Editor’s note: This is the second story in a series on hospital safety. Read the first here. Subsequent stories will explore the safety grades for specific hospitals in Fort Worth.
Every morning at 9:30 a.m., 25-30 senior leaders at Medical City Fort Worth gather for a “safety huddle.”
They review data in real time: which patients have a central line or catheter in place; safety issues that cropped up during the last shift; opportunities for “service recovery,” or reconnecting with patients who may have had a negative experience. They celebrate success stories and share patient compliments.
“It’s a daily commitment,” Dr. Terry Loftus, the hospital’s chief medical officer, said. “Everybody knows it. We all go through the routine.”
The huddle is one of many rituals the team at Medical City Fort Worth has embraced to improve hospital safety. And the commitment bears fruit: When The Leapfrog Group, a nonprofit that scores general hospitals in the U.S. for safety, released its spring 2022 report last week, Medical City Fort Worth was the only hospital in the city that earned an A.
“Sometimes (employees) first come into Medical City Healthcare, and it’s a little bit of a shock,” he said. “They may not be used to that level of intensity, obsession around quality and patient safety — but that’s what we do.”
Data and the ‘care excellence’ dashboard
When the pandemic began, Loftus and his colleagues noticed an uptick in central line-associated bloodstream infections among COVID-19 patients at Medical City Fort Worth.
A central line, or tiny tube inserted into a patient’s vein to deliver medicine, can become infected if germs also enter the bloodstream. Hospitals across the U.S. saw an increase in these infections during the early months of the pandemic.
At Medical City Fort Worth, providers track issues like these in the hospital’s internal “care excellence” dashboard. The dashboard, which maintains data on dozens of performance measures, can quickly indicate not only how well the hospital is faring internally, but among hospitals within the Medical City Healthcare system.
When central line infections started to go up, the hospital contacted the system’s corporate performance improvement team, which sent a central line specialist to Medical City Fort Worth. Over several days, the specialist observed how providers insert and remove central lines and, in the end, recommended a series of changes to hardwire better care.
The hospital hasn’t had a central line infection in over six months, Loftus said.
The dashboard serves not only as a place to collect and interpret data, but also as a directory that enables the sharing of best practices across the system. If Loftus notices his hospital isn’t performing as well on a particular metric, he’ll call the chief medical officer at a hospital whose own metric indicates success and ask about what works.
“The nice thing about it is there are no certain secrets within (our health care system),” he said. “If somebody has a best practice, if they’re doing something exceptionally well, it’s really your obligation to make sure that the rest of the organization understands what that is.”
Rituals and the ‘Great Catch’ award
Medical City’s commitment to patient safety predated Loftus’ arrival. When he joined the hospital’s ranks in 2017, his colleagues invited him to the morning safety huddle his first weekend.
He’d seen morning meetings like this one in previous jobs — they rose and fell because leaders didn’t attend. Medical City’s safety huddle, he could tell, was different. The meetings were inherent in the culture of the place.
“The first time I saw it, I was blown away by it,” he said.
Once, a hospital leader who had spent the day making rounds shared a patient complaint: The patient was cold. The leader left the room and shared the story with the huddle, suggesting they would contact facilities to turn the heat up in the patient’s room. Someone in the huddle asked, “But what did you do in the moment?”
The next day, another leader overheard a similar complaint. They immediately asked the nurse in charge if there were warm blankets — and there were. The leader also asked the nurse in charge to contact facilities about checking the thermostat. This time around, the patient’s immediate and longer-term needs were addressed in real time, and the story became a learning moment for others in the huddle.
“That was a big sort of ‘Aha’ for us,” Loftus said. “It wasn’t just about patient safety. It was also about service recovery — making sure the patient was feeling safe.”
Creating that environment of safety and felt safety requires an openness among the staff, a willingness to share and learn from each other when things go wrong.
That sort of environment — where people feel safe to discuss mistakes without fear of punishment — is a key component of patient safety, according to previous Fort Worth Report reporting.
And a central method for fostering that openness, Loftus said, is the ritual of celebration when things go right.
Enter the hospital’s “Great Catch” award — an accolade given to a team member who notices a potential error and speaks up before the error leads to patient harm. In the past month, for example, a provider noticed the wrong form in a patient’s case file. He double-checked the form with the team, and they confirmed he’d found a mistake.
“I think sometimes that’s what you need: You just need somebody to ‘stop the line’ and just ask that question,” Loftus said.
To celebrate the discovery, the senior leadership team bestowed upon the provider a trophy in the shape of a catcher’s mitt — complete with a baseball glove they’d signed.
“It seems kind of silly, but I don’t think it is,” Loftus said. “I think people recognize it as, that’s your senior team coming out and saying, ‘We want you to speak up.’ And that’s a big part of this too: You have to have that commitment to being able to speak up and feeling like you’re in a safe place to do that.”
Alexis Allison is the health reporter at the Fort Worth Report. Her position is supported by a grant from Texas Health Resources. Contact her by email or via Twitter. At the Fort Worth Report, news decisions are made independently of our board members and financial supporters. Read more about our editorial independence policy here.