Improving the Culture of Patient Safety
Improving the Culture of Patient Safety
This article outlines how one academic medical center's nursing service has developed programs to improve patient safety and quality outcomes through the use of the Magnet Re-Designation Accreditation Process® and a shared governance model. Successful programs have been implemented across the continuum of care. These programs include educational initiatives that increased both the number of nurses with BSN degrees and specialty certifications and also the number of patient-focused initiatives, such as a reduction in central line infection rates, an increase in hand-washing compliance, and a decrease in fall rates. In this article we will describe how our Magnet Re-Designation Accreditation Process® and shared governance model have contributed to strengthening our culture of patient safety. The manner in which the Magnet components of transformational leadership; structural empowerment; exemplary professional practice; new knowledge, innovation and improvement; and empirical quality results have all contributed to improved patient safety are discussed.
Cedars Sinai Medical Center (CSMC) (Cedars-Sinai) is a 958 bed, non-profit, medical center located in Los Angeles, California, at the borders of Los Angeles, Beverly Hills, and Hollywood. The medical center was designated an American Nurses Credentialing Center (ANCC) Magnet® hospital in 2000. Magnet re-designation was achieved in 2004 and 2008. In 2008, as a result of changes in Magnet re-designation criteria, Cedars-Sinai changed its focus from Magnet's original 14 forces to the five Magnet components of transformational leadership; structural empowerment; exemplary professional practice; new knowledge, innovations, and improvements; and improved empirical outcomes (ANCC, 2008). Inherent to these processes is the focus on improved patient outcomes as evidenced by not only meeting, but exceeding national quality benchmarks. As Magnet organizations mature and Magnet-required structures and processes become part of staff members' usual behaviors, increasingly more emphasis is placed on outcomes during the re-designation process. The purpose of this article is to describe the alignment of Cedars-Sinai's structure and processes with the five Magnet components and link this alignment to the development of a culture of safety resulting in improved patient care outcomes.
Although healthcare providers have traditionally avoided flaws or ineffective care processes, there has been a reluctant acknowledgment that a percentage of patient complications may be related to errors in care. The landmark study from the Institute of Medicine (Kohn, Corrigan, & Donaldson, 2000) shed new light on the extent and complexity of systems errors that contributed to almost 100,000 patient deaths each year. From that time forward, hospital leaders have focused on uncovering system-based failures and associated human factors in an effort to prevent patient harm and optimize clinical outcomes. Cedars Sinai's leadership team shares this goal with other acute care organizations. The commitment to building and sustaining a culture of safety requires a multi-faceted approach. One aspect of this 'culture' is that senior leadership is a critical component of establishing a climate in which safety systems are most effective (Sammer, Lykens, Sing, Mains, & Lackan, 2010).
Abstract and Introduction
Abstract
This article outlines how one academic medical center's nursing service has developed programs to improve patient safety and quality outcomes through the use of the Magnet Re-Designation Accreditation Process® and a shared governance model. Successful programs have been implemented across the continuum of care. These programs include educational initiatives that increased both the number of nurses with BSN degrees and specialty certifications and also the number of patient-focused initiatives, such as a reduction in central line infection rates, an increase in hand-washing compliance, and a decrease in fall rates. In this article we will describe how our Magnet Re-Designation Accreditation Process® and shared governance model have contributed to strengthening our culture of patient safety. The manner in which the Magnet components of transformational leadership; structural empowerment; exemplary professional practice; new knowledge, innovation and improvement; and empirical quality results have all contributed to improved patient safety are discussed.
Introduction
Cedars Sinai Medical Center (CSMC) (Cedars-Sinai) is a 958 bed, non-profit, medical center located in Los Angeles, California, at the borders of Los Angeles, Beverly Hills, and Hollywood. The medical center was designated an American Nurses Credentialing Center (ANCC) Magnet® hospital in 2000. Magnet re-designation was achieved in 2004 and 2008. In 2008, as a result of changes in Magnet re-designation criteria, Cedars-Sinai changed its focus from Magnet's original 14 forces to the five Magnet components of transformational leadership; structural empowerment; exemplary professional practice; new knowledge, innovations, and improvements; and improved empirical outcomes (ANCC, 2008). Inherent to these processes is the focus on improved patient outcomes as evidenced by not only meeting, but exceeding national quality benchmarks. As Magnet organizations mature and Magnet-required structures and processes become part of staff members' usual behaviors, increasingly more emphasis is placed on outcomes during the re-designation process. The purpose of this article is to describe the alignment of Cedars-Sinai's structure and processes with the five Magnet components and link this alignment to the development of a culture of safety resulting in improved patient care outcomes.
Although healthcare providers have traditionally avoided flaws or ineffective care processes, there has been a reluctant acknowledgment that a percentage of patient complications may be related to errors in care. The landmark study from the Institute of Medicine (Kohn, Corrigan, & Donaldson, 2000) shed new light on the extent and complexity of systems errors that contributed to almost 100,000 patient deaths each year. From that time forward, hospital leaders have focused on uncovering system-based failures and associated human factors in an effort to prevent patient harm and optimize clinical outcomes. Cedars Sinai's leadership team shares this goal with other acute care organizations. The commitment to building and sustaining a culture of safety requires a multi-faceted approach. One aspect of this 'culture' is that senior leadership is a critical component of establishing a climate in which safety systems are most effective (Sammer, Lykens, Sing, Mains, & Lackan, 2010).