Improving Reliability by

Empowering Patients
Sam Bagchi, MD
Chief Medical Officer
CHRISTUS Health System
Agenda

• Introduction
• Overview of CHRISTUS Health
• CHRISTUS Patient Centered Care
• The CHRISTUS High Reliability Journey
• The Role of High Reliability in Patient Centered Care
• Questions

2
International Catholic, faith-
based, not-for profit health
system comprised of almost
600 services & facilities, more
than 60 hospitals & long-term
care facilities, 350 clinics &
outpatient centers and dozens
of other health ministries &
ventures.
45,000 Associates $6.8 billion total assets
under management
15,000 physicians
60 hospitals on medical staffs

2018
CHRISTUS Locations
CHRISTUS operates in
4 U.S. states, 7 states in
Mexico, Chile &
Colombia
CHRISTUS is sponsored
by congregations of the
Sisters of Charity of the
Incarnate Word in Houston
& San Antonio & the Holy
Family of Nazareth.
 The mission of CHRISTUS Health is to
extend the healing ministry of Jesus Christ
 CHRISTUS Health Core Values
Dignity – Respect for the worth of every person, recognition and
commitment to the value of diverse individuals and perspectives, and
special concern for the poor and underserved.
Stewardship – Wise and just use of our talents and resources in a
collaborative manner

Excellence – High standards of service and performance

Integrity – Honesty, justice and consistency in all relationships
Compassion – Service in a spirit of empathy, love, and concern
Patient Centered Care at CHRISTUS

• Help me
• Heal me
• Be nice to me
• Don’t harm me

9
Evolution of Quality

Zero
High Harm
Reliability
Clinical
Quality

Regulatory
Quality

Beginning Developing Advancing Approaching

Culture of Safety Survey Results

Percentage
change in
Percentage
Favorable from
FY16 to FY17

*Overall Perception of Patient Safety question has changed to “I can report patient
safety mistakes without fear of punishment” in FY17. Result comparison above only
compare questions that are consistent between the two surveys.
High Reliability Characteristics

• Preoccupation with Failure

• Reluctance to Simplify Problems and Solutions
• Sensitivity to Operations
• Deference to Expertise in complex problem solving
• Commitment to Resilience
Building Reliability
Defining high reliability

• Error/Waste identification
• Safety event and variance reporting
• Error/Waste reduction
• Actions and behaviors that reduce errors
Celebrating Safety Event Reporting
High-Reliability Program

Leadership Skills
Daily Check-In or Safety Other Existing Leader Tools / Reflection &
Rounding Executive
Huddle/Daily hospital-wide safety TM Messaging on mission (such as story telling or
WalkRounds (IHI)
huddle mission moments or safety messages)

Universal Skills

Speak Up/ Inquiry,

Communicate Pay Attention/
Communicate Communicate advocacy, assertion
Clearly/ Repeat- Communicate Cross monitoring
Clearly/ Phonetic Clearly/ Numeric (ARCC,
backs and read- Clearly/ SBAR with assist (peer
clarification clarification TEAMSTEPSS _
backs checking)
CUS)
High Reliability Universal Skills

PAY ATTENTION TO DETAIL

Self-check. Cross-check.

COMMUNICATE CLEARLY
N
Repeat back. Clarity statement.
SBAR
W E

THINK CLEARLY & SPEAK UP

S
Questioning attitude. “I need
clarity”

USE PROTOCOL/CHECKLISTS
Reference use. Continuous Use.
Pay Attention to Detail

W E
SELF CHECK
Self-checking is the most
effective way to avoid slips
and lapses.
S = Stop and pause to focus
T = Think about what is to
be done
A = Act and perform the task
R = Review and check result
CROSS CHECKING
S Cross Checking is
watching-out for each
other. Share
situational awareness
and provide on-the-
spot second opinions.
Communicate Clearly

W E

REPEAT BACK PHONETIC CLARIFYING SBAR

CLARITY QUESTIONS
Sender Focused
initiates. Ask 1-2 communication
For sound-a-
like words, questions in a .
Receiver positive way
acknowledge use a clear
to increase Situation
s alphabetical
understandin Background
letter g of the
Sender Assessment
followed by information. Recommendati
confirms
the word on
accuracy
Think Clearly & Speak Up

“I NEED CLARITY”
QUESTIONING ATTITUDE
Safe statement to initiate a review of the
Validate – Does it make sense to me?
Verify – Check with an independent source
situation.
Use Protocols and Checklists To
Perform Safety-Critical Tasks:

EFFICIENTLY SAFELY
.
CORRECTLY

CONSISTENTLY N AND AVOID

.
USING MEMORY

W E

S
• HRO
Program is
essential, but
not sufficient
to create a
truly patient
centered
care model.

23
CHRISTUS C. Diff: A High-Reliability Story
1,90 Implementation of C Diff Protocol
UCL: 1.814
1,80

1,70
1,64 1,65 1,72
1,61
1,60

1,49 1,50 1,50

1,48 1,48
1,50
1,50

1,40
23% Reduction
1,30

1,20 LCL: 1.163

1,10 1,14 1,15

1,00
FY15 Q1 FY15 Q2 FY15 Q3 FY15 Q4 FY16 Q1 FY16 Q2 FY16 Q3 FY16 Q4 FY17 Q1 FY17 Q2 FY17 Q3 FY17 Q4
Patient Centered Care Project at IHI LATAM

Control and Pain Relief in Northern Mexico

– CHRISTUS Muguerza
• Yesika Deyanira Acosta
• Day 3 at 0900 in Gran Salon A

25
Improving Reliability by
Empowering Patients
26