FEATURES

Obsessed with Zero: Reflections on the Career and Achievements of Richard J. Brili, MD

October 1, 2020
Written by

John Barnard, MD, chair of Pediatrics at Nationwide Children’s Hospital, takes a look back at Dr. Brilli’s leadership toward the audacious goal of zero preventable harm.

In 2008, Richard “Rich” Brilli, MD, was recruited to Nationwide Children’s Hospital as its chief medical officer. Among other physician executive duties, he was charged with lowering the rate of preventable harm as leader of the hospital’s quality and safety programs.

After a few months of learning about our organization’s culture and assessing our potential, Rich made an audacious decision: zero preventable harm events as an institutional goal. We were the first pediatric hospital in the United States to establish such a quality and safety program and to make zero preventable harm its transparent, public goal.

Many of us were privileged to watch from front row seats as a remarkable revolution occurred on our campus. Catalyzed by its catchy moniker, the Zero Hero program caught fire, stoked by Rich’s passion and zeal for quality improvement. He led visibly and relentlessly as a safety culture revolution took hold in our hospital.

Our entire staff of 9,000 and all new employees since (we’re now at more than 13,000 employees!) have been trained in principles of quality and safety and the vocabulary of the Zero Hero program. Under Rich’s watchful eye, we developed and implemented tracking systems to better identify, measure and analyze harm events. We appointed multidisciplinary teams to establish best practices and monitor compliance with care practice changes.

“It is unacceptable that medicine is ever considered dangerous or that errors are considered routine — we all must reach for a higher standard, and for the sake of our children, strive to become Zero Heroes…” — Richard J. Brilli, MD, in U.S. News & World Report, March 14, 2017

Initially, our harm events seemed to increase as staff began to report and identify events that, in the past, had not been reported. However, about year later, we started seeing a shift. In the years since, so much has been accomplished. Principles and practices that originated at Nationwide Children’s spread to other Ohio children’s hospitals in a statewide collaborative, and nationally under the aegis of Solutions for Patient Safety. Among Rich’s many other accomplishments are the following:

  • Our Quality Improvement Services staff increased from 8 individuals when he started to now more than 60.
  • In 2009, we were experiencing a serious safety event once every 11-13 days. Now, we average one every 183 days.
  • He led the creation of a new way of being transparent and driving accountability, the Pediatric Harm Index, now used by more than 140 other children’s hospitals.
  • Our Preventable Harm Index has shown a decrease in harm events of 68% since 2010, the equivalent of saving 2,500 children from harm during that time.
  • Now, 145 hospitals share our zero preventable harm goal through the Children’s Hospitals Solutions for Patient Safety Network. Nationally, 17,000 children have been spared serious harm. Rich was an inaugural member of the network’s Clinical Steering Committee.
  • Under his guidance, Nationwide Children’s has trained 413 individuals at our hospital and other health care organizations in a formal educational program called Quality Improvement Essentials (QIE). Alumni have become improvement leaders in their own hospitals.
  • He launched the first quality journal dedicated solely to pediatrics, Pediatric Quality and Safety.
  • His patient safety principles have been expanded to staff safety. This inclusive approach to safety now permeates our hospital facilities as an important dimension to our Zero Hero program.

This issue of Pediatrics Nationwide focuses on the Pediatric Vital Signs project, a community quality improvement initiative. It should come as no surprise that Rich is front and center in this bold commitment to improve health for all children in a way that requires our hospital and community leaders to align and synergize on interventions to achieve a common goal of improving the health of children in our community.

Earlier this summer, Rich retired from his position as chief medical officer, having transformed this institution’s vision and the very idea of quality in pediatric health care. The COVID-19 pandemic has reinforced just how crucial his staff and patient safety principles are. Fortunately for us, and for every family we serve, Rich is the rare leader who can make the impossible seem possible. What has happened in his tenure is one of the most important chapters in Nationwide Children’s history, and it has had a profound impact on other children’s hospitals across the country. Rich, humble as always, credits the Nationwide Children’s team from the front-line care providers to his executive teammates.

We will now honor Rich by an annual Richard J. Brilli Visiting Professorship in Pediatric Quality and Safety to recognize outstanding achievement in research, implementation, advocacy and education in the field of pediatric clinical quality and safety. He will continue to work at Nationwide Children’s on special projects, continue to advance the mission of the Pediatric Quality and Safety journal and continue his professional obsession with zero.