Habits are the key to creating our identity as people and organizations. Here at KaiNexus, we have been doing a lot of work on how to create and sustain habits in order to create a culture of continuous improvement. Keystone habits are the holy grail of developing long-lasting behavior change. Greg Jacobson, our CEO, recently visited San Mateo Medical Center and met with Dr. Alpa Sanghavi, Medical Director, and Lawerence Cualoping, Quality Manager. He discovered a thriving safety culture based on the simple process of reporting every single incident. They noticed that not only had San Mateo built the habit of reporting incidents, but this fostered the behavior of reporting opportunities for improvement. The process of a habit creating an identity and then fostering other related behaviors is a tell-tale sign of a keystone habit.

I was curious about the story and wanted to know more, so I recently had the pleasure of interviewing Lawerence Cualoping, Quality Manager at San Mateo Medical Center. Lawerence has been with San Mateo Medical Center for over 15 years. Check out the blog post below to learn how fostering a continuous improvement culture can lead to powerful change.

San Mateo’s Continuous Improvement Journey 

San Mateo Medical Center started its continuous improvement journey more than ten years ago. As a healthcare system, their focus has always been to improve safety by encouraging employees to submit incident reports. They began recording incidents on paper and eventually moved to several iterations of electronic-based incident reporting systems. Making the switch from paper to digital systems improved the investigation rate on incident reports as managers were more easily able to keep track of the incidents and follow up on them. As the need for a more robust system became clear, however, they decided to transition to KaiNexus. 

A True Culture of Improvement

The Safety Alert From Employees (SAFE) System is the internal incident reporting program in which employees are encouraged to submit a 'SAFE' that involves a safety issue of any kind. Over the years, what they've discovered is that by creating a culture where everyone feels like their voice matters, employees feel confident not only in reporting safety incidents but submitting opportunities for improvement beyond patient safety. This trust and support to submit incidents of any nature have allowed employees to feel comfortable voicing their improvement ideas. So how did this happen? Encouraging employees to submit whatever they thought could be improved - no matter how small or ‘off-topic’ - helped to create a culture where improvement could naturally occur.

Making Time for Incident Reporting 

One of the most important ways San Mateo creates & sustains its culture of continuous improvement is by developing expectations and making improvement work a part of the organization's daily conversation. One way they do this is through daily huddles, where they discuss all incidents submitted the previous day. After this huddle, managers have three days to complete the investigation of the incident, identify countermeasures, and close out the report. At the end of the week, Lawerence goes through the closed incidents of the week and rates the managers based on the quality of their write-ups. These graded incidents are then sent to executives to keep them informed and updated on incidents within their organization. 

This structured path for incident reporting clarifies each department's expectations and removes barriers to employees doing this work.

Highlighting Outstanding Employees 

Highlighting employees' work is one of the best ways to reward people for doing a great job and inspire the rest of the organization to participate in improvement work. One way San Mateo rewards their employees is by granting the SAFE Award. This award is given to people who have submitted excellent SAFEs that are highly impactful on the organization and patients. When someone wins the SAFE Award, they are presented with a certificate signed by the CEO at the Department Managers' Meeting. The SAFE Award has only been awarded eight times in the last ten years, so it is highly prestigious. 

San Mateo not only focuses on rewarding highly engaged employees in incident reporting but also works to uncover barriers holding other employees back from participating. Lawerence shared,

 "If someone is hesitant to use the system – I encourage managers to dig into why. Getting to the root cause of why someone is hesitant will lead to the solutions of helping them to solve it." 

A culture like San Mateo’s doesn't happen overnight. It takes a committed organization - willing to celebrate wins, make the time every day for improvement work, and help those struggling - to create a deep-seated culture of improvement.