Transforming Your Hospital into an HRO: An Interview with LaRay Brown

May 2, 2018

In an ongoing commitment to improving the outcomes and quality of patient care, GNYHA and UHF launched the High Reliability Organization (HRO) Leadership Forum in January 2018. The Forum supports hospitals and health systems as they incorporate high reliability principles into their daily practices.

LaRay Brown, President of Interfaith Medical Center (IMC) and Chief Executive Officer of One Brooklyn Health System, Inc. (OBHS), spoke with Quality Collaborative (QC) on IMC’s experience with the Forum (OBHS is a partnership of Brookdale University Hospital Medical Center, IMC, and Kingsbrook Jewish Medical Center).

QC: Can you describe your strategy for promoting a safety culture prior to the Forum? What are your improvement area targets?

Ms. Brown: IMC has been highly engaged in clinical improvement initiatives and efforts to promote a safety culture. With GNYHA’s support, IMC is actively participating in the New York State Partnership for Patients (NYSPFP), and is proud to be one of the top-performing Brooklyn hospitals achieving higher than average performance on seven NYSPFP measures. When the opportunity arose to join the Forum, we felt it would complement and help further develop the behavioral and cultural components of initiatives already in place. Prior to the Forum, IMC leadership conducted monthly Executive Rounds. The Forum has provided insight into conducting more effective rounds that involve line staff. Leadership is revising the format to include HRO principles and concentration on “Zero Harm.” A guiding principle for our organization and staff is a commitment to compassionate, safe, and equitable care for all of our patients.

QC: In what ways has the Forum had an impact on IMC’s quality and patient safety efforts?

Ms. Brown: IMC is engaged in a number of quality improvement and patient safety efforts, many of which were underway before we joined the HRO Leadership Forum. We believe that embedding high reliability principles across the organization will drive further improvement by ensuring that staff execute clinical and other practices more consistently and effectively, leading to sustainable and spreadable change. We are moving from merely implementing patient safety interventions to establishing a deep-rooted culture of safety that can prevent errors and harm wherever risk exists.

More specifically, we are using the HRO principles to enhance and expand our existing initiatives. For example, IMC has participated in the Agency for Healthcare Research and Quality (AHRQ) Culture of Safety Survey through NYSPFP. Analyzing our results through the lens of the principles of HRO, our HRO leadership team developed six patient engagement and six quality improvement priorities, including propagating interdisciplinary rounding at the patient bedside and expanding successful daily patient safety calls to include weekends.

We are focused on expanding our infection control efforts and are committed to reducing the incidence of hospital-acquired conditions. Daily rounds are conducted to ensure that central lines and Foley catheters are utilized only when necessary. Our interdisciplinary Sepsis Team meets weekly to review compliance with treatment protocols. IMC maintains a close to zero Clostridium difficile infection rate and has taken a deep dive into sepsis improvement by participating in a sepsis readmission pilot program, as adapted from AHRQ’s Designing and Delivering Whole-Person Transitional Care: The Hospital Guide to Reducing Medicaid Readmissions (ASPIRE) tool. IMC was also the first hospital to host a GNYHA regional forum on sepsis.

QC: How has the Forum contributed to IMC’s leadership?

Ms. Brown: Having multiple members of the C-suite team engage in the Forum has helped us have important conversations on what high reliability means for the organization. These discussions have compelled our team to acknowledge our gaps, potential weaknesses, and that failure is a possibility.

The baseline assessment tool each team member completed at the onset of the Forum helped identify variation in how the quality and safety of patient care we provide is perceived. For example, the assessment demonstrated that staff throughout the organization had varying definitions of “harm.” This feedback is being used to identify and address potential areas of patient harm across the organization and establish our vision for improvement going forward.

QC: What have you learned from other HRO hospital teams?

Ms. Brown: It has been helpful to network with other regional teams thinking through innovative ways to achieve the same goal. Other hospitals are also challenged by measuring staff engagement in the organization’s “mental model” or “shared aims” for improvement and change. The challenge we often face to institute effective daily multidisciplinary rounds across the organization is a good example. These rounds, when done well, can lead to greater transparency about what is working well and what needs to improve. Learning how to more effectively engage staff and measure impact is difficult, but is a major goal for us. Our workforce has been bombarded with increasing pressure from not only changing policies and regulations, but also expectations to embrace innovation, to “do a lot with little” due to the financial challenges of a safety net hospital, while keeping faith that the new system’s transformation aims will meet the expected outcomes. Putting into practice the principles of a HRO will help IMC’s senior team lead this organization during these dynamic times.

QC: As the leader of a new health system, OBHS, how can GNYHA and UHF programming benefit your future engagements?

Ms. Brown: The leadership of OBHS has embraced HRO principles. In addition to Interfaith, Kingsbrook is also participating in GNYHA’s HRO Leadership Forum. Both the OBHS Governing Body and leadership of the three hospitals share a strong commitment to progressive values that prioritize patient safety, while striving to reduce health inequities.