The Target Remains Zero: Continuing the Quest for Quality at Children’s Hospital Colorado

Image of a woman looking through a telescope

Dr. Dan Hyman still remembers the phone call like it was yesterday.

The phone rang while he was meeting in his office with two colleagues. “I saw the AHA name flash on my phone and told them ‘wait — I need to answer this –,” he says.

As he was hoping, it was the American Hospital Association (AHA) calling to tell Hyman, now Chief Medical and Patient Safety Officer, and the rest of the Children’s Hospital Colorado (Children’s Colorado) team that they had won the 2015 AHA Quest for Quality Prize.

“It was something really to celebrate – not just the work we had been doing at Children’s Colorado for the previous five to eight years, but also celebrating everyone who had played a role in the site visit and application process for Q4Q,” says Hyman.

Talking about it three years later, Hyman still can’t stop smiling.

Setting sights on zero

“We were very candid in our application about where we thought our strengths were and where we thought we could improve,” says Hyman.

When Children’s Colorado received the award, it was two years into Target Zero, its core patient safety campaign. At the time it was a complex initiative – and the complexity has only grown since – based on one, simple objective: zero harm.  

Dr. Dan Hyman is the Chief Medical and Patient and Patient Safety Officer at Children's Hospital Colorado. 

It may seem like a lofty aspiration, and Hyman admits that in some ways, it is. “The science and technology might not be there yet for zero harm, but we can be zero for a shift, we can be zero for a day or a month – and that’s what we’ve set our sights on.”

Success comes in finding a balance between celebrating the small victories while keeping eyes set on the bigger goal. Children’s Colorado has proved that zero is possible. For example, in 2012, Hyman reported that the spine infection rate at the hospital went from four per hundred cases to two. Now, that number has been at zero for more than two years.

“There are a lot of things that we try that don’t work,” Hyman says, careful to characterize these abandoned initiatives as not failures, but learning opportunities.

One highly successful strategy Children’s Colorado shared in its Q4Q application was the decision to include a patient photo in the hospital’s electronic medical record to help reduce wrong ordering. At the time it “dramatically reduced” instances of wrong ordering.

But quality improvement never ends, explains Hyman. Two years after that success the hospital’s incident reporting system indicated an uptick in ordering errors, prompting the team to reexamine why the photo prompt wasn’t having the same effect. The culprit? Likely, it was alert fatigue and growing desensitization among staff to the photo prompt.

“It’s important to celebrate our successes, but these types of experiences are a testament to how ongoing this work is,” says Hyman. “You need to continuously redesign your system in order to continuously improve and a lot of the low-hanging fruit happens early – then it gets progressively harder.”

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Incorporating perspectives (no age or height restrictions)

Patients and families play a tremendous role in the quality improvement work at Children’s Colorado. Parents have played a role on over 50 committees, councils, task forces, and projects and are included on rounds; they play an essential role in guiding what quality improvement means.

“Their commitment to helping us learn and to ensure that errors that affected their children never happen to another family is amazing,” says Hyman.

But it’s not just parents’ voices that are included. Even early on in Target Zero, Children’s Colorado identified that children had a key role to play in the program.

Photo of a doctor giving a young child a high-five. Photo courtesy of Children's Hospital Colorado. 

Their creative approaches to involving patients have evolved over the years, from having them ask for a provider’s “autograph” when they saw them wash their hands as part of a hand hygiene refocus initiative to their latest project, involving virtual reality.

“We’re thinking that we’ll be able to reduce the fear and maybe even the anesthesia involved for certain procedures through the use of virtual reality goggles,” says Hyman. “And right now our patients are working with a company to help design them.”

These types of initiatives seem to embody the hospital’s tagline, Here, it’s different. But Hyman believes that the “magic” you find at Children’s Colorado is emblematic of children’s hospitals across the country.

“Something about the innocence of children changes the nature of the relationship between caregivers and patients and families,” says Hyman. “Everyone is so motivated that it just kind of works – I don’t know if it’s more complicated than that.”

Getting to the next level of quality improvement

Children’s Colorado knows that the quest for quality at their organization is an ongoing pursuit, and it’s not without obstacles. Even encouraging children and families to speak up about concerns or issues they witness is an ongoing challenge.

“The definition of patient- and family-centered care is providing care the way the patient and family want to receive it,” says Hyman. “But that in and of itself presents a fairly wide spectrum. We need to be able to bridge those gaps to meet our patients and families where they are.”

Hyman says one of Children’s Colorado’s focuses is to ensure that the dialogue between frontline staff and patients and families clearly convey what the latter should expect to experience during care and provide the knowledge and language required to speak up.

Speaking in the context of serious safety events, Hyman identifies diagnostic error and adverse drug events as two core areas of focus for Children’s Colorado. “We’re doing a lot of systems work and focusing on designing systems to avoid error, in addition to learning from it,” says Hyman. “We’ve added a human factors engineer to our team in the last six months to bring that science into the work.”

There’s an energy and vigor to reach the next level of quality improvement, says Hyman, highlighting the “great work” happening across the country both in terms of strategy and science.  

“We’re going to need more to get to the next level of quality improvement,” says Hyman, “We’re going to need advancements in medical science to drive out blood stream infections, we’re going to need advancements in technology to help eliminate adverse drug events.”

However, reaching milestones, like receiving the AHA Quest for Quality Prize, are important opportunities to reflect the journey so far.

“The target is still zero,” says Hyman, “But it’s important to recognize and look back on what we’ve accomplished.”

This year’s AHA Quest for Quality Award will be presented at the AHA Leadership Summit, July 26-28 in San Diego. Interested in applying for the 2019 award? Applications are now open - learn more!

RLDatix is proud to sponsor the AHA Quest for Quality Prize as the AHA’s Champion Sponsor for Quality.

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