03.21.16
Ingenuity

Pursuing the Safest Hospital in America

QA with Dr. Rick Shannon

McGregor McCance / 03.21.16

The challenges of financing American health care seem insurmountable. Your solution appears shockingly simple. Could this actually work?
“Be Safe” is the method by which we have chosen to try and improve health care delivery to reduce costs. And it is simple, if you think of the total cost of care. It’s estimated that about a third of that care adds no value, meaning they’re things that patients wouldn’t pay for if they had a choice. And we believe by eliminating those valueless forms of waste, we can free up a third of the current money spent on health care that could be used to pay for the Baby Boomers or to fund exciting new technologies that offer a cure for diseases. So what do I mean by waste? I mean harm to patients. I mean defects in care delivery, defects in care transitions, overtreatment and excessive administrative costs. So those are all things that if people had a choice, people wouldn’t pay for, but they are embedded in the current cost of care. That is distinctly different from cutting the payment for services, which is the current federal approach. So we are improving our way to savings as opposed to cutting our way.

Dr. Richard P. Shannon, the University’s Executive Vice President for Health Affairs, has an elegant and simple solution to America’s mushrooming health care costs: improve our way out of it. Called the “Be Safe” initiative, the strategy relies on a relentless pursuit of safety (elimination of harm in all forms), bolstered by an equally relentless elimination of waste — anything that does not add value for patients and team members. Shannon and his team believe that focusing on the things within their control will bend the health care cost curve more than any external regulatory approach ever would.

You describe patient safety and quality of care as the “new currency” of academic medicine. What do you mean?
A currency is what one uses to purchase goods. In health care, a third of what we spend adds no value. So if we can create the safest and the best-performing health care delivery system, the current dollars that we spend on unnecessary waste can be repurposed for research, for investing in our educational efforts and for developing and providing new technologies.

Column: 

A Prescription for the Nation

The “Be Safe” initiative aims to address critical and fundamental issues facing health care in the United States.

Eradicate Defects in
Care Transitions

Reduce Excessive
Administrative Costs

End
Overtreatment

Eliminate Harm
to Patients

What was the old currency? And why did it need changing?
The old currency was just “ask for more.” Ask for increases in premiums. Ask for more National Institutes of Health funding. Ask for more tuition. Academic medicine has grown up with an insatiable appetite for more. There is no “more” without making important social choices. So how do we live within our means? Our goal is to repurpose some of what we currently spend toward these important areas of investment.

How do you get buy-in?
The work of “Be Safe” is all about the engagement of front-line providers such as nurses, doctors, social workers and dietitians. We have built buy-in by conducting observation exercises where front-line providers actually step back and observe the way work is currently done. In that exercise, they see the chaos of unmet need. Once they see that, and realize there is a different way to deliver care without all that waste, they become convinced.

What results have you seen so far?
We’ve seen substantial reductions in bacterial sepsis as a result of the “Be Safe” work. We’ve seen a substantial decline in catheter-associated urinary tract infections, a decline in patient falls, and in August there were no central-line associated bloodstream infections, and we continue to track below the previous year. In its first year, the most notable achievement of “Be Safe” is the dramatic improvement in front-line employee engagement scores. Our nurses and our staff believe that we are deeply committed to patient safety at nearly twice the rate that they did before.

Something called a “Room of Errors” sounds a little frightening for a health system. But it’s actually an initiative aimed at safety at the Medical Center. How does it work?
The Room of Errors is a simulation lab, a learning lab where nurses and transporters and respiratory therapists and others can come and simulate potential errors, develop eyes to see those errors before they propagate into harm and to work as teams to solve those errors. It’s a virtual experience, but there’s nothing virtual about the teamwork and the creative solutions that emerge.

Team engagement is critical to the success of “Be Safe.” Under the leadership of Pamela Sutton-Wallace (above), CEO of the UVA Medical Center, “Be Safe” initiatives are being put into action and have already helped improve patient care and increased employee engagement among front-line health care providers. The UVA Medical Center’s goal is to be the safest hospital for patients to receive care, and for providers to work and deliver care.

What part of this pursuit of safety can be replicated elsewhere?
All of this work can be fully exported to every academic medical center in the country. In fact, we are increasingly asked to visit other centers to share with them these ideas. Reduction in payments for services will only go so far to stem the rising costs of health care, and ultimately we have to get serious about improving how we deliver health care.