Implementing a Quality and Safety Agenda in a Children's Hospital Within a Hospital: Challenges and Successes.

In the face of unspeakable tragedy, one can find hope. That is the beginning of the story and the journey at our children’s hospital, which highlights patient centeredness, safety, and quality.In 2012, a child was transferred from an urgent care center to our hospital, reportedly in stable condition, without first being assessed in our pediatric emergency department. By the time the child arrived on the pediatric ward, she was in extremis, was immediately transferred to the PICU, and quickly died of a treatable disease.Although it had been in use for years, the process for bringing children into our hospital was flawed. The outcome for this child may not have been different, but as a result of the event, we began to examine many of our long-held beliefs and processes. We recognized that significant changes needed to be made in our health system related to patient quality and safety. What we learned is that large-scale improvement in a children’s hospital within a large academic health center (AHC) requires patience, ingenuity, and the flexibility to shape the goals of the children’s hospital to fit within the existing quality structure.Shands Children’s Hospital is a 188-bed, quaternary care children’s hospital within a large AHC. We, like most children’s hospitals, are clinically very busy and have robust research and education missions. In addition to our pediatric providers, we have hundreds of medical students, physician assistant students, nursing students, residents, and fellows, who all, at various times, interact within our children’s hospital. This incredible number of providers, with varied educational backgrounds, was one challenge in developing our quality and safety agenda. Another was our identity as a “children’s hospital within a hospital.” Although we certainly had established leaders within the children’s hospital structure (a Medical Director of Inpatient Services, a Physician Director of …