Worker / Patient Safety: Steps in a Culture Change by n7uME0Gi

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									 Worker / Patient Safety:
Steps in a Culture Change

        Mary Margaret Jackson
        Director, Performance
        Outcome Services
        Self Regional Healthcare
           History of The “Journey”

   Idea conceived and grant sought
   Combining of six organizations with common
    bond of:
    –    All JCAHO accredited and in South Carolina
    –   All with same Worker Compensation & Liability
        carriers
Process Steps

   Gain organizational commitment
   Measure safety culture
   Form coordinator’s group
   Identify commonalities as well as individual
    needs
   Gain consensus on next steps
   Begin organizational work groups
Steps Continued

   Customize programs to the organization
   Develop individual and group measures /
    indicators
   Share successes and failures openly within
    the group
   Share with other S.C. organizations
Strategies / Activities

       Culture change takes a multi-pronged
        approach
       In some situations safety program
        reorganization needed
       Maintaining an internal focus and
        champion
       “Integrating” into current initiatives
Specific Activities

   Organizational identification of:
    –   Red Rules
    –   Behaviors at all levels that could best prevent error
        (“behavior based expectations”


   Used line staff who were first educated in concept
    and who next chose Self specific
Additional Activities

   Training in Root Cause Analysis & Common
    Cause Analysis
   Development of a “Scorecard” to consistently
    track results
   Enhancing communications organization-
    wide
Summary of the Key Activities

   Red Rules
   Behavior Based Expectations
   Accountabilities
   Scorecard
How are Red Rules picked?

   Choose those that focus employees on those rules
    that are most important to safety

   Choose those that clarify work expectations about
    processes critical to safety

   Choose those that make compliance with safety
    standards a routine activity
Getting Red Rules Implemented

   We are not there yet!
   Removal of barriers to successful
    compliance with a Red Rule
   Gain clear consensus on the “accountability”
    portion
What makes a good Red Rule?

1.   Is the proposed Red Rule critical to patient and/or employee safety if not
     performed consistently and exactly?

2.   Can the proposed Red Rule be applied throughout the hospital?

3.   Is the proposed Red Rule specific enough so interpretation is not required?

4.   Is it possible to directly observe/measure compliance?

5.   Are you willing, as a leader, to endorse 100% compliance as the minimum
     standard for the proposed Red Rule?
First Steps on Action Sheet

   Gain organizational approval and support of
    "Red Rule
   Identify processes for Medical Staff
    acceptance and support with Red Rules
   Attach red rule accountability expectations
    and measures at all levels of the organization
Self’s Red Rules
1.   I will always confirm patient identity using at least two hospital
     approved identifiers before any action.

2.   I will always perform hand hygiene before and after every patient
     contact and as specified by my department.

3.   I will always adhere to posted Personal Protective Equipment (PPE)
     requirements.

4.   I will always wear my hospital ID badge while on duty.
Some of the Barriers

   Policy conflicts
   Staff knowledge
   Ability to observe and measure compliance
   Need to anticipate and have solutions for
    common human factors- such as “I forgot my
    badge”
What might the Red Rules Do?

   Unify staff on safety- 100% expectation for
    ALL!
   Gain better understanding of individual’s role
    in safety
   Build personal accountability
   Create formal accountability systems
   Hard to argue against
What about Behaviors?
   Already in use was “SELF PRIDE”

   S – Show Respect
   E – Effective Communication
   L – Listen
   F – Follow Through

   P – Professionalism
   R – Recognize Every Individual
   I – Initiate and Inform
   D – Do The Job Right The 1st Time
   E – Expect The Best
Translates into the Following:

   Use Repeat-Backs & Read-Backs and Seek Feedback
   Ask Clarification Questions
   Identify Self, Department, Purpose
   Hand-Off Effectively – 5 “P’s” – Patient, Plan, Purpose,
    Precautions, Problems
   Follow Red Rules, Policies, Procedures
   Practice Peer Checking & Coaching Using ARC (Ask, Request,
    Concern)
   STAR – Stop, Think, Act, Review
   STOP when Unsure and Ask
How are Behaviors Introduced?

   Trainers developed
   Sessions grouped so communication
    improvements are emphasized
   Trainers carry “the message”
   Integrated into orientation and all safety
    training
What Other Things did the Six
Facilities focus on?

   Training in Root Cause Analysis
   Introduction to increased use of Common Cause
    Analysis
   Identification of leading, lagging, and real time
    indicators of both patient and worker safety
    (Scorecard)
   Defining incident types and sharing results openly
                                               Results
                                                            Consortium Patient Level 1 Events per 10,000 Patient Days
                                                                                (5 of 6 hospitals)

                                         60

                                                                          SCWPSI Consortium Patient Level 1 Events per 10,000 Patient Days
                                              50.02573982                 decreased by 22.5% from 2003 to 2004
                                         50
Level 1 Events per 10,000 Patient Days




                                                                                                                                              Better
                                         40                                                                                    38.77553476




                                         30




                                         20




                                         10




                                          0
                                               2003 Total                                                                        2004 Total
                                                                                      Year
                                              Results
                                                                 Consortium Worker Level 1 Events per Full Time Employees


                                         20
                                                      18.59133259

                                                                                       SCWPSI Consortium Worker Level 1 Events per Full Time Employee decreased by
                                                                                       50% from 2003 to 2004
Level 1 Events per Full Time Employees




                                         15
                                                                                                                                                                            Better


                                                                                                                                                                     2005 data is January
                                                                                                                                                                     1 - June 30, 2005
                                         10                                                                                              9.395285275




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                                                                                                                                      20
                                                                                                 Year


                                                                                       Level 1       Linear (Level 1)
Results?

   It is a three year journey- at least!
   Re survey of culture next year
   Does it make a difference- you bet!
   Gives a framework for change

								
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