Training Top 125 Best Practice: Reaching for Zero at Norton Healthcare

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Norton Healthcare initiated and completed a nine-month blitz—called “Reaching for Zero”—to train all employees about the importance of preventing harm, and how to utilize principles of high reliability in doing so.

One of Norton Healthcare’s primary goals is to avoid all preventable harm to any patient, family member, or employee. Safety is a core value within the organization. In keeping with this goal, Norton Healthcare initiated and completed a nine-month blitz to train all employees about the importance of preventing harm, and how to utilize principles of high reliability in doing so. This patient safety initiative is called “Reaching for Zero.” During the initiative period, more than 10,000 providers and staff members learned strategies they can use every day to prevent “harm events.”

Program Details 

The training centered on three behavior expectations that align with principles of high reliability in preventing harm:

  • Make a personal and team commitment to safety (200 percent accountability)
  • Communicate clearly and completely
  • Support a questioning attitude

The initial Reaching for Zero training sessions combined interactive presentations, group work, and video support. The effort did not stop after the initial training course. Reaching for Zero continues to be taught and reinforced throughout Norton Healthcare facilities through monthly classes that are ongoing for new employees as a part of Phase II onboarding. In addition, specific training has been developed for leaders that focuses on leadership methods designed to reinforce the error-prevention strategies taught in Reaching for Zero classes, and to provide procedures for communicating with staff about safety.


While Norton Healthcare hasn’t reached zero yet, it already is seeing positive results:

  • In the period between its most recent safety culture surveys, overall scores have improved system-wide, indicating greater employee awareness about the importance of safe behaviors in the organization. Hospitals were at or above the AHRQ (Agency for Healthcare Research and Quality) benchmark for percent positive responses in 7 of 12 domains. There was statistically significant improvement from the 2015 survey in 10 of 12 domains. System-wide, Norton Healthcare saw a 78.1 percent response rate. The overall percent positive response improved 3 percent  from 2015, with the AHRQ average improvement from survey to survey at 1 percent. Some 83 percent of respondents gave an overall patient safety grade of very good or excellent. 
  • The Norton Medical Group side (NMG) had a 73.5 percent rating of very good or excellent. The NMG was above the AHRQ benchmark in all 10 domains of the medical office survey. The response rate was 72.6 percent.

Statistically, Norton Healthcare has seen specific improvements across the system:

  • Good “catches” of potential harm events before they occur increased 34 percent.
  • Reportable infections decreased 27 percent overall, with continued improvement in 2018.
  • Hand hygiene compliance—one of the keys to infection prevention—has been observed at a 42 percent improvement over the pre-initiative baseline.