Winning Skeptics Over to Quality Initiatives

When Beth Israel Deaconess Medical Center in Boston set the audacious goal of eliminating preventable harm in October 2007, there were many skeptics who thought the hospital would bend the definition of preventability to excuse low performance. However, this goal actually encouraged BIDMC providers to establish a rigorous definition of preventability, calling harm preventable only when an interdisciplinary team could think of no feasible change to care processes that would have prevented the occurrence. Kenneth Sands, MD MPH, senior vice president of health care quality at BIDMC, explains how the hospital won over the skeptics and began a journey to a preventable harm-free organization.

The naysayers
"When we began, some skeptics that said, 'Well, you're talking about preventable harm as opposed to harm; that means you are going to use that language as an excuse to decide that something is not preventable, and therefore you aren't going to take ownership of that problem,'" Dr. Sands says. However, "adopting the concept of looking at the preventability of harm in the hospital challenged us to always be looking at whether we are doing everything to make sure that harm is preventable. If we [aren't], then we take responsibility for it."

While some criticized the hospital for the perceived ambiguity of the definition of preventability, others criticized the goal for being too lofty. "Some people felt it was not helpful to choose an aspirational goal like that, that it was sort of defeating and deflating to declare something so ambitious," Dr. Sands says. "We had to stress that we were striving for perfection, and that we had a lot of confidence that even if we didn't reach our goal, we would certainly be better for pursuing [it]."

The art of persuasion
Gaining the support of some of the skeptics was one of the biggest challenges in beginning work on eliminating preventable harm, according to Dr. Sands. To overcome this challenge, BIDMC used several strategies, beginning with leadership. The goal to reach zero preventable harm events in the hospital originally came from the board of directors, who returned from a retreat wanting to make patients safety and quality a strategic priority. The hospital's executive team and several clinical chiefs also strongly supported the goal. Top leaders' emphasis of the importance of aiming for a seemingly impossible outcome helped gain buy-in from others in the organization

Another way BIDMC broke through the critics was the commitment to transparency through constant, clear communication about the organization's progress on its goal. "[We said,] 'We're going to tell you exactly what we're finding and how we're defining things,'" Dr. Sands says. For example, the hospital provides quarterly data reports first to the board of directors, but then to all departments.

In addition, the hospital encourages input from everyone in the organization, partly through the creation of interdisciplinary teams that are tasked with combating different kinds of preventable harm. The hospital also involved providers and employees by seeking ideas and feedback on the definition of preventability BIDMC established. "I think the leadership commitment at the top of the organization; the broad communication and transparency; and the creation of opportunities for participation is what allowed us to overcome any skepticism," Dr. Sands says.

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