Patient safety is a cornerstone of quality healthcare. Achieving excellence in this area demands continuous effort. At Nashville General Hospital (NGH), our journey to an “A” Hospital Safety Grade from The Leapfrog Group is a testament to our commitment to our patients.
Laying the Groundwork for Change
When NGH started the process to improve overall safety and patient care, we recognized that establishing a genuine culture of safety would demand more than rolling out new policies. We had to do more including addressing the underlying processes that impact safety on a day-to-day basis. Understanding that the commitment and participation of every team member was vital, we prioritized fostering an environment where safety is everyone’s responsibility. We initiated programs to encourage staff to openly report unsafe events, viewing these reports not as failures but as valuable opportunities for learning and improvement.
We strongly emphasized continuous feedback in addition to encouraging reporting and implementing regular training sessions and safety briefings, allowing staff to share insights and experiences to enhance our awareness of safety issues. This proactive approach helped employees to take ownership of safety practices. Ultimately, we believe that by nurturing a culture of transparency and support, NGH can achieve lasting improvements in safety that benefit not just our staff but also the patients and communities we serve.
Tackling Key Challenges
With process improvements led by our team members laying the groundwork, we were able to focus on reducing preventable infections and adverse events, which was essential to achieving our final goal. Two key process measures evaluated by Leapfrog helped us focus on specific areas. Computerized Physician Order Entry (CPOE) enhanced patient safety by fully leveraging electronic ordering systems to ensure precise provider communication. In the intensive care unit, the implementation of intensivist-led care significantly improved outcomes for critically ill patients. Additionally, we have focused on hand hygiene compliance, successfully meeting observation goals across all patient care areas.
In recent evaluations of healthcare-associated infections, two critical areas, Central Line-Associated Bloodstream Infections (CLABSI) and Catheter-Associated Urinary Tract Infections (CAUTI), showed how our processes were changing patient outcomes. For CLABSI, there were zero reported events over the last three reporting periods. This underscores the effectiveness of implementing safety bundles and the diligent efforts of the healthcare team to maintain strict adherence to best practices for central line management. Similarly, in the case of CAUTI, the facility recorded zero events across two reporting periods, a result attributed to the rigorous safety bundle protocols established and comprehensive staff education initiatives. These outcomes reflect our firm commitment to patient safety and ongoing efforts to enhance the quality of care resulting from multidisciplinary efforts.
Celebrating Success While Looking Ahead
On November 15, 2024, NGH joined an elite group of hospitals recognized with an “A” Hospital Safety Grade. Maintaining an “A” grade requires constant vigilance and adaptability with a steadfast focus on improvement. To support our continued success, NGH has identified two key opportunities: To enhance transparency, we plan to share the results of our culture of safety survey with the Metro Hospital Authority Board while embedding our culture of safety more deeply into our organizational practices. We are committed to maintaining our record of zero cases of Clostridioides difficile (C. diff) by continuing our early isolation practices, ensuring rigorous hand hygiene, and conducting thorough environmental disinfection.
The Ripple Effect of Recognition
The Leapfrog “A” logo serves as a powerful symbol of our commitment to excellence in healthcare. Earning an “A” grade enhances our ability to attract and retain top-tier talent in our organization. This outstanding achievement not only engages our existing staff by fostering a sense of pride in their workplace but also builds a strong, positive reputation within our community.
Sharing the Blueprint for Success
Our journey offers valuable insights for other hospitals. Success is not about avoiding mistakes but creating a system where every team member can contribute by identifying risks and acting decisively. At NGH, we view our “A” grade not as an endpoint but as a promise to our patients, staff, and community to strive for excellence continually. Together, we are building a future where safety and quality are the primary standards of care.
Dr. Joseph Webb
Dr. Joseph Webb, D.Sc., FACHE, is CEO of Nashville General Hospital.
