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Conemaugh Nason Medical Center in Roaring Spring, earned a hospital safety grade of "A" this fall from The Leapfrog Group, a Washington-based nonprofit that promotes transparency in health care.
"It's the fruit of a long quality journey we've been on at Nason," said CEO Tim
Harclerode. "A lot of hard work went into (it)."
The A grade follows two successive B grades for Nason, bringing the hospital back to the A it earned in spring 2022, according to the hospital's dashboard on the Leapfrog website.
The recent high mark reflects a major improvement since 2016, when Nason had 33 "patient harm" incidents, compared to just two so far this year, Harclerode said.
Quality protocols established through the hospital's affiliation with Duke LifePoint Healthcare have been critical, along with staff "engagement" and high staffing levels, including a full roster of nurses -- unlike all the other hospitals in the 62-facility LifePoint system, according to Harclerode.
As do all LifePoint hospitals, Nason promotes the parent organization's "Foundational Five" Safety Behaviors, Harclerode said.
Those comprise a briefing before each shift; a debriefing after each shift; "huddles" after unexpected or problematic events; "learning boards" to notify staff about issues; and leadership "rounds" among all departments to deal with outstanding difficulties.
The start-of-shift briefings involve leadership, with information "cascading" down to all the departments -- including "who takes what assignments, how to divvy up the work and if someone is not feeling the best, how to rally around them,"
Harclerode said.
The end-of-shift debriefings involve discussions of what went well, what was learned, how things can be done better and what needs to be passed on the next shift, he said.
Huddles happen following untoward events, like patient falls, and involve all the staff, with an evaluation designed to get to the "root cause" through repeated applications of "why?"
As an example, he said the whys can include: Why was the bedrail down? Because there wasn't an alarm. Why was there no alarm? Because they were all in use. Why were they all in use? And why weren't more ordered? The exercise helps the hospital correct problems "on the spot," so they don't recur, Harclerode said. Huddles can also help staffers "decompress" after troubling occurrences like patient deaths, he said.
Learning boards comprise red, yellow and green sections that reflect issues that are outstanding, on the way to being fixed and altogether corrected, Harclerode said. They can be employed on something as simple as a burned-out lightbulb in a supply closet that is making it difficult to find something needed, he said. If night shift discovers such a problem, the learning board pointer is in the red, and if day shift orders a new bulb, it turns yellow, and when the new bulb is in place, the learning board pointer turns to green.
The safety rounds focus on problems that departmental managers have been unable to fix. Those rounds often include members of the hospital board and its Patient-Family Advisory Council, whose "outside eyes" are helpful in guiding improvements, Harclerode said. Subjects discussed during the rounds often become topics at the monthly board meetings, helping to hold staff leadership accountable, Harclerode said.
In addition to the procedural best practices, technological innovations like barcode medication administration, electronic ordering by physicians and a top-of-the line medical records system have helped ensure patient safety, Harclerode said.
Also helping ensure safety is the hospital's "culture," as reflected in Nason's "family" vibe, its low call-off rate and the preponderance of staffers willing to come to work in all kinds of weather, Harclerode said. Seeing evidence of that culture attracts candidates for employment, he said.
All the hospital employees, from housekeeping to physicians, "pulling in the same direction," are needed, Harclerode said.
The hospital has not used the "secret shopper" method of ensuring that staffers follow safety protocols for several years, noting that some staffers see that as "spying," he said.
The hospital has been getting equivalent information, generally related to patient satisfaction, through the Patient-Family Advisory Council, Harclerode said.
The Leapfrog safety dashboard assigns a desirable green, a mid-level yellow or an undesirable red rating for issues within each of five categories -- infections, problems with surgeries, safety problems, practices to prevent errors and medical staff interactions.
Nason received a green and a yellow for the only two applicable issues under infections in the most recent Leapfrog dashboard.
The hospital received two greens and three yellows for applicable issues under problems with surgeries.
It received two greens and five yellows under safety problems, and received four greens and two yellows under practices to prevent errors.
And it received four greens, a yellow and a red under staff interactions.
The hospital's lone red mark reflects the lack of an "intensivist" doctor to work in the intensive care unit, which in turn reflects the hospital's small size, Harclerode said.
UMPC Alrtoona also received an "A" from Leapfrog.