The Journey to Zero at Golden Valley Memorial
How Communication, Collaboration, and Discipline Paid Off
with Stephanie Ashworth, RN, CPHQ, CSSGB, CPBE, CIC, director of quality management and infection control, Golden Valley Memorial Healthcare
Three years ago, Golden Valley Memorial Healthcare (GVMH), an integrated rural healthcare system in Clinton, MO, committed to transforming into a “zero defects” safety culture. Today, GVMH has reduced catheter-associated urinary tract infections (CAUTI) and central-line associated bloodstream infections (CLABSI) to zero for over three years, healthcare-associated Methicillin-Resistant Staphylococcus Aureus (MRSA) and Clostridium Difficile (C-Diff) infections to zero in 2016, and reduced falls by 41 percent.
“We have more work to do, but we’re laser focused on patient safety,” explains GVMH Director of Quality Management and Infection Control Stephanie Ashworth, RN, CPHQ, CSSGB, CPBE, CIC. “In fact, we post ‘days at zero’ on key measures by each unit on communication boards. No one wants to be the one who ends a 1600-day streak!”
Fostering Open, Honest Communication
When The Joint Commission mandated new checks for MRSA, GVMH initiated a comprehensive hand hygiene campaign with accountability for non-compliant staff—including physicians—and added a new question on the patient survey asking patients if their caregivers had consistently washed their hands.
Secret observers also share their findings with the Infection Control Department, which then delivers an observation report to those who are out of compliance. The report reviews the hand hygiene policy and asks each individual to sign the report as a commitment to future compliance.
“It was a huge culture change but we did see a big improvement after implementing the observers and reports,” notes Ashworth. “There were lots of excuses at first …even tears. We tend to think that we are always compliant; it’s our co-workers who are not…so it can be jarring to receive a pink slip (i.e., observation report).”
But in the end, the individual observation approach made all the difference, where initially reporting out compliance by discipline hadn’t budged the numbers. Today, GVMH hand washing compliance is 90 percent and climbing.
Hardwiring Tools that Work
A safety culture doesn’t happen by itself. To ensure organizational alignment in consistently providing safe, high quality care, GVMH uses these tools:
1. Culture of Safety Team (COST)—This multidisciplinary team of directors and frontline staff meets monthly and includes representatives from pharmacy to food and nutrition. In short, everyone that has a role related to patient contact and patient support is included. Every quarter, each director asks staff, “What is the next way we are likely to harm a patient in this unit?” and requests their suggestions for addressing it. Departments report out to COST which then identifies the type of rapid cycle improvement team needed to address it.
“There’s just no substitute for insight from fresh eyes at the bedside,” suggests Ashworth. For example, Environmental Services recently pointed out that too many electronic devices plugged into outlets in patient rooms posed a tripping hazard, so cords were consolidated.
2. Multidisciplinary rounding and bedside shift report—Multidisciplinary teams round together on patients at the bedside to examine what’s best for the patient. In the morning, for example, the
team might include some combination of a clinical pharmacist, social worker, nurse, hospitalist, and certified nursing assistant (CNA) depending on what’s being discussed. Rounding is also coordinated with physicians to ensure productive decisions.
Because reducing CAUTIs has been a priority, a CNA—affectionately nicknamed the “Catheter Czar” at GVMH—questions the necessity of every patient catheter during rounds. Nurses also use bedside shift report to share fall risk scores of patients so oncoming nurses are always aware of safety issues.
Tips for Success
Ashworth attributes GVMH’s success with getting to zero on its CAUTI improvement project to diligent recruitment of frontline staff to champion culture change with coworkers and processes in individual units. “Otherwise, leaders can rewrite policies and processes all day long, but the wheels will fall off when it comes to implementation,” she explains.
And finally, validate, validate, validate! “Leaders have to be willing to have that uncomfortable conversation to ensure every individual is actually following the protocol every time until it’s hardwired and part of the culture.
“You don’t want to inadvertently throw out the process because it seems ineffective when actually it’s just not being followed consistently,” Ashworth adds. “That’s why Studer Group tools like huddles, rounding, and observing non-compliance are so effective,” she emphasizes. “They coach to very specific feedback.”