The University of Texas MD Anderson Cancer Center has reduced its serious safety event rate by implementing a patient care quality improvement strategy that includes tiered staff briefings, an incident command, an analysis model, awards program and patient safety quality officers.
José Rivera, chief administrative quality officer, said the Houston-based center’s decision to focus on quality was driven by results of regulatory surveys in 2019. The first step, in 2020, was to increase monitoring and readiness for quality improvement. “And that was really, really important for us, because we need to make sure that we establish a way to measure our progress, and making sure that that progress was sustainable,” Rivera said.
Safety initiatives and “high reliability training” began in 2021 and included all 27,000 employees. The cancer center that year also made safety a core organizational value, which Rivera said meant providing “a safe environment, physically and psychologically, for our patients, for our colleagues and for our community.”
By 2024, safety roles among the staff were expanded, the center’s “just culture algorithm” was strengthened, safety excellence awards were in place, safety champions were named and a focus was put on psychological safety. “Our leadership, our culture and structure integrations have made our improvements possible,” Rivera said.
The center embarked on a high reliability journey so that everyone saw quality improvement was a partnership across the organization with the goal of becoming safer every day.
Quality improvement is not new in health care
Quality improvement in health care has been evolving for at least 100 years as new methods and technologies have been developed to improve patient outcomes. It became a public focus, however, with the 1999 Institute of Medicine report, “To err is human: building a safer health system,” which found that some 89,000 people died each year due to medical errors in hospitals.
That put increased attention on patient safety and quality improvement programs as well as rules and regulations on reporting and compliance. The quality improvement program at MD Anderson builds from the call to action the IOM report represented at the time.
Getting physicians involved
The center prominently features physicians, according to Dr. Carmen Gonzalez, chief patient safety officer. Gonzalez said physicians must intervene and be involved in patient safety because it is a shared responsibility. “In addition, when physicians champion quality and safety, they can enable peer engagement, cultivate a stronger safety culture, and do so by contributing to building a social capital,” Gonzalez said.
The framework has four tiers of briefings for clinicians and other stakeholders, beginning with looking at what happened at the center in the past 24 hours, what’s going to happen in the next 24 hours and if there are any patient safety concerns. Events or concerns are escalated to the next level, if necessary, and to the Patient Safety Incident Command, which is organization-wide and includes areas such as leadership, patient safety officers, risk management and public relations.
A Root Cause Analysis Model is used to determine what happened, what should be done and monitoring that would be needed to ensure the situation is resolved. If an employee is involved in the issue, a Just Culture Performance Algorithm comes into play to determine things like harms, compliance with policies and training.
Safety quality officers
The initial patient safety quality officers included physicians and pharmacists, but in 2023, the group was expanded to include advanced practice providers. It now includes 144 members whose goal is to support a culture of safety and accountability, education and collaboration. The cancer center anticipates it will lead to cost savings for patients and the organization.
“Adverse events and patient harm increase care costs for patients, health care organizations, and the broader health care system,” Gonzalez said. “Additionally, adverse events can damage an organization’s brand reputation and erode trust among patients, employees and the communities we serve.”
A big challenge to having physicians participate in quality improvement is a lack of protective time or time they must dedicate to the task. MD Anderson system engineers created a time allocation tool that allows physicians to calculate the time they need for quality initiatives, with the ability to negotiate for additional hours.
Leadership involvement is critical
Habib Tannir, vice president of diagnostic operations at MD Anderson, said making the program successful requires leadership support and engagement. There must be psychological safety so everyone feels they can be involved. “It is daily. It is action by action, word by word,” Tannir said. “So it really requires a lot of investment there.”
Tannir added that listening skills also are important to the process as solutions are developed that work for frontline staff. And staff must learn from each event so what happened is not forgotten or “brushed under the rug.”
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