Improving Patient Safety and Quality through Culture, Clinical Analytics, Evidence-Based Practices, and Adoption

I recently attended the “Best Practices in a Culture of Safety” conference. This annual event brings a variety of population health ecosystems together: clinics, home health, skilled nursing facilities, rehab, acute care, hospice, and medical homes.

The featured speaker, Michael Woods, MD, MMM, trains clinicians, administrators, and board leaders on relationship-based care. He began his speech by asking the audience to listen to music and raise their hands when they heard five unique instruments. Then he played the music video below to demonstrate the coordination and communication required to be a healthcare team member; to effectively and efficiently deliver quality patient outcomes.

Healthcare is The Most Complex, Adaptive System

Healthcare is often compared to other complex, adaptive systems, such as the airline and nuclear industries. But there are striking differences. In the airline industry, for example, pilots don’t just get up and leave mid-flight. In the healthcare industry, patients often have different providers and nurses throughout their care experiences.

I experienced this first hand when my ear, nose, and throat (ENT) surgeon went on vacation immediately after performing my surgery. Within a week of the operation, I developed acute sinus pain and bleeding. I ended up seeing three different providers over a two-week period in search of an answer.

Each provider told me the pain and bleeding were normal, but I insisted they take a culture. When I called to obtain the results of the culture 72 hours later, the results still weren’t in. When I called the next day, I was put on hold for 30 minutes. Finally, after several weeks of bouncing from provider to provider, a nurse picked up the phone and told me I had a staph infection and needed to come in immediately. I ended up missing two weeks of work, and the staph infection had a long-lasting, negative impact on my health.

Every provider and nurse handoff creates the potential for miscommunication and mistakes. What does it take to thrive in such a complex, adaptive system? The answers center on culture, analytics, evidence-based practices, and adoption.

Improving Outcomes and Lowering Costs through Culture, Clinical Analytics, Evidence-Based Practices, and Adoption

The conference emphasized that patient safety and quality is an “and” science that centers on culture (organization, processes, etc.), healthcare (clinical) analytics, content (evidence-based practices), and frontline adoption of best practices.

#1: Culture

If your healthcare organization doesn’t have a culture that values teamwork, accountability, and an environment that encourages speaking up, then you’re more likely to experience quality issues. Conference speaker Dr. Woods effectively illustrated the importance of culture using statistics on wrong site surgeries:

  • 20 percent of healthcare professionals said they would not speak up if they witnessed an issue.
  • In retrospective wrong site surgery reviews, 60-80 percent of people interviewed said they knew the incision was being made in the wrong place, but did not speak up.

According to Dr. Woods, the one word that best describes a culture of safety is civility. Civility, illustrated in the diagram below, facilitates a safe environment in which people feel comfortable speaking up and changes are implemented and communicated.


Culture is often deemed a soft component in patient safety and quality, with clinicians and IT staff focusing solely on data. A clinician at the conference shared an interesting example: the clinician’s health system’s electronic medical record (EMR) data showed ASA utilization at 20 percent. He shared this data with his colleagues, provided education, and continuously monitored the data, but saw no improvement. It turned out to be a healthcare data quality issue and, after resolving the issue, the rate was actually greater than 90 percent.

This is a common anecdote; something I routinely hear from patient safety and quality professionals in my travels across the U.S. Texas Children’s Hospital, for example, discovered that their antenatal steroid administration rates were much higher than the EMR-reported data.

#2: Clinical Analytics

Clinical analytics plays an important role in scalable, sustainable quality improvement. Several conference speakers talked about the growing regulatory and performance requirements, the delay in getting reports from IT, and the need to integrate data sources (financial, patient satisfaction, operational, etc.). Data is a vital component of patient safety and quality. But data without the aforementioned supportive culture isn’t as effective.

#3: Evidence-based Practices

For years, many healthcare professionals have relied on the adage that medicine is art, not science. Now we have the analytic platforms and evidence-based content to operationalize standard, effective care practices. While there are unique cases and exceptions in patient care, we should leverage clinical analytics to enable providers to spend their time on the difficult cases, while ensuring quality standard care is given in all cases.

Kelly McGrath, MD, shared statistics that reveal just how important patient safety and quality is in achieving the Institute for Healthcare Improvement (IHI) Triple Aim (improved patient population outcomes, better patient satisfaction, and reduced costs):

  • According to the Centers of Disease Control (CDC), an estimated 70,000 patients die each year from hospital-associated infections (HAIs). This is in stark contrast to the fact that 35,000 people die each year in the U.S. from motor vehicle accidents.
  • HAIs create direct hospital costs between $35.7 Billion to $45 Billion annually (adjusted to 2007 dollars). This is in contrast to the $70 Billion annual U.S. Department of Education budget.

These statistics highlight the fact that a culture of patient safety and quality, in conjunction with clinical analytics, evidence-based practices, and adoption of these practices are essential to achieving healthcare transformation in our country.

#4: Adoption

Established and approved evidence-based practices, while critical components of ensuring patient safety and quality of care, are only effective if they are adopted. Adoption includes educating and training frontline clinicians and healthcare workers, engaging patients, and collaborating with clinician leadership to drive best practices adoption. Evidence-based practices need to be hardwired—thoroughly engrained in frontline practices—to result in patient safety and quality improvements.

Learn more from the eBook Healthcare: A Better Way

Healthcare: A Better Way describes the Health Catalyst three system approach to sustainable quality improvement. This valuable resource for frontline caregivers and clinical and operational leaders provides insights on a variety of topics:

  • Challenges in the healthcare industry
  • A systematic approach to improving quality healthcare services
  • How to use data to measure and improve efforts
  • The future of healthcare innovation

Powerpoint Slides

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