Spotlight On: Dignity Health Makes Patient Communication a Priority

Dignity Health, which recently aligned with Catholic Health Initiatives to form CommonSpirit Health, is now part of a network of 142 hospitals and more than 700 care sites across 21 states. So, when it chooses to focus on patient safety, it touches the lives of hundreds of thousands of patients and their families each year. Barbara Pelletreau, Senior Vice President, Patient Safety, has put processes in place to ensure that consistent, transparent and open communication between staff and patients is standard practice across its sites. In 2016 and 2017, she was recognized by Becker’s Hospital Review as one of the top 50 Experts in patient safety. Pelletreau’s expertise in large-scale change and her passion for patient-family engagement is evident in the strides Dignity Health has made in adopting the Communication and Optimal Resolution (CANDOR) process and the Patient Safety Movement Foundation’s (PSMF) Actionable Patient Safety Solutions (APSS):

  • Improved compliance with the sepsis bundle by 13%
  • Reduced cesarean sections for low-risk deliveries by 9%
  • Reduced hypoglycemia events by 38%
  • Reduced clostridium difficile by 34%
  • Reduced opioid-induced respiratory depression by 30%

Dignity Health recently received the PSMF 5-Star Award for its commitment to implementing PSMF APSS.

CANDOR: Beyond the Training

CANDOR is a process that guides the timely, thorough, and just response to medical errors and patient harm. The level of transparency CANDOR requires often comes with a big cultural shift for healthcare organizations, but the tenants of CANDOR fit well with Dignity Health’s faith-based roots. “It aligns with our values, it’s who we are,” says Pelletreau. “As a patient, we would want the same. It’s just the right thing to do.”

Pelletreau finds that the biggest challenge to implementing CANDOR is sustainability. “CANDOR can never be completely achieved because there’s leadership turnover — and safety is about leadership and keeping the culture and practices alive.” For Pelletreau, training is the bare-minimum – everyone gets trained. She suggests that beyond training, there needs to be a structure that encourages and supports CANDOR processes and culture. So, Dignity Health’s uses five other criteria to define what it means to have CANDOR at its hospitals:

  1. Present to the hospital board
  2. Present to the Medical Executive Committee
  3. Identify members of the Patient Communication Team
  4. Establish WeCare (care for the caregiver) program
  5. Track CANDOR events through a reporting system

Dignity Health requires its hospitals to satisfy four out of five of these criteria for CANDOR compliance: “We are currently at 75% of our hospitals qualifying, with the other 25% a step away,” she says.

Person and Family Engagement (PFE)

Related to CANDOR is Dignity Health’s commitment to Person and Family Engagement (PFE). Patients and their families play substantial roles in managing care, and often see and understand things that care providers miss. Dignity Health believes that patients who are actively engaged in their care see better outcomes, and so encourages patients to:

  • Confirm the hospital has a physical planning checklist that is discussed with every patient who has a scheduled admission
  • Confirm the hospital conducts shift change huddles or bedside reporting with patients and family members in all feasible cases
  • Confirm the hospital has a designated individual(s) with leadership responsibility and accountability for PFE
  • Confirm the hospital has an active Patient and Family Advisory Council (PFAC) or at least one patient who serves on a patient safety or quality improvement committee or team
  • Confirm the hospital has one or more patient(s) who serve on a governing and/or leadership board as a patient representative

The organization’s biggest challenge has been getting patients onto its hospitals’ boards. “Selecting the right patient or family member who has been involved is key. It helps if you have a patient who has some experience in a healthcare setting,” says Pelletreau. “It also makes sense to try to find someone who has been harmed, or had a family member harmed, and has spent time working through that harm so they can be an advocate for how the patient thinks, feels, and approaches these issues. They must have time to heal, though. Finding someone with the passion to make a difference brings together the patient, family, and hospital together in common cause.”

While getting patients onto boards is a step in the right direction, Pelletreau she finds even more value in having patient advisors who have had experience specific to service lines. For example, its Dominican Hospital facilitates monthly meetings for families who have newborns in its NICU. These meetings provide social support for those families, as well as the opportunity to give the hospital input. One of the ideas this group came up with was to have a bulletin board showing pictures of newborns when they were in the hospital, with information about how they are doing months or even years later. This gives parents with babies in the NICU hope that, however traumatic the situation, it’s possible to come through it and thrive. “This was designed through patient input that was very specific to that service line,” says Pelletreau. “It’s a great example of patient input leading to better the care for other patients and families.”

Wisdom of experience

For healthcare organizations wanting to improve patient communication, Pelletreau feels strongly that it starts with leadership. She also encourages healthcare organizations to take advantage of available tools and industry experts. “There are many organizations that have implemented CANDOR and PFE, and there are lots of experts out there to help with guidance,” says Pelletreau. “For example, there are the Communication and Resolution Programs out of the University of Washington Medicine — they are building on the AHRQ toolkit to help organizations fully adopt CANDOR.“

To patient safety champions encountering resistance to the level of transparency CANDOR requires, Pelletreau encourages them to focus on doing what’s right. “We owe it to our patients and to the healthcare industry to do what’s right and lead change.”

What’s Next?

Pelletreau is excited at the prospect of expanding CANDOR and PFE within the combined organization. “I now have the opportunity to influence another 80-100 hospitals to participate in these PSMF initiatives.” Getting the experts, support, training, and measurement tools in place to address the next levels of patient safety in these new hospitals is her top patient safety initiative. Her other goal is to be able to have transparency and shared learning across all of CommonSpirit Health.

Pelletreau’s experience and dedication will come in handy as she works toward these long-term goals. “My passion comes from doing it for the patient, she says. “There’s nothing better than to know that you’ve made a difference in outcomes for patients and helped those who care for them.”