Achieving “Zero Harm” Is a Never-Ending Quest
First, do no harm.
These words, translated from the Latin phrase, “primum non nocere,” is one of the bedrock tenets young physicians learn early on in their training. While the phrase is often mistakenly cited as part of the Hippocratic Oath—which it is not—its sentiment is at the heart of every interaction in health care. That is why Lifespan has embraced a patient safety aim known as “zero harm.”
The concept of zero harm in health care is inspired by what are known as high-reliability organizations (HROs). Examples of such organizations exist in the aviation and nuclear power industries, in which sustained excellence in quality and consistent adherence to safety practices prevents errors that can cost lives. During the last decade, the concept of zero harm has expanded to be more prevalent in health care as safety-conscious hospitals aim to evolve into high-reliability organizations. Hospitals that aim to be HROs strive to eliminate incidences of preventable harm.
In an environment where zero harm is embraced, safety is not just a priority for a health care system, but a core value. It means a committed leadership fosters a mindset that permeates the organization from top to bottom, and provides the training and technology necessary to achieve success. It relies on an atmosphere of trust in which employees report and correct small issues or unsafe conditions before they can escalate into major issues.
For example, In HRO hospitals, housekeepers do not just clean rooms, they prevent hospital-acquired infection. Registration staff don’t just complete administrative registration functions, they prevent misidentification and avoid harm by ensuring the correct patient is identified and registered at the point of care or service. Facilities staff maintaining our HVAC systems are not just HVAC experts, they prevent infection by ensuring appropriate air pressure and air flow.
Achieving zero harm might seem like a lofty, even unreachable goal. We believe, however, it is the only ethically justifiable goal.
Here are just some of the ways that we are striving to achieve zero harm:
- In 2010, Lifespan took the important first steps on the journey to high reliability by formalizing an internal infrastructure similar to those in other industries by adopting the process improvement tools of lean and six sigma to eliminate waste and reduce unnecessary variability—key tenets of all HROs.
- All Lifespan affiliates use an electronic reporting system called SafetyNet for staff and providers to report events that harmed or could have harmed a patient, and, most importantly, unsafe conditions that could lead to patient harm. The data is mined for trends that point out areas for improvement before they lead to actual patient harm.
- All Lifespan hospitals hold daily “safety briefings” to improve situational awareness, identify any actual or potential problems that require corrective action and quickly take steps to allay the risk of harm.
- In 2018, Lifespan partnered with the Center for Transforming Health Care (established by the Joint Commission in 2008 to assist hospitals on their journey to becoming HROs) to assist us in prioritizing our efforts to accelerate our progress.
These are just a few of the measures we are pursuing at Lifespan on our journey to “zero harm” and becoming a high-reliability organization. It is a never-ending journey, but one we remain steadfastly committed to achieving. Aspiring to achieve zero harm is one more way that Lifespan is Delivering health with care.
About the Author:
Timothy J. Babineau, MD
Prior to his appointment as Lifespan’s president and chief executive officer, Timothy Babineau, MD served as president and chief executive officer of Rhode Island Hospital and The Miriam Hospital. Before coming to Rhode Island in 2008, he was the senior vice president and chief medical officer for the University of Maryland Medical Center and School of Medicine in Baltimore, MD. Before the 2005 appointment at the University of Maryland, Dr. Babineau held numerous administrative positions, including vice chairman of the division of surgery, surgical residency program director and director of the center for minimally invasive surgery at Boston Medical Center and surgeon-in-chief and medical director for the Boston Medical Center Surgical Associates at Quincy Medical Center. He has been a trustee for the University of Massachusetts and a member of its Audit and Finance Committee.