Developing a culture of quality, safety, and trust through continuous performance improvement within a state trauma system

Although significant deficits have been well documented in the performance of health care facilities, corrective actions to safeguard patients and optimize outcomes have not been as robust as expected. Traditionally evaluation of facilities’ performance has been limited to internal review and frequently in isolation due to perceived vulnerabilities. These activities have been reactionary to patient events that occur, rather than proactive system evaluation or identification of opportunities for prevention of future issues or obtaining care excellence. Comprehensive patient care evaluations are an area that an established Trauma System review process can drive improvement by sharing of success and pitfalls, to reduce repetitive undesired patient care outcomes and achieve equitable regional trauma care. Why should we continue to provide inadequate care, when other respected colleagues have found answers or a best practice resulting in desired results or improved outcomes? Are these perceived vulnerabilities real? Do they trump patient care outcomes? How can do we safely proceed to establish a safe, just culture of trust to accomplish our goal? The primary goal of benchmarking patient outcomes is more than a metric submission or dashboard. Ideally, it is the identification of high performers that share their strategies for improving patient care with low performing entities. This obtained knowledge can be analyzed, and appropriate components used to promote the best practice of the weaker performers for desired improved results. This strategy of openness will require significant shifts in attitude, teamwork, accountability and a high degree of trust in all of these areas. Ultimately, newer strategies founded on these principles will accelerate learning, knowledge and impact patient care safety. Pennsylvania has one of the most extended established trauma systems in the United States, this documents steps taken to develop a statewide collaborative network of just culture to benefit all injured.