Teaching hospital crafts model safety program

University of Michigan Health Systems Chief of Clinical Affairs Darrell Campell, MD, believes thinking big leads to positive results.

That's why he declared his intention to make the University of Michigan Medical Center in Ann Arbor the nation's safest hospital. And he wants to spread that culture of safety throughout the UM system.

"The concept is safety underlies everything," he said. "Not only is it the right thing to do, there are a number of benefits that spring from it."

As a model, Dr. Campbell said he used Alcoa Corp., where, after CEO Paul O'Neill decided it would be the world's safest manufacturer, things like job retention and recruitment improved along with safety.

"Ultimately, it'll also save you lots of money," he said. Saving money helps justify such programs with hospital officials, but Dr. Campbell said listening to people's concerns and then acting on them has helped get the staff to buy into the culture.

Dr. Campbell said he makes unannounced visits with nursing and pharmacy staff during which they discuss issues with the medical staff.

The discussion generally revolves around three questions: What's the last thing that went wrong on your floor? What happened the last time a patient was harmed? What is your worst nightmare?

"It's called 'management by walking around,' " he said.

Talk is easy, but Connie Standiford, MD, the associate medical director for ambulatory care service, said what has made the program work is a policy of "rapid-cycle feedback."

"Their focus of 'We're going to work on this problem together and resolve it' has been great," she said.

Hospitals were the initial focus, but Dr. Standiford said ambulatory care safety is now getting increased attention, with 1.4 million annual ambulatory visits, compared to approximately 41,000 hospital admissions.

Using electronic medical records to reduce medication errors and track test results has been a major focus, Dr. Standiford said.

But, she said, marking surgical sites, repeating verbal orders, using two patient identifiers and keeping immunizations in a refrigerator that sounds an alarm if temperatures go above a certain range are also receiving attention.

Dr. Campbell said he has learned from aviation industry practices, and he believes other health systems can learn from what the UMHS has done.

"Teaching hospitals can be the safest places because we research it and study it systematically and then tell others about whether something is helpful or not helpful," he said. "That's what research institutions are supposed to do."