Service Standards Light the Way on Patient Safety Journey

Keep me safe.

Those three words are etched on the hearts of AdventHealth team members who are committed to making sure patients know that their personal safety is the health system’s top priority. Along with the three other service standards – Love Me. Make It Easy. Own It. – Keep Me Safe defines how team members interact with consumers and patients and their families, as well as with their fellow team members. The service standards debuted in 2018, shortly before the hospital system, which has more than 50 hospitals in nine states, unified under the AdventHealth brand. The standards are deeply embedded in AdventHealth’s strategic vision.

Grades Reflect Culture of Safety

Safety is in the spotlight March 10-16 during Patient Safety Awareness Week, a national observation initiated in 2002 by what was then the National Patient Safety Foundation to stimulate discussion on how to maximize patient safety in health care settings. For William Scharf, MD, executive clinical director of quality and safety for AdventHealth, patient safety is front and center every single day. That focus is reflected in the most recent release of The Leapfrog Group’s Hospital Safety Grades in fall 2023. The assignment of grades – A, B, C, D, F – to all general hospitals twice a year is intended to help people find safe hospitals in their communities.

Of AdventHealth’s 42 eligible hospitals, 31, or nearly three-quarters, received an A, which was more than double the number of hospitals with A’s in 2017. AdventHealth Daytona Beach achieved its 24^th straight A, making it one of only 18 in the country to receive the top grade in each reporting period since Leapfrog launched the grading system in 2012. In 2022, AdventHealth also received Leapfrog’s inaugural Emerald Award for Outstanding Achievement by a Health Care System in recognition of its strong culture of safety and accountability.

“It did not happen by accident,” Dr. Scharf said. “It happened because back around 2015 there were some really thoughtful leaders who said we want all of our hospitals to be safe, therefore this is the journey we want to go on.”

In an interview with Becker’s Healthcare, Dr. Scharf said, “It is very intentional. Our top leadership recognizes the criticality of this, and this has been a focused goal for the entire organization.”

The Ladder to Success

By the time he arrived at AdventHealth in 2018, Dr. Scharf said, “Very wise individuals, who were not pleased with the ‘sea of red’ they saw in 2015’s results, had drawn a line in the sand.” Many organizations, Dr. Scharf explained, use a “stoplight” approach for reporting health care grades: green for meeting targets; yellow, warranting closer attention; red, needing attention.

Those results prompted the establishment of “clinical imperatives,” and from then on, Dr. Scharf, who spent nearly 25 years as a general surgeon, said, “The expectation was that every hospital in our system would achieve four or five stars from CMS (Centers for Medicare & Medicaid Services), an ‘A’ from Leapfrog, and a top-quartile performance in all Adult Inpatient Mortality Rates.” While inpatient mortality is certainly an important quality indicator, the CMS and Leapfrog ratings are likely the two most familiar to and easily checked by consumers.

Behind the grades are a broad range of metrics and, in the case of Leapfrog, an exhaustive survey that is 300-plus pages. The patient experience metric alone – one of 22 curated by Leapfrog – includes nursing communication, doctor communication, staff responsiveness, communication about medicine and discharge information.

“Some of the worst things that happen are related to a failure to communicate,” Dr. Scharf said.

The CMS star-rating system has 47 metrics.

But rather than viewing grades or stars as the be-all and end-all of measures, Dr. Scharf said, they serve as more of a mirror. “If you’re a high-performing health care system, you should be looking at these and saying, ‘We really came out well on this, but there’s always more that can be done.’ We look at this information from a practical standpoint and figure out what it is we need to do because, at the end of the day, what is it that we’re here to do? We’re here to extend the healing ministry of Christ.”

When it comes to addressing any deficiencies, Dr. Scharf said, leaders closely study the “report card” to prioritize opportunities and make it easy for team members to own the results. “If they go after everything, they would get nothing done,” he said.

Finding the Opportunities

“We want all of our eligible hospitals to be Leapfrog As,” Dr. Scharf said. “Leadership is key to an A. You have to be doing something intentionally well.”

Helping pave the way to additional A’s for the system that cared for more than 7.3 million people in 2023, is an intentional, four-pronged strategy that, in close collaboration with hospital leaders, Dr. Scharf and his team have established to:

• Provide a clinical excellence touchpoint with hospitals twice a year.
• Meet people on those teams where they are.
• Focus on the greatest priority and/or areas of impact.
• Provide support.

Coaching is an integral part of that support system and it, too, has an intentional three-step process that involves meeting with a hospital’s chief medical officer and chief nursing officer to make sure “we set you up so you know your data. We set you up so you know what your opportunities are after talking about the issues head-on. And, three, we talk about what your plans are.”

Said Scharf, “But we’re more than coaches. I’m their fan as well. I’m their biggest fan.”

And that’s where another of AdventHealth’s service standards shows up in a big way.

Love Me.

That is key to how Dr. Scharf approaches hospitals that fall a grade or two short of an A. In some cases, those might be recently acquired facilities that have experienced years of disinvestment under different ownership. Dr. Scharf said he shares with those team members that “I love who you are, what you stand for. You’re coming in every single day because you want to extend the healing ministry of Christ. You’ve been through a lot. You need a hug.”

Ultimately, Dr. Scharf shared, “Safety is also a function of making team members feel safe. That’s a huge part of the culture at AdventHealth. And doesn’t it follow that if you take care of your team members, the results are likely to improve?”