Cincinnati Children’s Is A Unicorn, But It Should Be A Role Model

Cincinnati Children’s Hospital Medical Center is a unicorn – not the mythical kind, looking like a horse with a single straight horn, but the metaphorical kind, “something unusual, rare or unique.” Cincinnati Children’s is a patient safety unicorn, a place where achieving zero patient harm is a genuine cornerstone of the corporate culture.

At a recent government-sponsored webinar, for instance, Dr. Stephen Muething, the hospital’s chief quality officer, repeatedly used a word other hospital leaders typically deploy when describing the approach needed to preserve profitability. The word was “relentless,” but instead of describing how to preserve margin, Muething was describing how to preserve life, as in being “relentless” in pursuit of the vision of zero harm and “relentless” in a patient safety focus.

“Today is 274 days since our last serious safety event at Cincinnati Children’s,” said Muething before declaring, “It’s still too many.”

“Relentless” also describes the unique ways in which Cincinnati Children’s has doggedly persevered. Back in 2001, Cincinnati Children’s was one of just seven organizations (and the only children’s hospital) chosen to participate in the Robert Wood Johnson Foundation’s Pursuing Perfection initiative. In 2004, it embraced the challenge of becoming a “high-reliability organization.” In 2009 its leaders played a pivotal role in launching a statewide safety collaborative made up of eight Ohio children’s hospitals that agreed to candidly share data and stories of both success and of care gone horribly wrong.

“We do not compete on safety,” Muething emphasized.

That collaborative is now the Children’s Hospitals Solutions for Patient Safety Network and consists of 140 hospitals across the U.S. and Canada accounting for more than 70% of all pediatric admissions. Over the roughly 12-year period from 2012 through May, 2024, the network documented saving 27,509 children from experiencing “serious harm” from hospital-associated conditions such as adverse drug events. At the same time, the network hospitals created a financial windfall, saving an estimated $585.9 million.

Those eye-catching figures are based on extrapolating “how many children would have experienced each of the HACs based on baseline rates [of network participants] versus the rates following reductions across the network,” explained Muething in an email. “The dollars saved are calculated using published data for costs of various HACs.”

Meanwhile, while other children’s hospital websites are more likely to share kudos from families rather than concrete quality and safety information, and while adult hospitals typically disclose only the 12- to 18-month-old data that appears on government websites, the Cincinnati Children’s website provides HAC information showing historical data and current numbers just a few months old.

This transparency reflects what DeAnna Hawkins, vice president of patient services and a nurse, characterized as a partnership that values staff safety and patient safety alike. In that spirit, the website section entitled “Patient and Employee Safety” includes Occupational Safety and Health Administration Recordable Injuries. I can’t recall ever seeing anything like this kind of information being publicly displayed.

“We believe that transparency sharing our results drives us toward achieving our goals,” explains the hospital website. Patients are also an integral part of the governance of the Solutions for Patient Safety network.

Patients and families also participate in investigations when something does go wrong, as the hospital trusts them with its “vulnerability,” as Hawkins put it. The hospital’s director of family relations, Pam Wendel, spoke of avoiding off-putting jargon when talking to families about safety. Before joining the hospital, Wendel was a high school English teacher whose family moved to Cincinnati in part to be near a place that could care for their child with a complex medical condition.

(The hospital has also pioneered unique collaborations with chronic care patients, such as families whose child has cystic fibrosis. That’s a topic for another time.)

There are hospitals or health systems that have accomplished part of what Cincinnati Children’s has done, but none for as long or incorporating all the different elements of data-driven improvement, partnership with patients and transparency of outcomes. Tellingly, the longest track records in patient safety persistence belong not to providers, but to organizations such as the Leapfrog Group, the Jewish Healthcare Foundation and the Institute for Healthcare Improvement, which have been striving for years to make “First, do no harm” truly the first provider priority.

The path hasn’t been easy. At the 2009 AcademyHealth meeting, Dr. Richard Brilli, an early leader of the coalition effort, said he’d tried to recruit 330 pediatric intensive care units to join the initial participants, but after three years just 60 had accepted. The reasons they gave, as I related in a 2010 article for Health Affairs Forefront, were essentially excuses: they were busy; their patients were sicker; they would look bad to their peers; they didn’t need the collaborative because they were already world famous.

The webinar in which Cincinnati Children’s appeared was sponsored by another collaborative, the National Action Alliance for Patient and Workforce Safety, launched by the Department of Health and Human Services and led by the Agency for Healthcare Research and Quality. An appropriate measure of the National Action Alliance’s success would be for Cincinnati Children’s example of sustained safety leadership to be such a powerful role model for others that the hospital devolves from “unicorn” to just one more place where patients and staff are consistently and reliably safe.