High reliability in a hospital system refers to the organization’s commitment to minimizing errors and enhancing safety. This involves a culture of continuous improvement, clear communication and a focus on standardization. Leadership plays a crucial role in fostering this culture, emphasizing accountability and ensuring staff are empowered to identify and address potential problems. Examples of principles that encompass high reliability include standardized processes, preoccupation with failure, sensitivity to operations, commitment to resilience and deference to expertise. Being highly reliable encompasses moving safety forward individually and as teams.
As part of its journey to being a high reliability organization, Banner Health, Phoenix, implemented daily management system boards in the environmental services department at one of its hospitals in January 2023. The DMS boards have made a positive impact on environmental services performance improvement, including improved turnaround and response times. The health system plans to eventually incorporate the boards across all Banner hospitals.
The Mission
As part of its high reliability project in environmental services, Banner Health used evidence-based research to implement daily management system boards on all units for huddles at Banner Ironwood Medical Center, Queen Creek, Ariz. It is a full service, acute care hospital with more than 500 beds.
Dashboard Benchmarks
The DMS boards are prominently displayed in department hallways, serving as visual management tools that provide real-time information to care teams. It is important to note that DMS boards do not include any protected health information, which ensures patient privacy.
The purpose of DMS boards is to promote transparency of information by displaying key performance indicators, metrics and goals related to patient care, safety and operational efficiency. This transparency encourages awareness, accountability, a safe zone for staff to express concerns, and continuous improvement and education, and it fosters a culture of unending improvement within departments throughout the organization.
The DMS boards act as a central hub for communication among patient care teams for sharing important updates, information about improved and new procedures, and best practices. This improved communication helps ensure staff is well-informed, confident, supported and aligned in delivering exceptional care. DMS boards also both facilitate problem-solving initiatives by visually representing data and trends that help staff identify areas for improvement, and they encourage collaborative problem-solving and teamwork.
Alongside the DMS boards, Banner Ironwood Medical Center care teams engage in regular staff huddles, which include environmental services team members. The huddles provide an opportunity for team members to share critical information and discuss patient care needs while ensuring a seamless care experience.
The Outcomes
The visual representation of information on the DMS boards within the Banner Ironwood Medical Center environmental services departments has been a game changer. Visuals can convey complex concepts and data in a concise manner, making it easier to process and comprehend. Research published in the February 2023 issue of Management Review Quarterly suggests that our brains are wired to process visual information more efficiently than text or verbal information. Visuals engage multiple senses and can have a stronger impact on memory, making it easier to remember and recall the presented information.
Visual representations also have the advantage of being able to display relationships, patterns and trends in data more effectively. Through charts, graphs, diagrams and infographics, complex information can be simplified and patterns can be easily identified, allowing for better analysis and decision-making. Moreover, visuals have a universal appeal and can transcend language barriers.
The Banner Ironwood Medical Center environmental services DMS boards have positively affected departmental metrics since the boards were implemented in early 2023. As two examples, the team successfully decreased Request to Complete time from 77 minutes to 62 minutes and decreased Start to Complete time from 42 minutes to 39 minutes. (See graphs above.)
A throughput goal, “5 x 5” (5 minutes to accept, 5 minutes to start), and a focus on patient experience (every patient, every time) were added to the daily top five categories on the DMS board along with environmental services department goals and key performance indicators. The board provides a visual management tool to streamline communication with real-time information to the team. It clearly displays metrics and goals related to efficient operations. The visual aspect of the board helps team members understand both individual and departmental performance to facilitate problem-solving and identify areas for improvement as a team. This has propelled the Banner Ironwood Medical Center environmental services team into the top five in the system rank among all Banner Health facilities.
Staff Recognition
Environmental services staff who work in hospitals may have other employment options outside the hospital environment. Thus, their work satisfaction and retention are paramount to patient and quality outcomes and integral to organizational culture. Banner Health has supported the latter through human resources messaging of “One Team” and encouraging employee recognition through an online portal.
Banner Ironwood Medical Center leadership have encouraged the use of the DMS boards to emphasize that all employees “are Banner” and that employees and leadership are accountable for the respective departmental data, outcomes and DMS board content—and for the organization’s shared high reliability journey.
Tom Snyder, RN, FACHE, is director of quality (thomas.snyder@bannerhealth.com), Purvi Patel, PT, is quality specialist (purvi.patel@bannerhealth.com), and Steven Lewis is director, guest services (steven.lewis@bannerhealth.com), Banner Ironwood Medical Center, Queen Creek, Ariz.
Dashboard Benchmarks
The following dashboard benchmarks for all environmental services departments are updated daily, with the prior day completed request:
Request to Complete, also referred to as “turnaround time,” is the difference between the “Request Date/Time” and the indicated “EVS Completed Date/Time.” This is calculated in seconds, divided by 60 and rounded approximately. Unless otherwise indicated, any requests that took longer than 24 hours are omitted from the number on the dashboard.
Request to Start, also referred to as “response time end,” is the difference between the “Request Date/Time” and indicated “EVS Start Date/by Time.” This is calculated in seconds, divided by 60 and rounded approximately. No adjustment is made for this metric on the dashboard. The metric can be overstated, as EVS team members frequently mark it as “started” after they have already initiated the job.
Start to Complete is the difference between the “EVS Start Date/Time” and the “EVS Complete Date/Time” as marked by an EVS team member. This is calculated in seconds, divided by 60 and rounded approximately. Due to requests being marked as started after a job is almost complete, there is an “adjusted Start to Complete” metric shown on the dashboard, which omits any request that was completed within 120 seconds.