MossRehab is proud to be a leader when it comes to designing and implementing novel initiatives aimed at improving patient safety and outcomes during rehabilitation. Recently, Jerry Zuckerman, MD, chief quality and patient safety officer at MossRehab’s parent, Einstein Heathcare Network, sat down to discuss current collaborative efforts geared toward providing exceptional quality and safe patient care across Einstein Healthcare Network.

MossRehab’s dedication to safety is part of a broader mission to improve safety and patient outcomes at Einstein Healthcare Network. And, in turn, efforts at Einstein are part of a nationwide quality improvement program. Could you talk a little about national efforts to improve hospital safety?
Dr. Zuckerman: At the end of 2014, the Secretary of Health and Human Services (HHS) announced a new report on hospital safety called “Safety Across the Board” which now serves as a guide for helping healthcare organizations develop systematic approaches to safety. This guide was prepared by 26 Hospital Engagement Networks (HENs) across the country, all of which are part of a national program called Partnership for Patients. Einstein Healthcare Network is a member of the Hospital & Healthsystem Association of Pennsylvania, which is one of the 26 HENs. We have carefully reviewed this report as part of our response to a national call to improve safety, and we have worked hard to refine many of its guiding principles to better fit our needs. We created an internal Safety Score that reflects a composite of events experienced by our patients while under our care. These events include hospital acquired infections, hospital acquired conditions, readmissions and/or unplanned transfers and medication events. In the Guide to Safety Across the Board there seems to be a greater emphasis on system-wide approaches to safety, rather than on individual unit-based projects.

The Safety Across the Board report noted that one of the hallmarks of an exemplary healthcare organization is a “healthy preoccupation with failure.” Can you explain what that means?
Dr. Zuckerman: An organization that has a healthy preoccupation with failure is one that encourages the full disclosure of all safety-related events, including near misses. We encourage this type of reporting at Einstein. We understand the value that reporting plays in helping us to better understand our processes and how we can improve them to ensure that care is provided in a safe fashion. We also understand the importance of making reporting non-punitive; everyone is encouraged to identify potential safety-related problems. Staff members also have the option of providing information anonymously. The Safety Scorecard, I believe, has increased awareness about patient safety and paradoxically we have seen an increase in reporting. It’s likely that the same number of events were occurring in the past, but we simply weren’t capturing them. However, I am OK with our score getting slightly worse before it gets better. Reporting more events is not a bad thing–it tells me that there is a heightened awareness of potential risks to patients, and that will help us establish a solid foundation from which we can move forward. 

In a recent presentation you emphasized the importance of “putting a face” on the measurement of safety, or safety metrics. Can you explain what that means?
Dr. Zuckerman: I think our staff frequently struggles with statistics and rates related to safety. For example, what does it mean to a staff member when he or she hears that our organization has 0.4 infections per one thousand catheter days? That kind of information is too abstract—it is a number that lacks significance for our staff. Therefore, on the Safety Scorecard we also portray the actual number of patients who experience events. It is far more meaningful for a unit, for example, if we can say that six patients on their unit experienced a particular event. Putting a face on safety-related events makes them more tangible, and it reminds us that someone is at the receiving end of any potential harm event. 

How does MossRehab interact with the rest of the Einstein Healthcare Network when it comes to issues involving safety?
Dr. Zuckerman: MossRehab is on our network quality dashboard and there are several metrics on which MossRehab and all other members of our network report. These include improving the Safety Score, reducing unplanned readmissions and/or unplanned transfers, and improving the patient experience. The leadership at at MossRehab serve as members of our Board Quality Committee as well as our Performance Improvement Committee, and our Patient Safety Committee. Each component of our network tries to learn from the others. Even though the patient populations vary considerably, there are many times when it is possible to learn from a project developed specifically for one unit or facility and apply that knowledge to other areas of the organization, and thereby avoid recreating the wheel.

Have divisions of MossRehab, in some cases, piloted successful safety initiatives that were later rolled to other parts of Einstein Healthcare Network?
Dr. Zuckerman: Divisions of MossRehab have led a number of unique and successful safety initiatives. Most recently they developed a strategy for helping to prevent transmission of C. difficile, a serious bacterial infection, which involved bundling together instruments, including a dedicated thermometer, stethoscope and blood pressure cuff, to be used for individual patients with this infection. This strategy helps to ensure providers have equipment necessary to evaluate patients at the point of care and reduces the risk of transporting a potentially contaminated device into another patient’s room. It is one that we are trying to reproduce at our main campus and other sites.

They also developed a pressure ulcer prevention program that has proven to be enormously successful. Prompted by a change in mandatory reporting in 2012, MossRehab worked to ensure that its accuracy in the clinical assessment and reporting of pressure ulcers exceeded new expectations by the Centers for Medicare and Medicaid Services. They began to report both mandatory and voluntary information, and heightened communication among physicians, nurses, team leaders and data collectors at MossRehab. After implementing new processes they were able to reduce their healthcare hospital acquired pressure ulcers (HAPU) rate by 66 percent during nine quarters of data collection. Safety leaders from MossRehab subsequently presented this project so that other facilities in our network could learn from their success and determine potential next steps of dissemination. Several remarkable efforts were launched in a single division of MossRehab and then successfully rolled out to its other divisions. 

Could you mention an example?
Dr. Zuckerman: MossRehab has developed a number of unique evidence-based safety projects similar to the pressure ulcer prevention program. One of their earliest initiatives was a successful catheter–associated urinary tract infection (CAUTI) program, which involved investigating and analyzing catheter-associated urinary tract infections with the goal of dramatically reducing infection rates and eventually preventing the infections. After the implementation of this program by their UTI team in 2009, MossRehab succeeded in reducing infections by more than 50 percent in the first year. This program was initially piloted in the spinal cord injury units but has since been rolled out to all six inpatient locations and satellite units served by MossRehab.

Could you talk a little about the CUSP program at MossRehab?
Dr. Zuckerman: CUSP stands for comprehensive unitbased safety program, and it is a critically acclaimed five-step program developed by the Johns Hopkins Quality and Safety Research Group. In 2014, the stroke rehabilitation unit at MossRehab became one of the first rehabilitation units in the U.S. to adopt the CUSP program, which uses teamwork and heightened communication to improve the awareness of potential safety problems and leverage a facility’s ability to learn from errors. MossRehab tailored the program to meet its unique needs, and their modification of CUSP succeeded in joining executives, physicians and staff in achieving reductions in safety-related errors. The programs developed by MossRehab clearly reflect high internal safety standards.

Does MossRehab also seek external accreditation?
Dr. Zuckerman: Absolutely. Every year since 1969, MossRehab has pursued recognition of its own high standards by seeking CARF (Commission on Accreditation of Rehabilitation Facilities) accreditation. This type of accreditation is really the gold standard in the field of rehabilitation, and MossRehab is CARFaccredited in 15 different areas of rehabilitation service, which is quite an achievement. Throughout Einstein Healthcare Network, we understand the value of seeking external validation of our own very rigorous internal standards, and we are proud that MossRehab regularly pursues these clearly defined and internationally accepted standards of safety and quality. Safety leaders at MossRehab, including Director of Quality and Education Julie Hensler-Cullen, RN, and Chief Medical Officer Alberto Esquenazi, MD, set the tone for quality improvement at MossRehab and contribute significantly to the improvement of safety standards at Einstein. When it comes to patient safety across our network, it takes a village to provide the very best to our patients, and we are grateful for opportunities to collaborate with MossRehab.