In this section:
Quality
Quality healthcare leads to improved health and well-being and a better consumer experience. To strengthen our quality management and care delivery, Texas Health assembles multidisciplinary teams to implement evidence-based practices and design innovative, patient-centered care models.
- Prioritize patient needs, preferences and values.
- Foster open communication, shared decision-making and seamless coordination of care.
- Deploy measures to prevent medical errors, infections and other adverse events.
- Provide training and education on the latest medical advancements and best practices.
- Systematically identify, analyze and address areas needing improvement.
- Maintain continuous readiness for emerging infectious diseases.
- Adhere to and exceed regulatory requirements and accreditation standards.
- Engage with patients following discharge to increase their adherence to care plans.
- Monitor systemwide data to address care quality and equity gaps proactively.
2023 Highlights
Texas Health:
- Achieved top decile performance in overall inpatient mortality.
- Reduced central line-associated bloodstream infection (CLABI) rates by 58% since 2021, putting Texas Health in the top quartile of performance. We also reduced colon surgical site infections (SSIs) by 44%, Clostridium difficile infections by 26% and abdominal hysterectomy SSIs by 28% over the last two years. Additional data can be found in Performance Data.
- Improved performance against key quality measures. We reduced our mortality observed-to-expected (O/E) ratio by over 38%, pneumonia mortality O/E ratio by over 55% and sepsis mortality O/E ratio by nearly 43% since 2020.
- Developed analytic tools to assess a broader range of non-medical factors impeding patient health outcomes. This data is helping us develop action plans to keep people from being readmitted to the hospital.
- Educated front-line caregivers about the impact of social determinants of health (SDOH) on patient outcomes and provided tools to communicate effectively with patients about these factors.
- Achieved Magnet® designation at seven hospitals and Pathway to Excellence® designation at 10 hospitals. These organizations have superior nursing processes and quality patient care, leading to the highest levels of safety, quality and patient satisfaction.
- Received numerous awards for quality and clinical excellence, from the Bernard A. Kershner Innovations in Quality Improvement Award to Texas Health hospitals named among the Best in the Nation.
During the COVID-19 pandemic, central line-associated bloodstream infections (CLABSIs) sharply increased in hospitals nationwide due to the number of high-acuity patients and longer lengths of stay. According to the U.S. Centers for Disease Control and Prevention, CLABSIs result in thousands of deaths each year and billions of dollars in added costs to the U.S. healthcare system, yet these infections are preventable.
According to the Centers for Disease Control and Prevention, each year, at least 1.7 million American adults develop sepsis, an extreme, life-threatening response to infection that requires urgent medical care.Reliability
Reducing unnecessary variation and being consistent in specific care processes helps us save lives, reduce medical errors, deliver a better experience and lower costs.
Our Reliable Care Blueprinting™ (RCB) initiative is designed to optimize and standardize care processes and make it easier for caregivers to deliver high-quality, safe care every time, in every care venue, for every person. Interdisciplinary teams collaborate to develop and implement evidence-based and efficient care approaches.
Our goal is to optimize care delivery, and to promote that objective, to date we have completed and deployed more than 60 RCB modules across a broad range of clinical processes. Adoption rates for many of these modules have exceeded 95% systemwide. To drive accountability, we’ve made RCB metrics a part of our key performance measures. Each hospital reports its results quarterly.
2023 Highlights
Texas Health:
- Standardized evidence-based care processes across the system for heart failure and cesarean sections to reduce non-beneficial variability in care delivery.
The Joint Commission (TJC) offers a voluntary Disease-Specific Certification program that hospitals can pursue to demonstrate that they incorporate the most current, evidence-based clinical practice guidelines, comply with consensus-based national standards and implement a proactive performance improvement plan. Safety
Consumers count on us to keep them free from harm as part of their expectations during their care, so we continually raise the bar on error prevention and safety behaviors to avoid adverse events. To reach our goal of zero preventable harm events, we:
- Use a comprehensive set of error prevention tools that give us a common language to discuss safety. These tools help caregivers verify patients’ identity, predict their risk of falling and monitor medication reactions and changes in vital signs.
- Adhere to safety policies, processes and systems. To reduce actual serious harm, we expect every care team member to report unsafe behavior and near-miss events. Safety events undergo a rigorous, stepwise analysis, emphasizing shared learning and process change to reduce the risks of recurrence.
- Conduct daily safety briefings at entities, weekly system safety briefings, and departmental safety briefings at shift changes to address emerging concerns. These discussions help discern the status of operations, identify problems, assign ownership for resolution and share a common understanding of safety priorities. We share management practices and alert system leaders when issues arise to mitigate risks that could occur elsewhere in the system.
- Deploy Virtual Patient Companions to remotely monitor patients at elevated risk of falling and alert nurses to offer assistance.
- Capture safety data to monitor performance and accelerate improvements.
We assess our safety culture and incidents by:
- Tracking physical and emotional harm event rates, which examine the number of potentially harmful events that occur based on the number of patients we serve. We also monitor near-miss events to catch and address risks before they could potentially harm a patient.
- Gathering patient feedback through the Agency for Healthcare Research and Quality’s (AHRQ) Surveys on Patient Safety Culture™ (SOPS®) program.
- Reviewing employees’ Net Promoter Score® (NPS), which rates how likely they are to recommend this facility as a place to work on a scale of zero to 10. We take this further and correlate other consumer surveys for consideration of trends.
2023 Highlights
Texas Health:
- Improved patient safety by reporting 103 near-miss events for every one actual serious safety event (SSE) that occurred. Since near-miss events are 10 to 100 times more common than actual SSEs, a stronger reporting culture has helped us reduce actual SSEs by 38% since 2020 by emphasizing the prevention, detection and correction of safety events.
- Continued encouraging the reporting of near-miss events to address concerns before they reach the patient. While we have a key performance measure to address process failures and reduce the likelihood that issues will reach a patient and cause harm, we are enhancing this measure by adding a documented Plan-Do-Study-Act process in 2024. This process will help us take specific actions to handle major safety issues and near misses to prevent their reoccurrence.
- Increased the average of all “percent positive” responses to questions on the AHRQ safety survey from 73.3% in 2021 to 75.2%.
- Implemented a Deterioration Index predictive model that uses analytics to help identify patients showing signs of deterioration. Every 15 minutes, it collects vital signs and other pertinent data, which displays a prediction score on a dashboard of how likely a patient will deteriorate. The score alerts caregivers to transfer patients to a higher level of care or deliver immediate interventions to avoid serious safety events. We use this same approach for monitoring ICU and other high-risk patients. After a successful pilot at three entities, a dashboard featuring the Deterioration Index and other relevant clinical information will be deployed systemwide in 2024.
- Delivered Question, Persuade and Refer gatekeeper training to 214 employees, helping them recognize a crisis and the warning signs that someone may be contemplating suicide. A well-executed, strong and positive response to these warnings improves the likelihood of positive outcomes.
- Received Press Ganey’s 2023 Human Experience (HX) High Reliability Horizon Award and the Serious Safety Event Rate Reduction Award for uncompromisingly valuing safety and methodically deploying high-reliability organization principles to prevent adverse events and optimize outcomes. Four of our entities also received Press Ganey’s Zero Harm Award.
When we consider harm to a patient, we typically think about physical harm caused by clinical errors, such as missed care or patient falls. 
After discovering the limitations of disparate leadership rounding platforms and tools, Texas Health spent the year developing a rounding platform grounded in high-reliability principles and best practices. This platform offers a consistent and reliable approach to collecting systemwide data and information, generating more accurate insights into ways to detect and reduce patient harm. Equity
Texas Health is committed to delivering healthcare in an equitable manner regardless of patients’ socioeconomic status, race, gender or other social determinants of health (SDOH) factors. To deliver equitable care, we are:
- Analyzing and addressing disparities in outcomes and eradicating bias in our words, behaviors and actions across our system and the communities we serve.
- Screening patients for SDOH conditions to help them remove non-medical barriers to good health. We aim to discharge patients to an improved situation compared to when they arrived.
- Delivering culturally competent, sensitive care in direct alignment with our Vision of partnering with consumers for a lifetime of health and well-being.
These actions aim to enhance access to and facilitate receipt of timely, high-quality, safe care across Texas Health regardless of race, ethnicity, social conditions, economic status or any dimension of diversity.
Current health equity work focuses on two specific clinical areas with recognized disparities nationally and in North Texas: maternal health and hypertension.
Maternal health
Studies show that black mothers are disproportionately affected by severe maternal morbidity, and mothers of non-white races have cesarean sections at higher rates. To reduce the observed disparities in these areas within our patient population, we are:
- Continuing a quality initiative (including designation of C-section rates as a key performance indicator) to reduce C-sections in first-time mothers meeting low-risk delivery criteria.
- Adhering to evidence-based protocols during C-sections to minimize non-beneficial variability.
- Collecting SDOH data from postpartum patients to identify and rectify disparities in pregnancy outcomes. Consenting patients are surveyed every six months for three years.
- Regularly providing C-section performance data to clinical leaders and obstetrical physicians on the medical staffs at Texas Health hospitals.
- Training labor and delivery nursing staff on the latest birthing techniques to facilitate vaginal births.
- Participating in the Tarrant County Maternal and Infant Mortality Coalition and the Texas Alliance Innovation on Maternal Health to leverage data, resources and programming to improve maternal health. Our hospitals also participate in the Texas Ten Step Program, which helps birth facilities improve breastfeeding outcomes.
Hypertension
Nearly one-third of Texans are affected by high blood pressure, with racial and ethnic minority groups experiencing significantly lower rates of control. Left unchecked, hypertension can escalate into serious health complications, including heart disease, heart attacks, stroke, kidney damage and more. To mitigate the prevalence of hypertension and address associated disparities, we are:
- Educating consumers and patients on the importance of diagnosing and managing hypertension.
- Implementing an electronic hypertension registry and remote monitoring platforms to help us more effectively manage hypertension.
- Screening North Texans for hypertension through our community health improvement programs and referring them to resources for support.
- Tracking a new hypertension key performance indicator among patients treated by Texas Health Physicians Group providers.
2023 Highlights
Texas Health:
- Progressed about 25% towards a goal of reducing C-section rates for first-time mothers with low-risk deliveries. The decrease signals early progress, but we will continue improving care in this area. Specifically, C-section rates for first-time mothers with low-risk deliveries were reduced by 2.9% overall, 4.9% for mothers of Black race, 1.3% for mothers of Asian race, 2.9% for mothers of White race and 2.7% for mothers of Hispanic ethnicity since 2022. Maternal morbidity rates also dropped slightly year over year, and we will continue efforts to improve outcomes in 2024. Additional data can be found in our 2023 Diversity, Equity and Inclusion Transparency Report.
- Provided labor-management training to 92% of all labor and delivery nursing staff across the system.
- Established the Texas Health Perinatal Research Repository to help researchers identify maternal health improvement opportunities.
- Connected new parents to community health resources and services through an app developed by the Tarrant County Maternal and Infant Health Coalition.
Texas Health is committed to fostering inclusive and equitable healthcare by recognizing and replacing biased language. Each care team member is pivotal in ensuring that every patient receives fair and equal treatment. This commitment is upheld by eradicating implicit biases and stereotypes that may influence our interactions.