A safety culture transformation: its effects at a children's hospital

To improve pediatric patient safety at a tertiary, 200-bed children's hospital by changing the safety culture and implementing processes, practices, and measures to sustain improvements. Although many core quality and safety measures exist for adult acute-care facilities, equivalent measures for pediatrics are lacking.

Helen DeVos Children's Hospital in Grand Rapids, Michigan, part of the Spectrum Health system, led a 2-year initiative beginning in late 2007 to improve pediatric patient safety. Key strategies included safety-based staff training, training in root cause analysis, failure mode classification of events and safety behavior, integration of and collaboration between risk management and clinical staff, consistent coding and classification of serious safety events and adoption of multiple safety metrics, creating a new safety leadership infrastructure, and fostering transparency of data and safety event details.

The 2-year initiative led to an estimated 68% decrease in the number of serious safety events and adoption of a serious safety event metric reported monthly. In addition, compliance with the ventilator-associated pneumonia bundle rose from 2% to 96%; hand hygiene compliance rates rose from 56% to 95%; and the Children's Asthma Care-3 core measure, home management plan of care given to patient/caregiver, rose from 0% to 83% within 6 months. Medication errors with serious harm were reduced to only two during the initiative, and ventilator-associated pneumonias dramatically decreased, with only one occurring in 2009.

The initiative led to key improvements in safety culture and patient safety and also had a broad impact on several clinical quality outcome measures. Using safety metrics improves transparency and enables future benchmarking with peer institutions to help improve pediatric patient safety nationwide. Because of the initiative's success in our children's hospital, the entire Spectrum Health system, including more than 16,000 staff members, is now undertaking a similar effort.