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What does Quality & Safety mean for your child?

When you get “outstanding quality” health care, it means your care is based on evidence, family –centered and provided by skilled and knowledgeable professionals who communicate and coordinate the care in a timely way.

You and your child should feel safe at MGHfC, and of the best ways to improve patient safety is to constantly monitor performance and family experiences to set up systems to provide the best care for your child. The MGHfC Quality and Safety is committed to this work every day.

High Quality & Safe Care at MGHfC is

  • Evidence - based
  • Family - centered
  • Provided by skilled professionals
  • Rooted in a culture of open communication and continuous improvement
  • Driven by feedback from our families

About Us

Our Vision for MGHfC Quality and Safety

MGHfC, as a national leader in Quality and Safety, is distinguished by a culture that partners with patients and families to assure that care is safe, high quality, equitable, and efficient.

This culture is characterized by:

  • Teamwork
  • Transparency
  • Continuous learning and improvement
  • Communication
  • Innovation

MGHfC Quality and Safety Core Team

Peter Greenspan, MD,Vice Chair; Medical Director, MGHfC

Sandra Dodge McGee, MHA,Executive Director, MGHfC and Partners Pediatrics

Esther Israel, MD, Quality Chair, Pediatrics

Cassandra Kelleher, MD, Quality Chair, Pediatric Surgery

Lindsay Carter, MD, Director, Inpatient Quality and Safety

John Co, MD, MPH, Director, Outpatient Quality and Safety

Kristen Solemina, MPH, Quality and Safety Manager

Caren Harris, RN, MSN, Quality Nurse Coordinator

Jessica Mascola, BS, Quality and Safety Program Coordinator

Michael Peer, MS, Quality and Safety Data Analyst

Our History

The MGHfC Quality and Safety Team work with leadership and staff to provide the highest quality, safest and patient-centered care to our families. We strive to create a culture of continuous improvement through communication, education, information dissemination and data-driven improvement.

Since 2009, our team has implemented safety initiatives and evidence-based care models across all care delivery areas at MGHfC.

MGHfC Quality and Safety Structure

Our structure begins with unit-based triads (physician, nurse and administrator), that report into our ambulatory and inpatient quality and safety team to foster shared learning, teamwork and communication. Our work is driven by priorities set by MGHfC leadership, and MGH leadership including Patient Care Services, Practice Improvement and the MGH Center for Quality and Safety.

Diagram of Quality and Safety Structure

Strategic Plan (5 year plan, 2017) – Our key areas of focus

  1. Reinforce the culture of continuous improvement
  2. Improve safety culture
  3. Improve patient safety, especially in high risk areas
  4. Optimize the patient experience
  5. Advance provider skills in safety science and quality improvement
  6. Establish a national presence through scholarly activity

A Culture of Continuous Improvement

Strategic Plan, Goal #1. Reinforce the culture of continuous improvement

Quality and Safety Initiatives

MassGeneral Hospital for Children (MGHfC) is engaged in a variety of local and national quality improvement (QI) initiatives, impacting children's health care locally and nationally.

  • Every primary care practice, subspecialty division, and inpatient unit is engaged in quality improvement initiatives that they have identified as most meaningful to their patients and themselves. Projects focus on improving different dimensions of care delivery, including patient safety, care effectiveness, patient experience and value.
  • To help encourage and support improvement work, MGHfC has developed a Quality and Safety Mini-Grant Program to provide resources and recognition for work initiated by front line care providers. Projects and initiatives are highlighted on the Department’s Quality Dashboard, with practices encouraged to present their practice specific data and metrics at division level meetings.
  • MGHfC assesses several key quality metrics according to patient/family demographics in an effort to identify and reduce health care disparities.
  • At MGHfC, several practices/care units are engaged in quality improvement efforts through national collaboratives, including:
    • Every primary care practice, subspecialty division, and inpatient unit is engaged in that they have identified as most meaningful to their patients and themselves. Projects focus on improving different dimensions of care delivery, including patient safety, care effectiveness, patient experience and value.
    • To help encourage and support improvement work, MGHfC has developed a Quality and Safety Mini-Grant Program to provide resources and recognition for work initiated by front line care providers. Projects and initiatives are highlighted on the Department’s Quality Dashboard, with practices encouraged to present their practice specific data and metrics at division level meetings.
    • MGHfC assesses several key quality metrics according to patient/family demographics in an effort to identify and reduce health care disparities.
  • At MGHfC, several practices/care units are engaged in quality improvement efforts through national collaboratives, including:

Safety Culture/Patient Safety

Strategic Plan, Goal #2. Improve safety culture

Strategic Plan, Goal #3. Improve patient safety, especially in high risk areas

It can be difficult for infants and children to communicate their concerns or changes in symptoms.  MGHfC offers our patients, families and staff a robust patient safety program which focuses on family participation in care, mitigation of safety risks, teamwork and rapid response to emergencies. We are committed to being a high reliability organization where our systems support patient safety and allow our patients, families and staff to feel free to speak up about patient safety concerns.

Some examples of our Patient Safety initiatives include:

Safety Culture – MGHfC is committed to a strong safety culture in which families and staff feel free to raise patient safety concerns and those voiced concerns result in patient safety improvements. We are proud that we have outperformed our peers on the AHRQ (Agency for Healthcare Research and Quality) Safety Culture Survey.

Near Miss Safety Reporting – Staff are encouraged to report near misses which represent opportunities to improve patient safety.  Over 1200 reports are filed across pediatrics every year.

Medication Safety – An interdisciplinary medication safety committee, Preventing Pediatric Medication Errors (PPME) Committee, consisting of physicians, nurses, pediatric pharmacists, information systems experts and quality specialists who oversee pediatric medication safety projects.

Rapid Response – MGHfC Neonatal and Pediatric Rapid Response Teams can be activated for any acute or unexpected clinical concerns. The Rapid Response Team comes to the patient location to assist patients and care teams with their urgent concerns.

Good Catch Program – MGHfC recognizes staff who speak up and prevent an error which could have reached a patient.

Photo of Michael Flaherty, DO

Integrated Electronic Medical Record – Single electronic medical record across all practices enables all providers to review notes from other provides, test results and medication lists. The patient portal (My Chart) provides patient access to parts o their medical record as well as a secure portal for communicating with their providers.

Family Centered Rounds – Families are encouraged to participate as team members during morning rounds.  This enables parents to actively participate in their child’s care planning and provides a time for raising questions or concerns.

The Patient Experience

Patients and families may receive a phone call or mail survey following their hospitalization or ambulatory visit asking about their experience and anything that we can do better for the family in the future. At MGHfC, we utilize our patient experience survey scores and responses to continually assess the quality of care we provide to our patients and families. Suggestions that families make or improvement opportunities identified allow us to constantly hold ourselves to the highest standards of care for our patients and families.

The MGHfC Quality and Safety team partners with parent volunteers to hosts staff training sessions. These sessions focus on understanding and optimizing the family experience at MGHfC. Staff gain perspective from the parents as well as strategizing improvement opportunities by directly collaborating with families.

Patient Experience Survey Comments

Dr. Shannon Scott-Vernaglia with a patient
Dr. Shannon Scott-Vernaglia with a patient

 “The staff were amazing. The receptionist is amazing. The nurses are brilliant. My kid just loves it there. Anytime he goes there he feels comfortable, and the staff are unbelievable.”

“They delighted me because they are kind of like an extended family to us. They always treat us with respect. They are always just very courteous. It's just a great experience in stressful times, especially.”

“They were very respectful. They kept us informed on the time of wait. They gave us very good information about the procedure, as well as having very good bedside manner.”

“His ability to sit and talk to a child, engage a child, explain what he was doing, and what was happening. He's a wonderful doctor.”

“[The doctor] is a phenomenal medical doctor, surgeon, and caretaker. He had a kind and wonderful bedside manner with my 11-year-old son. He explained the surgery, was reassuring, and confident. [The doctor] was kind to my son. He patiently listened to questions I had and answered each question. He is the best pediatric surgeon in the world.”

“[The doctor] is the best pediatrician I have ever encountered. She is nice, courteous, great with kids, and has excellent medical knowledge. I have the greatest possible confidence in her abilities to care for our children and have recommended her to numerous friends.”

Quality & Safety Education

Strategic Plan, Goal #5. Advance provider skills in safety science and quality improvement

Pediatric Residents prepare for rounds on Ellison 17.
Pediatric residents prepare for rounds on Ellison 17. Family-centered rounds improve patient safety through patient engagement. Structured medication review during rounds and handoff improvements improve the reliability in daily workflow.

Resident Program The MGH Pediatric Residency program is committed to educating its trainees in the principles of patient safety and quality improvement, as well as meaningfully engaging residents in improvement initiatives for providing experiential learning opportunities as well as ensuring its initiatives are informed by residents.

  • During the first year of the residency program, residents are taught the fundamentals of patient safety and quality improvement by faculty from MGHfC/MGH Quality and Safety leadership.
  • By the end of the second year of training, residents are expected to have become a member of and meaningfully participated in a quality improvement initiative at MGHfC.
  • The MGHfC Quality and Safety team has implemented “Resident Quality and Safety Rounds,” which is a forum for communication between residents and MGHfC Quality and Safety leadership regarding residents’ quality and safety concerns.

Psychological Safety Leadership Programs – A four session psychological safety leadership series focused on communication techniques and teamwork.

Partners' Clinical Process Improvement Leadership Program (CPIP) is an intensive 6 – 8 session program with the purpose of engaging clinical teams in the use of process improvement tools to reduce variation in care and improve outcomes for patients.

Team STEPPS – An evidence-based teamwork system to improve communication and teamwork skills among health care professionals.

Patient Safety Awareness Week  MGHfC celebrates patient safety accomplishments and educates patients, providers and staff on patient safety. Every year the hospital recognizes a select group of Patient Safety Stars, nominated by their peers, for their commitment to patient safety within the hospital.

Interdisciplinary Tracer Program - A team consisting of nurses, doctors, physician assistants, registered pharmacists and quality and safety specialists visit each unit to evaluate hospital and patient care operations.

Scholarly Activity

Selected Scholarly activity

Strategic Plan, Goal #6. Establish a national presence through scholarly activity

March 2017 Quality and Safety in Children's Health Conference (poster)
 “Parents Co-Facilitating Staff Helpfulness Trainings at MassGeneral Hospital for Children”

July 2016 The 7th International Conference on Patient and Family-Centered Care (poster)
“Parents Co-Facilitating Staff Helpfulness Trainings at MassGeneral Hospital for Children”

March 2014 Implementing Quality Improvements in Children’s Health Conference (enhanced learning session)
“Keeping in Local: Engaging Pediatric Physicians in Quality Improvements”

March 2013 Children’s Hospital Association’s (formerly NACHRI) “Creating Connections” Conference (presentation)
“Agreeing On, and Implementing, Clinical Standards across Practice Sites”

July 2012 National Patient Safety Foundation in Washington, D.C. (poster)
“Safety Reports - A Vehicle for Change and Improvement at MGHfC”

May 2012 National Patient Safety (poster)
“Can Low Volume High Risk Pediatric Medication Safety a Large Academic Medical Center?”

2012 Digestive Disease Week (poster)
“Measuring Colonoscopy Quality in Pediatrics – A Quality Improvement Initiative”

March 2009 Creating Connections Conference NACHRI/CHA
“Speak Up- Engaging Patients, Families and Staff in Quality and Safety”

Papers

- A Pilot Study of Autism-Specific Care Plans During Hospital Admission

- Association Between Allergen Exposure in Inner-City Schools and Asthma Morbidity Among Students

- The Impact of Pediatric-Specific Vancomycin Dosing Guidelines: A Quality Improvement Initiative

- Improving Clinical Remission Rates in Pediatric Inflammatory Bowel Disease with Previsit Planning

- Emergency Department Utilization Report to Decrease Visits by Pediatric Gastroenterology Patients

- Cost savings associated with decreased emergency department utilization by reporting emergency department visits to specialists

- Department Utilization Reports to Address Avoidable Visits by Patients followed by Pediatric Specialists – accepted for publication

- Review of quality measures of the most integrated health care settings for children and the need for improved measures: recommendations for initial core measurement set for CHIPRA

- Measuring patient and family experiences of health care for children

- Impact of online education on intern behaviour around joint commission national patient safety goals: A randomized trial

- Pediatric resident education in quality improvement (QI): a national survey

- Providing educational content and context for training the next generation of physicians in quality improvement

- A mixed methods approach to developing and evaluating oncology trainee education around minimization of adverse events and improved patient quality and safety

- Use of spaced education to deliver a curriculum in quality, safety and value of postgraduate medical trainees; trainee satisfaction and knowledge

Quality Improvement Project

Specialty Care Quality Projects

Allergy and Immunology

  • Improve completion of food allergy action plans annually
  • Improve completion of TB Risk Status module

Adolescent and Young Adult Medicine

  • Population Health Management/Medical Home Implementation

Cardiology

  • Rate of Outpatient EPIC Pre-Visit/Huddle Documentation for Cardiac Testing

Endocrine

  • Improve the % of DM patients that are screened with the PSC

Genetics

  • Ambulatory Encounters Closed within 72 Hours

GI/Nutrition

  • Vitamin D Status Monitoring of Patients with IBD

Hematology/Oncology

  • Optimizing safe opioid prescribing: compliance with MASSPat and monitor EPIC documentation

Infectious Disease

  • Improving Documentation of Antibiotic Dosing Recommendations in Initial Consultations

Lurie Center

  • Provider Dashboard Review - medication authorizations and cosigns
  • Ambulatory Encounters Closed within 72 Hours

Nephrology

  • CORT: Cardiovascular Outcomes in Children with Renal Transplant: annual echocardiogram, fasting lipid profile, and anemia documented on the problem list with intervention
  • Rate of Outpatient EPIC Pre-Visit/Huddle Documentation

Rheumatology

  • Improving assessment of methotrexate intolerance in Pediatric Rheumatology clinical encounters by completing MISS questionnaire

Inpatient Services Quality Projects

Critical Care Medicine

  • Standardizing asthma care in pediatric Intensive care: order for nurse driven asthma weaning protocol and WARME score documentation

Hospitalist

  • Standardizing and Improving Daily Medication Review During FCC Rounds
  • Allergies reviewed by a hospitalist within 24 hours of admission

Neonatology and Newborn Medicine

  • Improved compliance with Cytomegalovirus testing for hearing screen failure in newborns

Primary Care Quality Projects

  • Standardizing Asthma Control Test documentation
  • Improving HPV documentation in adolescents
  • Population Health Management/Medical Home Implementation

Quality and Safety Mini-Grants

2016-2017

  • Assessing patient reported outcomes and screening for psychosocial co-morbidities in pediatric patients diagnosed with Inflammatory Bowel Disease
  • Limited English Proficiency Patient Education Access Initiative
  • Vancomycin monitoring in targeted pediatric patients utilizing the ratio of the 24-hour area under the concentration-time curve to the minimum inhibitory concentration (AUC24/MIC)
  • Effective Transition of Patient Care in the Pediatric Critical Care Unit
  • High Flow Nasal Cannula For Bronchiolitis On The Floor And In The ED

2015-2016

  • Implementation of Updated Neonatal Resuscitation Program (NRP) Guidelines
  • “Every Inpatient, Every Time”™: Standardizing Communication on Rounds to Improve Timeliness and Efficiency

2014-2015

  • Standardizing inpatient asthma education at MGHfC
  • Reducing Racial and Ethnic Disparities in Care for Children with Autism Spectrum Disorder
  • Reducing Diagnostic Errors in Pediatric Echocardiograms: Standardization of Pediatric Heart Imaging
  • Improving Pediatric Housestaff, Nurse, and Gastroenterology Subspecialist Communication with Family Centered Multidisciplinary Rounds
  • Safety and Efficacy of Vancomycin Utilization and Monitoring in Pediatric Patients at MGHfC: A Review of Current Practices, and Implementation and Evaluation of a Pediatric-Specific Nomogram

2013-2014

  • Improving Resident Management of Acute Pediatric Pain Management in Hospitalized Children Through a Directed Educational Intervention
  • Installation of Claricode Monitoring System to Improve Patient Satisfaction, Decreasing the Total Wait Time in the Pediatric Ortho Clinic
  • Improving Family attendance at rounds through a staff project to establish daily rounding order and communicating to staff and families prior to daily rounds
  • Outpatient Treatment of Low-Risk Fever and Neutropenia for pediatric oncology patients

2012-2013

  • Initiate non-invasive ventilatory strategy in the delivery room to reduce chronic lung disease (CLD) in premature infants
  • Optimizing nutrition and growth in the neonatal intensive care unit
  • The safe patient handoff checklist for postoperative patients
  • Time to antibiotics in seriously ill children at MGHfC

2011-2012

  • Improvement of Survey Metrics “Wait Times”, “Staff Courteous”, “Staff Helpful”
  • Communication, Connection and Quality
  • Implementation of the admission check list in the NICU
  • Family-Centered Approach to the PICU Admission Process
  • Autism Hospital Admission Plans: Improving the quality of care

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