 Welcome to the broadcast. I'm Robin Betts, the Vice President of Quality Clinical Effectiveness and Regulatory Services for Kaiser Permanente in Northern California. And I'm here with DeAndre Turner. He's a clinical practice consultant and hospital acquired pressure injury performance improvement expert. This is really a follow up broadcast to an earlier one hosted by the Patient Safety Movement Foundation on hospital acquired pressure injuries in the face of COVID. Pressure injuries really represent a major burden of illness for patients and their families, as well as really increase the total cost of care. In America, it's one of only two hospital acquired conditions that hospitals have really struggled to consistently decrease year over year. Based on participant feedback, the Patient Safety Movement Foundation really wanted insights from an organization that has adopted the recommendations outlined in the actionable patient safety solution, creating a foundation for safe reliable care, which incorporates high reliability science to sustain improvement. Specifically for today, we'll focus on two components required for sustainability. Optimize reporting and increase detection. So any drift and performances quickly identified and course corrected. We can do that by incorporating these two principles of high reliability into our operations, sensitivity to operations and deference to expertise where we engage with our frontline to help us find and fix our problems. So with all that in mind, Dre, what programs and structures have you built to support greater sensitivity to operations around HAPIS in our organization? Oh, thank you so much, Robin. And so I really love this topic. Thank you so much for inviting me here today. But one of the things that we have here for our program, let's talk about programs first, HEROES program, and it really stands for Hospital in ED, Operational Excellence and Safety. And so what that is is our multidisciplinary approach to HAIs, HAPIS and falls. And so in this collaboration, we actually have quality and a lot of operational nursing and physician and ancillary teams that really help support this work. And really what this is is, you know, sharing best practices and establishing like a regular reporting cadence, if you will, to detect that drift. And so one of the frameworks that we use for our HEROES program is IHI. And so it's really around quality planning, quality control and quality improvement. And as I mentioned earlier, we'll get into some of those things when we talk about increased detection, as you can see here in escalation and performance improvement. And I also have something that I wanted to talk about too, is like we have different other structures as well to really support that sensitivity to operations that you're talking about. And I know that this slide is a little busy here, but I think some key takeaway from here is that when you're looking at quality control and improvement and quality improvement, there are some key tasks and data and guidance that you can do from a senior leader level all the way down to a patient level. And I really think that gives us a little bit more standardization, if you will. And so we can really work on that sustainability and detecting drift and optimizing reporting. And so one of those examples of that for happy reporting in general, at our daily safety briefings, we talk about the day since the last event. And so as happy is definitely one of the high priorities for our organization, we do report out the day since the last pressure injury. And so I think that's a really great coin of phrase for our hospital operations. SBAR, one of the things that we talk about in really raising the awareness there. And our SBARs here in our organization really comes into play with our tiered huddles. And with our tiered huddles is really our collaboration with our local partners and regional partners. And what that happens is I've gotten emails from you before about this and as we reach out to our local facilities to really give them guidance and offer support in these trying times. Thank you, Trey. I know I benefit from those SBAR escalation summaries and it allows me to activate you and your team to lean in quickly and course correct when we see drift. I'm thinking about all of this work. Could you maybe share with us some recent performance improvement efforts around pressure injury reduction? Sure. So the most recent one was actually Center for Transforming Healthcare by Joint Commission. It was a two year project that we've done and with pressure injuries. And the goal of that was to develop a targeted solutions tool. Really great learnings out of this whole two year long project, some aches and pains there if you will. But some key takeaway points that I really, it really spoke to me and something that will carry forward with me is really your analysis, really truly understanding your standard work and really understanding identifying those issues and what you need to work on. And so for our particular facility, we really focused on mobility, nutrition and braiding because that's what our data was telling us. And so I think when you see here at the bottom of the slide, there's a lot of different avenues within that mobility, nutrition and braiding. However, there's another thing that they actually implemented was Measureventionist, which was coined by Dignity Health. And it's really to increase that peer-to-peer accountability and feedback and really engage in your front line in the work to really drive that forward. And I think over the whole period of this time, I was a 56% reduction and reportable happy. So that's a really, really great accomplishment for the facility. Thank you, Dre. I really appreciate how you deferred to the frontline, our experts to build all that work. How would you recommend we engage our frontline teams in optimizing reporting of pressure injuries? Oh, yes. And so definitely you want to have those really great practices. And the other thing is going back to the why and, you know, when we talked about AHRQ earlier in the video here. So the staff really have to understand the data. And I think there's some really creative ways you can do that from a hospital or unit level. The day since last event, like I said, that really gets people's attention really quickly, especially in a unit that is, you know, have some really active pressure injury performance around it. So from, you know, 190 days down to zero or one, it is going to take notice because they're invested in the work. So I think that's really great. Another way is leader rounding. And so when we're out rounding, you know, as leaders reinforcing those priorities and offering support and encouraging feedback and solutions in real time. It's really important for our staff to have that really intimate connection with leaders in that way and inviting them to ensure their experiences, if you will, with pressure injuries and these complex wounds. It's not a civil bullet for pressure injuries as a lot of different components and we have to individualize the care. And so really getting their feedback about that really starts to create that learning system with your standard work and really to look for those opportunities if you will to improve. Wonderful. Is there anything else you would encourage leaders to do to support and partner with our staff and in happy reduction? Yes. And so, you know, definitely that connection with your staff, you know, so leveraging those unit based champions and leveraging frontline that are very interested in really helping resolve this problem and reducing the, you know, and getting gains. And I think that's really important in leveraging your wound care nurse and that expertise at the frontline because they know they are the closest to the patient. So we have to take their word for it and support them with evidence and the things that they're seeing, of course. And so your quality governance as well. So establishing a rhythm of connecting, you know, your matrix and your performance. So you can really start to look for those early signs of drift, you know, with your performance and your standard work, if you will. Daily management systems. I think that's really great as well. So you, we talked about huddles earlier with day since last events, we talked about tiered huddles as well. I think that's a really, really great way because you can really start to look at those causal factors, if you will. And course correct as well very early on and share those learnings with and having a platform to share those learning as well with your, your other facilities. Recognizing to speak up culture, you know, so definitely taking an account what the staff is telling us and promoting that environment with them and celebrating success. I can't say that enough. Sometimes we leave that out, but it is really important for our staff and our physicians and our care members to really understand that they're doing an excellent job. And we are there to support them the way. Oh, thank you, Deandre for sharing with us how you've been able to use some of the elements from the actionable patient safety solution, creating a foundation for safe, reliable care and high reliability science to really optimize reporting and improve detection of Happys in our organization. And I also want to thank all of you for joining us.