For a decade, leaders at the Betty Ford Center (Rancho Mirage, Calif.) looked on with pride as the National Association for Addiction Treatment Providers (NAATP) recognized addiction treatment organizations for outstanding quality improvements with an award inspired by the Center's first medical director, James W. West, MD.
“When we were approached by NAATP to get involved in creating a quality award, we immediately thought of Jim,” says Michael Netherton, president of the Center's Betty Ford Recovery Hospital. “He is a world-renowned surgeon and was asked by Mrs. Ford to be the first director of the hospital. He has taught us so much about patient care, about clarity and singularity of purpose, and about treating all with dignity and respect.”
“It would take days to tell you what all of us have learned from Dr. West,” says Netherton.
Fortunately, such proof wasn't necessary, since Behavioral Healthcare contacted Netherton, along with Briar Geraci, the Center's vice president and corporate compliance officer, to congratulate them and their colleagues for a patient safety program that earned NAATP's 2010 James W. West, MD, Quality Improvement Award.
“It's a tremendous honor,” says Netherton, who acknowledges that “for some time, we had hesitated to submit our work because of the Center's association with this award. Finally, this year we asked Dr. West if he thought it would be appropriate. We all felt it was time, because, under Briar's direction, the team has accomplished so much.”
Origin of the patient safety program
The roots of this award-winning patient safety program are everywhere at the Center, but they started in its strategic planning process. “We've invested a lot in long-term strategic planning, not only at the board level, but throughout the organization,” says Netherton. One of the board's most significant decisions was to encourage the integration of functions and departments as a way to improve communication throughout the organization. As early as 2002, this led to the goal of creating a single, seamless experience-“one Betty Ford program”-to deliver care to patients and families. This approach reflects Betty Ford's vision of “‘serving patients, saving families,’” says Netherton. “Everything springs from there.”
Around 2005, Center leaders made two other important decisions: They streamlined eight key result areas (KRAs)-Quality of Services, Safety, Patient Satisfaction, Referent Satisfaction, Employee Satisfaction, Financial, and Public Perception and Education-into a structure of just two-“Quality of Services and Safety” and “Financial.” The Center also adopted a single methodology for designing, implementing, and monitoring all process improvement projects: The Plan-Do-Study-Act (PDSA) Cycle.
The Center's ongoing drive to simplify and clarify strategic priorities had implications for the patient safety program as well, Geraci explains: “We've always had a safety program, but we realized that if we merged all of its components under the umbrella of our improving organizational performance program, we could provide greater clarity to staff.”
As that change took place, Center leaders determined that they would revamp the patient safety program around the best and most current organizational strategies available in the current body of knowledge. One key resource was the Institute for Healthcare Improvement (IHI), which explained how systematic application of industrial quality improvement methods could significantly improve clinical processes and healthcare outcomes. From this and many other resources, the Center selected a set of strategies as the foundation for a new patient safety program.
To refine and flesh out these strategies for staff, the Center knew it would need a strong and experienced program leader. Through what Geraci calls “an alignment of the stars,” the Center brought in Jann Robinson, RN, as its new certified patient safety manager in 2008. For about a year, Robinson teamed with Geraci to build out the details of the program, which was ready for launch in early 2009.
The program's first challenge was to evolve the Center's safety culture “to foster the understanding that errors are opportunities for improvement,” says Robinson. “People don't come to work intending to make errors. Often, errors are a signal that a system or process ought to be updated, changed, or risk-mitigated.”
Center leadership shared this understanding, recognizing that its organizational culture had to support continuous improvement in all areas on a long-term basis. Such a culture must, from a staff perspective, enable individual initiative and encourage a willingness to take what Netherton calls “responsible risks.” Yet it must also sustain a sense of safety and trust that enables individuals to feel that they can report errors honestly-an essential element of any quality improvement program.
Such a culture can only “flow from the top, from the board down,” says Netherton. “Making mistakes is something that we all learn from. The attitude must be that if I am acting in the best interest of a patient, it's OK.” He calls it creating “a culture without fear,” where “people can enjoy coming to work. They feel secure, and they feel engaged.”