physical and emotional safety of patients and workforce across the care continuum.
  8. Focus strategy on identifying and mitigating risks and harm.
  9. Require a fair, just, and transparent culture.
  10. Require learning from failures and successes, driving a culture of continuous improvement.

Limited progress in patient safety

In November 1999, the Institute of Medicine (IOM) published the report To Err is Human: Building a Safer Health System, concluding that between 44,000 and 98,000 people die each year as the result of preventable medical errors. The report led to a new focus on patient safety.

Looking back over the decades since the IOM report, Gandhi notes that progress has been made to improve patient safety, but not enough.

“I think we’ve made improvement in pockets, but there’s still a lot of variation. There’s still some big gaps,” she says. “I do think CEOs and boards still delegate quality and safety as opposed to—and this is generalizing—really having that ownership at the top. From a measurement standpoint as an industry, we still don’t measure patient safety very well. We measure some narrow slices like the hospital-acquired conditions, but that’s very narrow in terms of all the safety issues that occur.”

The Zero Harm 24/7 initiative is reminiscent of a program Press Ganey announced in March 2020, Safety 2025: Accelerate to Zero. That initiative had a goal of reducing patient and caregiver harm by 80% by 2025; unfortunately, the timing of its launch coincided with the start of the COVID-19 pandemic, which obviously commanded the full attention of healthcare leaders for the next few years.

How the program will work

For Zero Harm 24/7, Press Ganey is currently recruiting participating organizations.

“Organizations are signing up as we speak and their CEOs are committing to their participation and then there are various components that they will be committing to. So we’re sort of in that enrollment recruitment process,” Gandhi says. “I don’t have a sense yet of how many health systems, but I’m guessing it’s going to be somewhere around 50 to 75 just to start based on the interest that we’ve had.”

Participating organizations will then be expected to participate in upcoming Zero Harm 24/7 meetings.

“We are asking that they will participate in a convening that we’re going to do in the fall with CEO, CQO, and either the board chair or board quality committee chair because I really want to engage boards in this,” Gandhi says.

The meeting will serve “to talk through like what that what needs to happen at that level of leadership to advance these commitments and we are going to also convene a council of these board quality chairs” to discuss what leaders in those roles should be doing, she adds.

The purpose of these meetings will be to provide guidance to board quality chairs, especially those who don’t have much quality and safety expertise, says Gandhi.

The councils will “talk through how to optimize those board quality committees as well to make sure that it is not a just a show and tell,” she says. “All of this is in full alignment with the CMS patient safety structural measure because I’m not trying to say this is new stuff or different stuff. This is like the foundational stuff that needs to happen and then you’re going to be fine on your CMS structural measure.”

The measure emphasizes board involvement in healthcare quality and having boards and leaders engaged.

“We want to work with these board quality chairs to really help them advance that in an effective way,” Gandhi notes. “If the board is really focused on this, it will just drive through the entire organization.”

Measuring progress

Gandhi says Press Ganey is still developing how it will measure how participants are making progress on Zero Harm 24/7.

“We’re going to have sort of an initial assessment of where organizations are on those 10 areas. We’re still building out exactly how that assessment’s going to play out, but then we’ll be tracking over time,” she says.

“If we said, ‘OK, what percentage of these organizations are actually asking questions around safety on their patient experience surveys?’ we can track that over time. What percentage of organizations are using a robust net around their safety event detection based on this assessment tool that we have and how is that improving over time? What percentage of the board chairs are participating in our council?” says Gandhi.

“There are ways that we can have kind of structure/process measures to track this over time as well as engagement in the community and all that. I think we can even start thinking about safety culture measures over time for organizations that use us for safety culture, or even if they don’t, we could be measuring impact on safety culture over time,” she adds. “The outcomes measures are always tricky, partially because they are so narrow. And so I think things like safety culture are probably going to have to be a good proxy, at least initially, that we can use as well as the patient perceptions of safety and other types of measures that we have.”