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A Recap of What Happened at the Symposium

When RMF Strategies clients and members of Harvard’s medical community came together in September for the first time, they explored some of the thorniest issues in patient safety today. More than 150 attendees learned, shared, and took home ideas from the CRICO/RMF Strategies Symposium on September 11 and 12, 2006. Among the ideas shared were:

• An “Apgar Score” for surgery patients
• An organizational chart built around patient safety
• A creative malpractice insurer that motivates hospital leadership
• A CEO who said he was the patient safety problem at his hospital
• A zero-tolerance approach to credentialing

New Concepts in Surgery Safety

Beginning with best-selling author and New Yorker writer, Atul Gawande, a surgeon at Brigham and Women’s Hospital in Boston, the discussion was focused on leading edge approaches and practical implementation. Dr. Gawande shared his latest research on the nature of surgical error.

“With funding from CRICO last year, we looked at patients using 38 intraoperative measures to try to see whether we could come up with two or three measures that were the strongest predictors of how that patient would do at the end of surgery, kind of like an Apgar score to say at the end of an operation, how did someone do?”

Dr. Gawande described other activities in the Harvard system to improve surgical outcomes. Since communication played such a large role in the errors identified in the study, a group of surgical leaders is developing standards for sharing patient information among providers, especially between junior physicians and attendings.

Leadership Creates Change

CEOs of two Boston-area hospitals shared how their institutions changed, based on what they learned from high-profile events. Jeannette Clough, President of Mount Auburn Hospital in Cambridge, told of a surgeon with a history of problems who got through the credentialing process. After an event where this physician left a patient on an operating table to go to the bank, the credentialing process was changed significantly at Mount Auburn.

“When something goes wrong, it is how the organization reacts that can re-shape and re-define the culture," said Clough. "We made significant policy and procedure changes internally, which also resulted in many cultural changes. It is unfortunate that in many parts of our lives, we find that sentinel events are needed to create changes.”

Similarly, Children’s Hospital Boston CEO James Mandel, MD explained how he and his leadership team took responsibility for elevating patient safety following a tragedy in its institution. He said he looked around to identify the biggest impediment to safety at Children’s and decided it was himself. He had to change his orientation to set the priorities for improved safety.

Senior officer accountability is now built into an organizational chart, with a Patient Care Assessment Committee at the top. Senior clinical leadership reviews all adverse events within 24 hours The policies for consultations and discharge are standardized, and senior accountability is embedded in protocols for following up on identified system flaws.

Practical Innovation

During break-out sessions, RMF Strategies client MedStar Health of Maryland brought ideas for the use of technology in obstetric safety. Clinical and corporate officers explained how MedStar uses bed-side decision support and required documentation in software for ordering tests and medications during labor and delivery.

In another session, we were asked how a professional liability company can help hospital leadership focus on patient safety issues. CRICO/RMF President Jack McCarthy and CFO Garrett Parker gave some detailed examples of what has worked at Harvard. They emphasized the importance of trust and interaction. Through premium incentives and research grants, the company uses a philosophy of offering carrots, instead of sticks, to motivate institutions to try new things. With significant involvement by insured physicians who designed interventions, CRICO/RMF is promoting creative efforts, such as using simulators, training hospital leaders in an MBA-style curriculum to understand systems, and offering premium incentives to encourage training and education.

Day Two…and Days Ahead

Finally, several participants attended a Day Two session about building confidence in patient safety analysis. A case study in using data to develop interventions gave users of RMF Strategies programs some insights into turning the numbers into change.

All participants and colleagues were invited to continue to share concerns and ideas in on-going Internet discussions on The Exchange. This new community is currently discussing such topics as Disruptive Physician Behavior, Incentives for Surgeons in Handoffs, and Disclosure and Apology.