How an 'F' grade became a wake-up call for this hospital

Twice a year, Leapfrog Group grades more than 2,800 hospitals on how well they perform on patient safety. Generally, less than 1% of hospitals receive the lowest grade of "F," which indicates that they did not perform well on several safety standards, including infection prevention, surgical errors, and communication.

In 2021, St. Bernard Hospital was one of the hospitals that received an "F" from Leapfrog. The independent safety-net hospital serves an almost all Black patient population, and a majority are covered by Medicare and Medicaid.

According to Devereaux, the "F" grade from Leapfrog was a "major wake-up call" for the hospital's leaders.

"We thought we were doing a great job, so when we got that 'F grade, it was like, 'That can't be right, they made a mistake,'" said Yolanda Penny, the hospital's VP of nursing services. "We really felt our impact in the community during [the COVID-19 pandemic], and to come out still standing was important. But it didn't show on paper."

How St. Bernard accomplished this 'extremely rare' feat

Although St. Bernard had a quality department to report data and follow CMS regulations, it did not have a central person overseeing safety efforts or coordinated leadership to improve certain aspects of patient care at the hospital.

To start, St. Bernard hired Michael Richardson for a newly created chief quality and patient officer role. Once in the role, Richardson quickly organized a committee of key stakeholders, including nurses, pharmacists, and physicians, to determine why the hospital was doing poorly on patient safety and identify quality barriers that could be easily fixed.

"One of the first things we noticed was that safe medication administration wasn't where we needed it to be," Richardson said. According to the committee, widespread equipment failures, internet outages, and bad habits among staff members often prevented clinicians from scanning patients' wristbands and medications.

To fix this issue, the hospital retrained its nurses, fixed malfunctioning equipment, and improved its Wi-Fi system. Over time, St. Bernard increased its rate of barcode medication administration to roughly 98%.

The hospital was also having trouble with hand hygiene and implemented an electronic hand hygiene monitoring system to address the issue. The system allows leaders to track how often staffers wash their hands though a device that all employees wear. The device changes colors whenever a staff member leaves a room, reminding them to sanitize their hands.

"Since we've had the system in place, which is just over a year now, we've seen over a million episodes of hygiene opportunities, with a compliance rate of around 92%," Richardson said. "We set our goal at 95%."

St. Bernard has also worked to establish a "just culture" where staff are comfortable with reporting safety risks and leadership works to analyze any mistakes and address system issues. The hospital has also improved its staffing ratios and infection prevention protocols.

With these improvements, St. Bernard was able to achieve a "C" grade from Leapfrog in spring 2022 and an "A" grade in spring 2023.

There's still room for more improvement

According to Missy Danforth, VP of healthcare ratings at Leapfrog, it's "extremely rare" for a hospital to go from an "F" grade to an "A" grade as quickly as St. Bernard did. However, even with its improved Leapfrog grade, St. Bernard has noted that there are still areas that it needs to address to improve care for its patients.

For example, the hospital currently has a one-star quality rating from CMS, largely due to its lengthy ED wait times and high percentage of patients who leave without being seen.

"We're going to continue our journey on patient safety, making sure that we have zero harm, zero central line infections, zero catheter-associated infections, zero MRSA infections," Richardson said.

Some of the hospital's priorities going forward include creating a more efficient discharge planning process and educating community members about the hospital's services. St. Bernard is also considering hiring a director of patient experience and utilizing external services to follow up with patients after discharge more effectively.

In addition, the hospital has started including patient safety and quality costs, including personnel, service fees, and equipment, in its budget. According to Robert Springer, St. Bernard's CFO, annual quality improvement expenses typically cost the hospital around $100,000.

"We try to prioritize patient safety and quality while budgeting because without quality, reliable care for patients, there is no need for anything else," Springer said. "The ramifications and costs of providing poor quality care far outweigh the costs of safety initiatives." (Devereaux, Modern Healthcare, 8/2)

Download quick guides that summarize the methodology and metrics used in four hospital quality rating programs.