JANUARY 23, 2017, PORTSMOUTH, Va. (NNS) – “Navy Medicine has always had a preoccupation with patient quality, patient safety and process improvement,” said Capt. Frank Dos Santos, Navy Medicine East (NME) high reliability deputy chief of staff. “We have embarked upon the journey of high reliability, and upon embarking on that journey we’re seeking to instill principles in the delivery of health care within Navy Medicine.”
The Joint Commission (TJC)-the national accrediting body for all U.S. hospitals-recognizes the road to a high reliability organization (HRO) for the health care industry is an ongoing journey. The tenants of HRO consist of leadership engagement, culture of safety and a robust process improvement.
NME’s high reliability team has been engaged in a variety of clinical quality metrics such as ORYX (the TJC’s performance measurement data), Healthcare Effectiveness Data and Information Set, National Surgical Quality Improvement Program and National Perinatal Information Center. These are in addition to TeamSTEPPS ® strategies and tools that are systematically utilized by all of NME’s military treatment facilities. All levels of NME’s staff are capturing near misses and patient safety event reporting through the Department of Defense Patient Safety Reporting System.
In 2016, NME established the role of a chief medical officer (CMO) at each military treatment facility to focus solely on HRO. It has also established Six Sigma black belts at NME to assist facilities with projects, and plans to continue to grow its headquarters team to include subject matter experts such as patient safety and risk management personnel for oversight.
“Our goal with the additional resources we are providing to our military treatment facilities is to move us further along the path to becoming a highly reliable organization,” said Dos Santos. “Ultimately, it is about improving quality and safety, enhancing both the patient and staff experience, and supporting open communication lines across all levels of the health care staff and the patients they care for.”
NME’s high reliability team oversees hundreds of military treatment facility projects each year, ranging from improvements to access to care, to improvements in medication management processes. And one way it shares those best practices is through the NME Virtual Continuous Process Improvement (CPI) Fair it launched in 2015. The CPI Fair provides military treatment facilities the opportunity to submit successfully implemented projects.
For example, U.S. Naval Hospital (USNH) Naples was one of NME’s 2016 winners based on their project that reduced infection risk through the regulation, overall management and recycling of non-gastrointestinal flexible endoscopes throughout Navy Medicine’s European military treatment facilities and its surgery health care enterprise. Through rigorous process improvement, USNH Naples optimized the standards of care by identifying patient safety risks and reducing the cost of repairs and maintenance of the scope.
The staff at Naval Health Clinic (NHC) New England, Rhode Island, also won for their project that focused on improvements to the documentation and return of the Pap (Papanicolaou) test results that resulted in increased compliance rates from 86.83 percent to 97 percent.
The NME CPI Fair was such a success that its counterpart, Navy Medicine West, launched its own fair in 2016. NME will announce its 2017 winners in March.
Along with the additional resources NME is providing to its health care facilities to support high reliability, a baseline assessment was sent out in 2015 to each one of the commands evaluating key elements such as the data, safety culture and effective methods instilled by leadership. Findings demonstrated that all NME military treatment facilities were moving ahead with becoming highly reliable.
Many military treatment facilities are also pursing unique local, regional and national patient safety partnerships with the broader health care community. For example, two of NME’s facilities in South Carolina, NH Beaufort and NHC Charleston, are participating in the South Carolina Safe Care Commitment multiyear project that launched in 2013. It is based on a collaborative model to improve the quality and safety of patient care and underscores the principles of high reliability.
“It’s simple. Our goal is to leverage all available best practices and resources-inside and outside military medicine-to ensure the best patient outcomes,” said Dos Santos.
NME is one of two regional commands that manage Navy Medicine’s global health care network. It oversees the delivery of medical, dental and other health care services to approximately one million patients across almost 100 facilities in the eastern hemisphere-including the Tidewater Enhanced Multi-Service Market which brings together Naval Medical Center Portsmouth, U.S. Air Force Hospital Langley and McDonald Army Health Center. Plus, its public health activities extend globally. For more information, visit www.med.navy.mil/sites/nme.
Mass Communication Specialist 2nd Class Stephane Belcher, Navy Medicine East Public Affairs