Improving engagement scores

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Safety Champion program improves culture of safety and staff engagement

Safety champions at Henry Ford Health System have helped transform the way staff members prevent patient harm

Henry Ford Health System's (HFHS) "Safety Champion" program began in 2008 with around 10 staff members from the radiology department who were interested in improving patient safety. Although it represented a small fraction of the system's 23,000 employees, the pilot program would become the launching pad for a program that includes more than 600 staff members today.

The program coincided with the health system's "No Harm" campaign, also launched in 2008, with the goal of reducing patient harm events by 50% "by enhancing the culture of safety, improving quality and clarity of clinical communication, identifying top causes of harm and redesigning care to eliminate common causes of harm." As of December 2012, HFHS had reduced harm events by 34% and mortality by 31%.

The Safety Champion program was the ideal complement to the system's push toward reducing harm by measurably changing the culture of safety throughout the organization. Rather than focus on a top-down approach to changing that culture, safety champions offered a grassroots methodology that included a wide variety of staff members from different departments.

"This was an effort to focus on a bottom-up approach, enhancing engagement with our employees, arming them with the skill set to be proactive, and then giving them a voice and empowering them to act," says Mary J. Voutt-Goos, MSN, RN, CCRN, CPPS, director of patient safety initiatives and clinical care design at HFHS in Detroit.

Over the last six years, staff members have responded positively, engaging in the program and using the educational information provided to improve specific aspects on their unit.

"What blows me away is the absolute passion and engagement in it, and it's continued for all these years," Voutt-Goos says. "They show up and email regularly, they participate and send in stories to the newsletters, so it's a great way to engage people."


Building a training structure

To ensure the Safety Champion program would be effective, the patient safety quality team at HFHS developed a foundation of training that focused on identifying potential patient safety problems and finding ways to effectively address them.

All safety champions start by taking three introductory courses that serve as the baseline for their training:

  • Patient Safety 101
  • Introduction to the Safety Champion Role
  • Human Factors


All of these courses, which include videos and interactive group activities, were developed in-house and focus on ways staff members can recognize patient safety problems that are system-based failures.

Once a staff member completes the intro courses, he or she is included in the group email, has access to the Web page and bimonthly newsletters, and can participate in the quarterly quality development forums. The program also conducts continuing education and development courses, releases monthly toolkits, and posts improvement efforts to a designated Facebook page.

When the program first went into effect, staff members were motivated by the training, which offered a new way of looking at patient safety. The human factors course, in particular, offered a different perspective on medical errors, and having the title of Safety Champion gave staff members an identifiable role in the process.

"I think some of these frontline staff can appreciate the fact that they can do something that impacts their immediate work on a daily basis," says Jane Felczak, MSN, RN, CPPS, principal quality consultant at HFHS.

Organizers pushed for the program to be voluntary in order to foster a truly grassroots effort that would be embraced by the staff. Although some system leaders wanted to make the program mandatory, Voutt-Goos says hard and fast requirements can actually hinder staff engagement.

"My team didn't want anyone there that was mandated to attend anything because typically that's a bad idea," she says.

In the beginning, program organizers worked with department leaders that were early adopters. The radiology department was one of the first to engage in the program, bringing in a managing physician and the vice chair of diagnostic radiology, along with a manager and radiation techs. Soon after the initial training, the department began meeting on its own to discuss patient safety issues. That created a snowball effect where other departments began to see the benefits of the program.

"That's what we wanted," Voutt-Goos says. "They started meeting separately over and above the elements of our program, and they identified a problem where pediatric patients were coming into areas that had no protective covers on the electrical outlets, so they made that change. And then our facilities people were so excited about it, they started spreading that change to other areas on their own."


An all-inclusive program

One of the key elements of the HFHS Safety Champion program is that it includes staff members from every sector of the organization. Although patient safety initiatives often revolve around the workflow of clinicians, nonclinical staff members brought a unique perspective to patient safety issues?problems that they were aware of but didn't previously have a way to address.

"We wanted to move away from this whole idea that it's only nurses and physicians that are members of the team, which we found that a lot of people thought," Voutt-Goos says. "The focus always seems to be nurses and physicians; we wanted to include everyone. We have housekeepers. They play a huge role in infection control, so we have a little bit of everyone."

For example, an administrative secretary at one of the system's physician offices recently raised a concern about people coming to the clinic looking for a way to dispose of containers filled with used syringes. "They were putting them in sawed-off plastic jugs or pop bottles with pieces of tinfoil on the top, and she noted that this is a serious potential hazard for employees," Voutt-Goos says. "In one incident, the patient dropped a container, and they had these used sharps all over the floor."

Once the issue was raised at the quarterly meeting, experts from infection control, occupational health, and hazardous waste put together a plan to manage this problem. "The safety champion that brought that up, she's not clinical; she just has a passion for patient safety," says Jeanette Tanafranca, MSN, RN-BC, clinical quality facilitator II for patient safety initiatives at the office of clinical quality and safety at HFHS. "Her perspective is completely different."

HFHS has also incorporated information about the safety champion program into new employee orientation. New employees are told that even if their unit already has a safety champion, they are still welcome to join.

Units that have had the most success often have managers and leaders that are accepting of the program and allow safety champions to devote the time necessary for patient safety initiatives, additional training, and attendance at quarterly meetings.

"If you have a great manager that believes in the program, the safety champions thrive," Tanafranca says. "If you have managers that aren't able, for whatever reason, to give them the time, the safety champions don't come to the forum and don't bring back those benefits. That's one of the key things."

The patient safety quality team built the Safety Champion program simply by highlighting and publicizing some of the impactful patient safety initiatives that came from safety champions. Because some patient safety improvements are hard to quantify, Voutt-Goos and the patient safety team found the use of qualitative improvement stories was more effective in gaining additional support. The team utilized in-house newsletters along with social media and dedicated Web pages that regularly featured improvement stories.


Improving engagement scores

Although Henry Ford Health System's (HFHS) Safety Champion program built its success on qualitative storytelling, patient safety leaders at the Detroit system were able to show the program had a positive impact on culture of safety through questions embedded in an employee engagement survey, which was given to employees in 2006, 2008, 2010, and 2012.

The percentage of respondents that "agreed" or "strongly agreed" increased from 2006 to 2012 in the following areas:

  • Management actions show safety is a priority76% in 2006 vs. 84% in 2012
  • We are encouraged to speak up77% in 2006 vs. 85% in 2012
  • I would feel safe as a patient here 74% in 2006 vs. 81% in 2012

Previous questionnaires, between 2006 and 2010, have included questions in other areas of safety culture such as:

  • Lots of nurse-doctor teamwork62% in 2006 vs. 73% in 2010
  • Clinical disagreements are resolved well59% in 2006 vs. 70% in 2010
  • Communication breakdown leading to care delays is rare34% in 2006 vs. 58% in 2010


Additionally, patient safety leaders found that safety champions have a measurable impact on culture in the unit.

"What we've been able to show two surveys in a row (2010 and 2012) is that units and clinics that have safety champions have statistically significant improvements in their score over units and clinics that did not have safety champions," says Mary J. Voutt-Goos, MSN, RN, CCRN, CPPS, director of patient safety initiatives and clinical care design at HFHS. "That was compelling data for leaders, especially when they are being asked to focus on employee engagement."