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Among the many milestones reached in 2024 was the 10-year anniversary of Be Safe, the Lean management system that has become the cornerstone of our efforts to provide safe, quality healthcare. The champion of this effort, Tracey Hoke, MD, was just a year into her current role as Medical Center Chief of Quality, Performance Improvement and Population Health when she brought Be Safe to life a decade ago.

“Implementing Lean management systems in healthcare is a very long process and involves continuous evolution,” she says. “As we evolve, the foundation of the program remains the same — we strive to find the best ways to make data transparent, so that we can identify and solve problems by escalating to leadership and deploying resources to those closest to patient care.”

Since its launch in 2014, Be Safe has transformed the way we solve problems within our organization. “Before Be Safe, we had a traditional approach involving work groups addressing problems that the institution had identified, trying to implement solutions and then tracking data on a monthly or quarterly basis,” says Hoke.

With Be Safe came a standardized, proactive process for tracking issues daily, and ensuring that issues received attention from the right people in real time. It also allowed us to look at trends over the long-term and use internal data for benchmarking.

Facilitating real-time solutions

A key part of the Be Safe process are the cascading huddles, which occur every day across our organization. According to Hoke, the first huddle takes place around 7 a.m. on the inpatient units. It gives team members an opportunity to bring to light anything good or bad that happened the day prior, to discuss any potential challenges for the day ahead and to make suggestions for ways to address them. It’s also an opportunity for the team to identify issues that can’t be solved without additional support. These more complex problems get escalated to a mid-morning huddle with senior leaders, who discuss and either deploy solutions or escalate to a house-wide level.

“If unit leaders can't solve a care delivery problem, or they think it could affect other areas and they want everybody to know about it, they then bring it to the 10 a.m. Medical Center Cabinet Leadership Huddle. The CEO and her Cabinet, dozens of managers, medical directors, and other corporate support teams attend. “Front-line providers identify problems and appropriate senior leadership team members will sponsor a solution in the moment,” says Hoke. “A process that used to require weeks of emails and phone calls and inflexible committee meeting schedules is now facilitated in a matter of hours.”

Change for good

Be Safe was a culture shift for front-line team members, and a welcome one, according to two nurse leaders who were there at the beginning. “It was a new way for us to escalate problems that we couldn't solve on our own,” says Associate Chief Nursing Officer Karin Skeen, PhD. “People could identify something that they wanted to work on and really be able to see the results.”

“Be Safe gave us a common language that allowed us to describe and work through problems. We were expected to do something, whereas before there was no systematic mechanism to address issues,” adds Associate Chief Nursing Officer Veronica Brill, MSN, RN.

Empowering staff and giving them tools to implement change led to lasting solutions, not just workarounds. Skeen says there is one Be Safe success story that stands out for her. “In the NICU, we had a problem with unplanned extubations [dislodgement of a breathing tube]. So the team used the Be Safe A3 problem-solving method every time this occurred to get to the root of the problem. We found around 15 different reasons why this was happening and addressed them systematically. Now we have one of the lowest rates in the country for unplanned extubations and we’ve sustained it for 10 years,” she says. “It’s really impressive because we’ve used the methodology to not only solve problems, but to sustain success.”

“The reason why hospitals implement Lean management systems is that they improve patient outcomes, like less infections, shorter lengths of stay, fewer readmissions and better patient satisfaction,” says Hoke. “Process improvementis nice, but if it doesn't improve outcomes, then it's just a good process.”

A model of success

Be Safe has been transformed over the years. It’s been customized to suit the needs of each care delivery area. And it’s been a saving grace in times of unprecedented challenges like COVID. “It's become an anchor for our organization, a testament that patient safety and quality of care is paramount,” says Brill.

The success of Be Safe is reflected in outcomes data, and its ability to stand the test of time, as well as the number of other organizations who have adopted it as a model. “In 2017, we started hosting other academic medical centers like Duke, UNC, Iowa, MUSC. Our peers came to see what we were doing because they heard about how effective it was and they watched our outcomes improve,” says Hoke.

“The fact that other organizations are using Be Safe as a model is amazing,” adds Skeen. “In the children’s hospital, many organizations have come to observe our huddles and ask questions. The team takes a lot of pride in that, knowing that they are teaching others and making care safer — not only here, but in other institutions,” says Skeen.

For Hoke, Be Safe is an accomplishment that has defined her career. “It's my legacy here at UVA Health and among our peers,” she says. “It’s rewarding knowing that I have helped other leaders implement a system that identifies and solves problems for the benefit of our collective patients and communities.”