Highlight on Texas: Hospital Quality and Safety- What Do the Numbers Show?

Texas hospitals, and providers everywhere, are working to improve quality and patient safety. This is particularly true due to the heightened level of interest by government, as evidenced by the enactment of the Patient Safety and Quality Improvement Act of 2005 (PSQIA), payers and consumers.

The PSQIA establishes a voluntary reporting system designed to make data available to assess and resolve patient safety and health care quality issues. PSQIA also authorizes the Agency for Healthcare Research and Quality (AHRQ) to maintain a list patient safety organizations (PSOs), external experts that collect and review patient safety information. Provisions of PSQIA were implemented in the Patient Safety Rule (73 FR 70732) and codified at 42 C.F.R. Part 3. In addition, on December 2, 2013, CMS released a proposed rule to implement section 1311(h) of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148), which requires hospitals of more than 50 beds to have an agreement with a PSO in order to contract with a qualified health plan by January 1, 2015. For now, however,  hospital agreements with PSOs remain voluntary.

In the state of Texas, which has 630 hospitals with 83,000 licensed beds, successes have reportedly included a higher-than-national average reduction in surgical site and central line-associated bloodstream infections. These results have been achieved, in part, due to implementation of Texas Center for Quality & Patient Safety (TCQPS) initiatives, such as (1) Patient Safety Organizations (PSOs), (2) Partnership for Patients (PfP) and (3) Team Strategies and Tools to Enhance Performance & Patient Safety (TeamSTEPPS).

One of 26 CMS-awarded Hospital Engagement Networks, TCQPS collaborates with nearly 80 hospitals in Texas. In addition to reducing surgical site and central line-associated bloodstream infections, the Texas Hospital Association notes the following successes:

  • 65 hospitals have implemented strategies to engage patients and families to reduce harm, improve care experiences and transition safely from hospital to home.
  • 72 percent of hospitals with TCQPS and PfP are considered high performing for reduction of hospital-acquired conditions (HACs) and readmissions.
  • 200 hospitals are working with PfP to reduce HACs and readmissions.
  • Over 400 frontline hospital staff and quality personnel in Texas are participating in TeamSTEPPS.


The mission of the TCQPS-PSO is to advance the continual improvement of health care quality and patient safety outcomes throughout the state of Texas. The benefits of participation in the Texas-PSO include the following:

  • Hospital data is aggregated with that of other TCQPS-PSO hospitals, providing a comparative database to ensure more accurate identification of safety improvement opportunities.
  • Hospitals receive a comprehensive analysis of recurring safety issues.
  • Hospitals gain access to the collective expertise of all TCQPS-PSO hospitals.
  • Hospital participation demonstrates a commitment for safety improvement to providers, the public, accrediting organizations and public officials.
  • By pooling resources and sharing ideas with other TCQPS-PSO participants, hospitals will have the opportunity to proactively improve patient safety.

Texas PfP

The goal of the Texas PfP are to decrease HACs and reduce preventable readmissions. The PfP focuses on ten areas:

  • adverse drug events
  • catheter-associated urinary tract infections,
  • central line-associated blood stream infections,
  • injuries from falls and immobility,
  • obstetrical adverse events,
  • pressure ulcers,
  • surgical site infections,
  • venous thromboembolism,
  • ventilator-associated pneumonia, and
  • preventable readmissions.

Through the PfP, hospitals are provided access to forms, guide books, presentations, toolkits, webinar recordings, and a national repository of valuable resources through the Communities of Practice website.

Some of the many benefits of participation, provided at no cost include:

  • Virtual education programs on a variety of topics including evidence-based practices for specific HACs, patient and family engagement, health literacy, and leadership;
  • Face-to-face conference featuring content experts and applicable continuing education credits;
  • TeamSTEPPS Master Trainer workshops;
  • Administration of the Hospital Survey on Patient Safety Culture;
  • Site visits to support hospitals in evaluating their patient safety processes;
  • Hospital-specific reports;
  • Hospital recognition programs for high performers; and
  • Educational opportunities for hospital boards.


TeamSTEPPS is a teamwork improvement system based on over 25 years of research on team performance in high risk areas like health care. Developed by the Department of Defense, TeamSTEPPS is a face-to-face and instructor-led program which optimizes patient outcomes by creating a shared mental model through teachable skills that focus on leadership, situation monitoring, mutual support, and communication.

The TCQPS-led master trainer training course, combined with the TeamSTEPPS National Implementation Project, provide continuing support for trainees through webinars, a toll-free telephone line, and a website. Trainees also receive continuing education through new tools and measures that are researched, developed and validated to supplement the curriculum.

TCQPS believes that TeamSTEPPS is ideal for: (1) hospital frontline providers, including senior clinical and administrative leaders such as presidents and chief executive officers; (2) chief nursing, medical and patient safety officers; and (3) unit supervisors. Participants in the master training course implement TeamSTEPPS within their hospital or health system.