About SC Zero Harm
A Commitment to High Reliability
When you board a flight, you trust that any issues with the plane will be found before takeoff. Not because the pilot, mechanics or fuelers never make errors, but because the system was built to catch those errors. Commercial aviation is an industry where every employee is constantly thinking about what could go wrong, and their collective mindfulness leads to resilience over long periods of time—to the point where there’s now just a 1 in 11 million chance of dying in a plane crash. It is, effectively, the safest way to travel, largely because airlines have effectively committed to being Highly Reliable Organizations (HRO). That is the model—and goal—for the South Carolina hospital community.
The Story of SCHA’s Zero Harm Program:
For more than a decade, the South Carolina Hospital Association has worked with healthcare systems and partner organizations to make our state a leader in these efforts. One of our earliest efforts was “Every Patient Counts” in 2008, a statewide partnership to advance patient safety and quality healthcare. Working with Health Sciences South Carolina, SCHA helped hospitals implement a culture of safety, supported the adoption of evidence-based medicine, and championed efforts to prevent adverse events and promote patient-centered care. As part of the work, hospitals across the state engage in formal programs to achieve quality and safety improvements and to share their results with other hospitals.
That broad-based initiative led to a host of other efforts, including statewide coalition efforts like the South Carolina Birth Outcomes Initiative focused on maternal and newborn health and the Alliance for a Healthier SC, a public-private partnership focused on making a collective impact on population health in South Carolina.
SCHA has also continued to evolve and refine their support of high reliability efforts in our member hospitals. In 2012, SCHA teamed up with The Joint Commission Center for Healthcare Transformation, Health Sciences SC, PHTS Risk Management Services, and 31 hospitals and health centers for The South Carolina Safe Care Commitment, a collaborative designed to help hospitals become high reliability organizations. The goal: deliver dependably excellent healthcare at high levels of safety every time, for every patient.
That collaborative effort, along with tremendous strides SC hospitals made as part of CMS’ Partnership for Patients Campaign, led to creation of SCHA’s Certified Zero Harms program in 2013. The goal of the program is to officially recognize the progress South Carolina hospitals are making in common areas of harm, like bloodstream and post-surgery infections, through procedural improvements fostered by a culture of learning and accountability. Thanks to those kinds of improvements, hospitals across the state have demonstrated 12, 18, 24 and even 45 months of harm-free stretches, all of which are validated by the South Carolina Department of Health and Environmental Control. After five years, two-thirds of our members have now won at least one Zero Harm Award, and we’ve certified more than 500 awards during that period.
While the Zero Harm Awards continue to be a tremendous success and recognize the ongoing improvements of our member hospitals, we’ve recognized that reaching our zero harm goals requires more than just focusing on the results; in fact, that the very nature of a high reliability culture is as much about process as it is bottom-line metrics. With that in mind, in 2018 SCHA is also launching the Zero Harm Blueprint, an upstream approach that assesses and builds on the foundational elements of a Zero Harm culture. Based on the American College of Healthcare Executives and the IHI/NPSF Lucian Leape Institute’s Leading a Culture of Safety: A Blueprint for Success, this new approach celebrates leadership-based benchmarks that are essential on the journey to high reliability but often one step removed from clinical practice. The Blueprint will focus on six key domains: Vision for Safety, Trust & Respect, Board Engagement, Leadership Development, Just Culture and Behavioral Expectations.
South Carolina hospitals are all at different points on their journeys to high reliability, and the Blueprint wants to recognize their different needs while providing an accessible yet highly codified model that assists hospitals establish where they are on their journey and the specific steps they need to take next. The six domains laid out in the pages of the Blueprint come with specific scoring metrics that define a hospital’s achievement in that area and instruction for additional improvement. Using The Joint Commission for Transforming Healthcare’s self-assessment tool, SCHA will help hospitals develop individualized plans to ensure that each can make progress toward their zero harm goals and continue on the path to making South Carolina’s hospitals the safest in the world.