- Quality Commitment

Our Commitment

Tenet is committed to providing safety and quality care at each of its facilities. Over the past several years, we have devoted countless hours and resources to continuous quality and safety improvements.

As an innovative leader in this area, Tenet has implemented a number of science-based solutions designed to protect our patients and reduce the potential for medical errors. We believe we are ahead of many of our competitors in doing this. Specifically, some of the areas we've focused on include:

Patient Safety Committee. We've put together a Patient Safety Committee whose sole task is to utilize internal and external patient safety information to develop patient safety initiatives and implement them throughout all of our hospitals.

Expanded Quality and Safety Database. Whenever there is an unexpected event or outcome at one our facilities, the incident information - or what we call the "root cause analysis" - is put in our proprietary data base. The database gives us the ability to develop and disseminate to all our hospitals specific guidelines, protocols and policies related to patient safety. This is an enormous advantage for Tenet hospitals over facilities that are not part of such a large and forward-thinking system.

Safety Liaison. Because patient safety is truly a multi-disciplinary responsibility, Tenet created a specific safety liaison position to act both as support for the Patient Safety Committee and liaison with all other corporate departments and hospitals to ensure that we leverage all available information, technology and expertise at our disposal.

The Partnership for Change. About three years ago Tenet developed a unique quality initiative called The Partnership for Change. The initiative uses research based on clinical data and scientific evidence to help physicians in our hospitals identify best clinical practices and implement safer, more effective treatments for their patients. The Partnership for Change will be in 80 percent of Tenet hospitals by the end of this calendar year. In the 36 hospitals that have already implemented Partnership for Change, we have adopted rigorous policy to continuously monitor patient outcomes.

Evidence-Based Methods: A Focus on Quality and Safety

In addition to the initiatives mentioned above, Tenet has implemented or is testing many evidence-based methods focused on quality and safety. The size of Tenet's system gives us a large "laboratory" to test and roll out solutions that work. For example, we have made several efforts in areas where medical errors commonly occur:

Surgery. We gather data and reports from our hospitals and use that information to develop, test and implement protocols designed to eliminate the most common surgical errors. In fact, we are currently implementing a protocol for use throughout our system to help reduce wrong-site surgeries.

Medication. Our Partnership for Change initiative has adopted a rigorous approach to help our caregivers prevent medication errors. For example, our pharmacy monitoring initiative involves surveying antibiotic use and making sure that medications are adjusted based on individual patients and compliance with drug-specific dosing guidelines. We also are working to identify "look-alike" medications that may easily be confused with others and are developing systems and
ordering changes to stop buying these drugs. Broadlane, our group purchasing organization, is also working with pharmaceutical manufacturers to change "look-alike" labels as well.

Recurrent Heart Attacks. Scientific evidence indicates that heart attack patients who receive aspirin and/or beta blockers immediately upon arrival at the hospital have lower in-hospital mortality rates than those who do not. We've adopted a concurrent monitoring system to help ensure that these patients receive the appropriate medication. And since scientific evidence also shows that taking these medications produces a lower rate of recurrent heart attacks, we've also put in place a monitoring system to help ensure that our patients receive prescriptions for maintenance of aspirin and/or beta blockers upon discharge from the hospital.

In addition, all Tenet hospitals will adopt the American Heart Association's "Get With The Guidelines" protocol for recurrent heart attacks within the next 12 months - one of the largest single system to adopt the AHA guidelines. Although we are delighted to adopt the AHA protocols, we're even more proud that our Partnership for Change protocols adopted earlier are even stricter than those of the AHA program.

In-Hospital Infections. We have implemented an increasingly aggressive program designed to reduce in-hospital infections associated with intubation and the presence of intravenous lines and catheters. These are showing great promise in an area that is often under-recognized as a safety issue in hospitals.

Additional Methods

Based on research done last year, scientists commissioned by the Agency for Healthcare Research and Quality recently recommended that hospitals consider 11 quality and safety methods that are supported by solid clinical and scientific evidence. Tenet has already implemented, is in the process of implementing or is actively studying all of these recommendations, and in most cases we believe that we are ahead of many of our competitors in doing so. The quality and safety methods identified focus on the way in which our hospitals deliver care to patients. By using these quality and safety methods, we're concentrating on ways to improve our processes that will lead to better care for our patients. These process changes and improvements range from simple changes like using pressure-relieving bedding materials to prevent bed sores to very complex changes requiring close coordination between physicians, nurses and other hospital departments. For example, streamlining systems so our nurses can administer antibiotics 30 to 60 minutes prior to a patient going into surgery requires great coordination between dozens of hospital departments and personnel, but can result in lower wound infection rates.

As demonstrated here, there are many issues involved in patient safety and quality. Tenet is committed to being an industry leader in studying and implementing ways to reduce medical errors and improve hospital safety.

Who is Leapfrog and what is Tenet's Position on the Leapfrog Survey?

The Leapfrog Group was organized by the Business Roundtable and a number of major corporations to study and publicize ways to reduce medical errors and improve hospital safety. Although we wholeheartedly agree with Leapfrog's overall goals, we believe that its initial three "leaps" are not supported by enough scientific research to prove they are as effective as steps we are already taking to reduce preventable medical mistakes. That does not mean we won't implement them at some point in the future, but just that we believe the steps we're taking are based on more research and have more immediate promise.

We are troubled by Leapfrog's focus on its three leaps at the expense of many other worthy efforts being made that show as much or more promise. In fact, no national consensus has yet developed in prioritizing steps that should be taken to improve quality and safety in hospitals. As a leader in this area, Tenet would welcome the opportunity to participate in a real dialogue on these issues.

Just this week, a study commissioned by the Healthcare Leadership Council, the American Hospital Association and the Federation of American Hospitals urged the adoption of a framework to recommend measurable standards for patient safety and quality. We endorse the findings of this study. We believe that all standards - including Leapfrog's leaps - should be studied thoroughly before hospitals are asked to implement them.