In June, ISQua was visited by Paul Sharek, Professor of Pediatrics at Stanford University, creator and Medical Director of the LPCH Center for Quality and Clinical Effectiveness, and Chief Clinical Patient Safety Officer at Lucile Packard Children's Hospital. Paul kindly agreed to be interviewed by Elaine O'Connor, our Head of International Accreditation and Regulation, on the US based collaborative - Solutions for Patient Safety.
Paul is also the Director of Quality Improvement for the California Perinatal Quality of Care Collaborative (CPQCC). He is on the Solutions for Patient Safety Clinical Steering Committee, and on the Strategic Planning Committee for Quality and Patient Safety for CHA (Children's Hospital Association).
In 2013, Paul was awarded the inaugural Paul V. Miles Fellow in Quality Improvement from the American Board of Pediatrics, an Award bestowed on individuals who have "dedicated themselves to quality improvement and demonstrated accomplishments leading to better healthcare for children."
Elaine O' Connor (EOC)– Welcome Paul, do you want to tell us a little bit about why you are over here in Ireland?
Paul Sharek (PS) – I’m a professor at Stanford University, School of Medicine and am on a two-month sabbatical. My role there in part, I am a Chief Clinical Patient Safety Officer and I have built out a Center for Quality and Clinical Effectiveness at Lucile Packard Children's Hospital, which is the children’s hospital associated with Stanford.
While I’m here I am visiting ISQua, to learn more about how quality and safety is done here in Ireland and internationally. I will be visiting Great Ormond Street Hospital in London, UK; I was a visiting professor there about 10 years ago so looking forward to going back and learning from them again.
And tonight I’m giving a lecture in the Royal College of Physicians of Ireland (RCPI) on 'Patient Safety - What's the big deal?'. The talk will be on the background to the patient safety movement, both in the US and across the world, the data and the literature that support the imperative around improving this, and both present and future approaches to improving the safety outcomes in paediatrics, but they’re very transferable to adult medicine.
EOC – So, Paul, would you like to tell us something about Solutions for Patient Safety?
PS – I’d love to! SPS or Solutions for Patient Safety presently consists of a collaboration of 109 children’s hospitals in North America. It’s a collaborative focusing on two major areas, one is the reduction of hospital acquired conditions (HACs) and the second is serious safety events (SSEs). We are a collaborative that deploys best practice bundles, potentially better practices when there’s no literature behind them, which we actually study and learn from each other. It’s a collaborate that is largely taught by each other – we use the motto ‘all teach; all learn’. We’ve seen some profound improvements in our HACs (as well as our SSEs. This data is being submitted as we speak to JAMA (Journal of American Medical Association). We’ve seen profound statistical improvement across the collaborative over the last years.
EOC – You say it’s a collaborative and you work together and share the learning, how is this done?
PS –The Collaborative is formally funded by the US Government. It is largely based in Cincinnati Children’s Hospital, where there is a cadre of 15 project managers and data analysts that help support the work. There is a clinical steering committee that consists of about 10 of us, patient safety and quality experts, and we make the decisions about what information is deployed, how we deploy it etc. There are two major conferences a year where each of the hospitals bring between 3-6 people. One a year is focused on the more executive level and leaders of the hospitals and the other one is for frontline staff.
EOC – So could you tell us a little more about your conferences?
PS – Yes, I think the real learning from these groups mostly comes from each other; they present to each other, we have breakout sessions during meetings, we have countless webinars every month on different topics, some are high liability topics, some are basic quality improvement topics, some are focused specifically on a HAC, like Klebsiella. All the topics are represented each month in webinars that are structured and standardised.
EOC – I suppose based on the evidence the bundles changing are all the time?
PS – Oh yes, they are; we have borrowed from bundles that were pretty well established, for example a Klebsiella bundle or Ventilator-Associated Pneumonia (VAP) bundle or surgical site infections bundles; but there are several where we have had to learn from each other and establish the bundle. We are helping to create the literature as well, which is pretty neat!
An example of that is actually, our government required us to have obstetrics involved which turned out to be great - we created a best practice bundle for obstetrics that did not exist before. We learned about best practices to decrease post-partum haemorrhage, to decrease necessary primary C-sections and the big one was elective delivery before 39 weeks. That’s a big deal, in the States at least, because the outcomes seem to be worse when you electively deliver before 39 weeks.
So, long-winded answer, but we have both borrowed best practice bundles from the literature and from CDC (Centre for Disease Control) endorsed; and if they weren’t present in paediatrics we helped establish them. We have actually run experiments and done scholarships around those to establish statistical validity to those new bundles. It’s a marvellous blend of improvement work as well as science.
EOC – You mentioned that you are aiming to publish soon in JAMA so in that way you’re getting the evidence and information out there through the scientific literature and journals.
PS – Yes, this is one of the challenges for us. I am the co-Chair of the Scholarship and Publications Committee, which is an effort to facilitate and encourage our massive database for use for scholarly work; it turns out that most of those doing this improvement work, in the 109 sites, are much more interested in improving outcomes than publishing about the improvement outcomes, and many of them have never published anything. There has actually been a bit of a struggle, despite the very robust data and resources we have, to translate to the literature. I am helping find and support people to publish the work.
For example, we have just published the bundle and experiences across the collaborative in paediatrics, around paediatric surgical site infections, which has been a very well received publication. The bundle and experiences across the collaborative on paediatric pressure ulcers is being submitted right now and there is a cadre of other early scholarly work that’s being submitted right now.
We are really trying to encourage people who are leading the work or are actively participating in their sites to translate that to the literature.
EOC – Is this information freely available on the website? Can anyone access it?
PS – Yes it is, the website is really great – solutionsforpatientsafety – it actually shows the data in our outcomes. This is very rare, I have not seen this in any other collaborative, where its open to anyone in the world to look at. You can get the bundles, you can find the results, you can see how compliant we are across the nation or across the collaborative to the best practices. We collect very robustly our compliance data to the best practices, a lot of process measures. It is a fantastic website, there are potentially unlimited resources, presentations, ideas on how to implement etc.
EOC – I know that you know our CEO, Peter Lachman well. So how did your paths cross?
PS – I’ve known Peter since PIPSQC!
EOC – Can you tell us a little about PIPSQC?
PS – It’s the Paediatric International Patient Safety and Quality Community – PIPSQC – and that was an acronym that was largely created in a Toronto Jazz bar amongst Peter, myself, Eddie Molden from Melbourne Children’s Hospital, Matt Scanlon from Milwaukee and a few others.
It’s a largely volunteer, international, paediatric patient safety group that’s seen value in, and a gap, in communicating best practices across the world, around paediatrics focused patient safety. It’s a group that has immense knowledge, insight, experience, energy and passion.
EOC – I’m just looking here at your list of publications and you have a very wide range of interests, do you want to tell us a little bit about the work you do? Obviously you work with a lot of young clinicians within your organization. Your work is not just primarily neonatal?
PS – I’m not a neonatologist. In the US the neonatal community was by far the earliest group of sub-specialists to start to do aggressive, structured, collaborative quality improvement work so I started when I was a fellow at Stanford in the late 90’s. I was a fellow in quality improvement health services research so I participated in their work quite a bit and spent a lot of time working with them and a lot of literature came out of that work. But I’m not a neonatologist, I just happen to have a shared interest in quality improvement and patient safety with that group.
I think because of the relative wide openness of scholarly work in quality improvement in general, the work we have done at Lucile Packard Children's Hospital and some of the collaborative work I have helped lead or participated in across the US has been ripe for scholarship and publication. There is a real yearning for that, I think, a real opportunity for that, and I have been fortunate and willing to translate that to scholarship and to the literature.