In 2019, The University of Texas MD Anderson Cancer Center identified opportunities to improve the safe delivery of healthcare and has engaged in multiple continuous improvement initiatives. However, to run a complex enterprise efficiently, MD Anderson needed to break silos, learn from the frontline and educate and train leaders in a psychologically safe environment in effort to improve the culture of safety by developing a safety-focused workforce, improve robust processes around high-harm events, increase transparency/feedback regarding safety events and advance the institution towards a High Reliability Organization (HRO) with zero preventable patient harm.

This session will delve into MD Anderson’s significant journey toward establishing a culture of safety and reliability in the complex, high-risk environment within the nation’s top cancer center. Practical examples and detailed insights will be shared on the numerous strategic steps taken and innovative programs developed, such as unique approaches to daily briefings, invaluable learnings gleaned from patient safety events and the inspiring leadership that sets the example for others.

Speakers will describe key interventions including root cause analysis redesign, the development of a Quality Assurance Performance Improvement (QAPI) council, implementation of tiered readiness briefings, the selection and transparency of Serious Safety Event Rate as the organization’s measurement of patient safety, implementation of a mandatory training program in HRO principles and skills and the creation of priority focus areas supported by QAPI.

The session will conclude with a real-word application of the commitment towards an HRO in the diagnostic imaging space and review the actionable findings vigilance unit, which discovers potentially actionable radiologic findings unrelated to the original cause for imaging. . As well, the development of a safety net structure and process will be described for ensuring that such findings are resolved within appropriate timeframes. Intervention, process and patient safety outcomes, including achieving the number one spot in the 2023 Vizient Quality and Safety Scorecard will be reported.

Learning Objectives:

• Describe a blueprint towards safety and a High Reliability Organization.
• Explore tacit and explicit knowledge, models, approaches and frameworks for change in a complex environment; develop metrics for success and sustainability and take inspiration from other change leaders.

Faculty:

Carmen E. Gonzalez, MD, FACP, FACMQ, Chief Patient Safety Officer and Professor, Emergency Medicine Department, The University of Texas MD Anderson Cancer Center

Habib Tannir, FACHE, Vice President, Diagnostic Operations, The University of Texas MD Anderson Cancer Center

José Rivera, Chief Administrative Quality Officer, The University of Texas MD Anderson Cancer Center

ACHE Qualifying Education Credit 

This activity is eligible for 1 ACHE Qualifying Education credit toward earning or maintaining your FACHE credential. 

Credits must be self-reported at My ACHE upon completion of this activity.