Children's National Hospital: Devoted to Excellence

A culture of safety makes this health care facility one of three winners of the 2021 Workers' Comp Risk Management Award. (Part 1 of 3)

Children’s National Hospital is devoted to improving patient and staff safety. (Photo provided by Children’s National Hospital)

Since its founding in 1870 with just 12 beds for displaced youth after the Civil War, Children’s National Hospital of Washington, D.C. has established itself as one of the most distinguished pediatric medical centers in the United States.

In addition to numerous national and regional awards, Children’s National is ranked as one of the top 10 pediatric hospitals in the country by U.S. News & World Report for the fifth year in a row. It boasts the No. 1 ranked neonatology program in the United States, and it has earned top 10 honors in neurology and neurosurgery, cancer, nephrology, orthopedics, pulmonology and lung surgery, and diabetes and endocrinology.

Children’s National can now add the well-deserved 2021 Workers’ Comp Risk Management Award for Excellence to its illustrious list of accolades.

Quality care mission

Children’s National served 223,856 patients last year, conducted 614,769 outpatient visits, and performed 16,234 surgeries. As a hospital centered on a mission of providing a quality health care experience for patients and families, Children’s National has devoted considerable time and resources to improving patient safety over the years.

“I can’t think of an organization that could be more mission-driven than a children’s hospital in an urban area,” says Rebecca Cady, vice president and chief risk officer at Children’s National. “We’re the only source of health care for a lot of kids, and we take that very seriously.”

Despite improvements in patient safety over a 10-year span, however, hospital leadership noticed that the same traction was not being achieved with employee injury prevention.

“I think people were appropriately focused on the patient, but hadn’t quite made the connection that those same safety behaviors needed to apply to their own safety at work,” says Cady, who began her career as a nurse in San Diego. While working as a nurse, she earned a law degree and eventually became a litigator and partner at a boutique San Francisco law firm. There, she spent more than 20 years defending medical malpractice claims for a range of care providers.

“I still think of myself as a nurse,” she says. “Teaching people is part of the nurse in me. As a caregiver, I want to make sure that we’re taking care of those employees who get hurt.”

Expertise-driven approach

When approaching the issue of worker safety, leadership at Children’s National decided to revisit the successful strategy taken to improve patient safety. Namely, to leverage the expertise of the organization’s staff and develop solutions to common risks.

“We looked at all our work on patient safety, and we decided there is no reason why we can’t apply those same processes to improve safety for employees,” Cady says.

Thus, Children’s National created the Employee Staff Safety Steering Committee, a multidisciplinary committee composed of representatives from several departments, including Risk, Quality, Workers’ Compensation, Nursing, Security, Environmental Services, and Occupational Health. Every month, the committee meets to review common employee injuries, such as those involving sharps, fluids, violence, falls and overexertion.

“The workgroups that worked on all these were really frontline staff,” she adds. “Our success here just illustrates that one of the important principles of high reliability is that you have to go to where the work is done in order to figure out how to solve a problem.”

The committee established definitions, metrics and key drivers for each injury. It employed cause analysis techniques to determine the root causes of injuries and key driver diagrams to develop effective interventions.

Through the committee’s work, a focal point for one common employee injury emerged from an unexpected place: the hospital café.

Children’s National was founded in 1870 with just 12 beds for displaced youth after the Civil War. (Photo provided by Children’s National Hospital)

“We really looked at hallway falls and realized people were not putting lids on their beverages from the café. So, we put up signs, trained cashiers, and made sure they had extra lids. We got people to understand that putting a lid on your drink is actually an important way to keep others from getting hurt. Once people understood why that was important, they did it.”

That’s just one example. Through the efforts of the Employee Staff Safety Steering Committee, Children’s National was able to dramatically improve employee safety overall.

Just look at the results:

Life after an injury

The return-to-work (RTW) process at Children’s National is designed to get injured employees the medical treatment they need to get back to work as quickly as medically possible.

“We don’t wait until the end of an employee’s injury to start talking about a return to work,” Cady says. “We start to discuss that with the employee right away, as well as their manager.”

Early discussions are crucial to an employee’s return to work. According to Cady, “We want to make sure that we’re bringing folks back in to do something for the organization as quickly as we can because we find that the longer a person stays out, the less likely it becomes that they are going to come back. So, we want to keep them mentally attached to us.”

Depending on a worker’s injuries and subsequent limitations, a return to work may start in the employee’s initial department or in a different department altogether. In some cases, a nurse case manager is assigned to the file to serve almost as a concierge, helping injured employees make appointments, and visit their doctors.

Since COVID, the notion of working remotely has expanded considerably. This made a big impact.

“We used to think, well, okay, how could a doctor possibly work remotely? Now there’s telemedicine,” says Cady. “So, if a doctor has a broken leg, depending on their specialty, they may be able to conduct visits via telemedicine. The ability for people to work remotely enables us to keep people working if they have mobility limitations, which is a win-win for everybody.”

Looking to the future

Cady says Children’s National will continue to invest in employee wellness and retention, with a renewed look at workplace violence, a problem shared by hospitals and homecare workers across the country.

“Workplace violence is something we are devoting a lot of time and energy to, especially in situations where patients are involved. That’s one of the most complex and difficult things we’re dealing with. We’re making progress. I think it can be done.”

The work of the Employee Staff Safety Steering Committee has ultimately helped more than just the employees and safety metrics of Children’s National; it also serves as inspiration to other organizations. Various hospitals have reached out to Children’s National to learn about its employee safety work in hopes of adopting the processes within their own organizations.

Children’s National has shared its process strategy through published works and has presented at the Solutions for Patient Safety Group and the Children’s Hospital Association.

Frank Merkl is a Colorado freelance writer.

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