Why would a well-respected, venerable health care organization adopt a soft and squishy approach—tracking disrespect and other forms of emotional harm—to monitor its performance?
In 2007, Beth Israel Deaconess Medical Center (BIDMC), a 672-bed health system affiliated with Harvard Medical School, adopted the audacious aim of eliminating all preventable harm by January 1, 2012. According to Kenneth Sands, MD, chief quality officer of BIDMC, the organization has not yet achieved perfection in this area, but the bold goal has catalyzed substantial advancement in patient safety at the organization.
Sands and colleagues described this courageous approach and their patient safety efforts at a presentation at the Institute for Healthcare Improvement Annual Forum in December. BIDMC patient safety experts have developed a process by which serious events, such as medical errors, are sifted from the “noise” of the thousands of reports received each year, such as “near miss” events. High-level statistics regarding these events are included on the organization’s performance dashboard, portions of which are shared publicly. Since launching the initiative, BIDMC has seen a 70 percent drop in serious harm events, despite improved reporting mechanisms that likely increased the number of harms reported.
According to Sands, the bulk of the improvement was due to several initiatives to decrease specific harms (for example, decreasing cardiac arrest in med/surg units). Quality and safety leaders realized that the harms that remained would require a broader approach.
At the Wingspread Summit in November, I met many colleagues engaged in addressing physician burnout. From Corey Martin, MD, I learned about a really innovative program in Minneapolis—although initially I struggled to see the connection between the initiative and physician wellbeing.
The Bounce Back project builds on the evidence that happiness improves health outcomes and on the idea that specific practices (“tools”) can build resilience to stress—enabling people to “bounce back when life doesn’t go as planned.”
On the phone recently, I asked Martin why he became involved in Bounce Back. He explained that three painful events led him to help found the Bounce Back project.
In 2014 a young, well-loved physician at Martin’s hospital died in a vehicular crash, leaving a spouse and four children. As the hospital staff struggled to recover from his death, a respected pediatrician took his own life in the hospital chapel. His death profoundly shook the hospital staff and the local community.
The morning after his death, a unit clerk confided to Martin that when she heard the news, she thought it was Martin who had died by suicide. He told me, “If other people could see the burnout in me and I could see it in my colleagues, I knew we had a serious problem.”
Soon thereafter, a 15-member group consisting of medical staff and senior administrators of the hospital attended a conference on resiliency convened by the Minnesota Hospital Association. Bryan Sexton, PhD, director of the Duke Patient Safety Center at Duke University Health System, presented several tools that have been shown in research studies to increase resiliency. According to Martin, these evidence-based tools form the basis of the Bounce Back project.