Patient Safety Leadership Walkarounds: How Organizations are Enhancing Patient Safety Culture

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Patient Safety Leadership WalkaroundsHow
Organizationsare Enhancing Patient Safety Culture

• QHN 2008 Open House Series
• Tuesday May 28th, 2008

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A Frame of Reference

• Cathy ONeill, Patient Safety Specialist
• Sunnybrook Health Sciences Centre

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Building Safer Hospitals

• Key Ingredients
• Culture of Safety
• Reliable design
• Measurement
• National Steering Committee on Patient Safety,
  Building a Safer System (RCPSC) 2002
• Baker Norton. Healthcare Papers 20012(1)10-31

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Origination of WalkArounds

• Other highly reliable organizations and
  industries
• Aviation
• Nuclear power plants
• Air traffic control systems
• Adopted by health care
• Numerous hospitals in USA
• Now being adopted as best practice in Canada

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Theory

• A tool to connect senior leadership to patient
  safety and to inculcate safety ideas into the
  health care system.
• (Dr. Allan Frankel, Partners Healthcare System)
• Improve patient safety
• Foster trust and communication
• Proactive response to patient safety issues

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What Do Walkarounds Accomplish?

• Promote a Culture of Safety
• Alignment
• Commitment
• Commiseration

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Objectives

• Increase awareness of patient safety issues by
  all clinicians and senior leaders
• Make it apparent that patient safety is a high
  priority for senior leadership
• Obtain and act on issues elicited from staff
  about patient safety concerns
• Provide a forum for commiseration

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Who, What, Where, When How?

• Multiple iterations
• need to find the right fit
• Common goals
• Build a culture of safety
• Improve the safety of our patients

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The Sunnybrook JourneyChapter 1

• Guna Budrevics
• Performance Improvement Specialist

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Background

• Brigham Womens Hospital 2002
• Adaptation of Executive Walkrounds

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The Process/The Timelines
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Our Vision

• Fast turnaround of the priority issues is
  essential to building the momentum for patient
  safety walkarounds

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Indicators

• Priority issues addressed
• Turnaround times for priority issues
• Identification of trends across the units
• Feedback on the process by
• the participants
• the senior leaders

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Our Experience

• A good balance of representation from the patient
  care team is essential
• Environmental issues invariably arise as part of
  the discussion

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Our Experience

• The importance of staying on the topic of patient
  safety
• How does this affect the safety of your
  patients?
• Discussion of other issues or organizational
  priorities minimizes the patient safety focus

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Findings

• Newer Infection Prevention and Control standards
  affect teams ability to deliver care processes.
• SARS, MRSA, and other nosocomial infections have
  increased the time and complexity of safely
  caring for patients

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Findings

• Multi-campus organizations struggle between
  standardizing policies and procedures yet
  encouraging the spread of innovative best
  practices

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Findings

• Organizations must balance the need for patients
  autonomy (patient focused care) and the safety of
  staff and others within an increasingly assertive
  and sometimes violent society

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Findings

• Aging facilities are not designed to deliver safe
  and optimal care
• Need for ergonomic solutions
• Integrating human factors fundamentals
• Engineering solutions
• Safe and secure storage of materials
• Design of space and furniture

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Findings

• Difficulties in integrating all information
  systems, databases, and other sources of patient
  information
• EPR
• CPOE
• Patient Care Systems
• Results from external labs

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Challenges

• Senior leaders experience as patient safety
  advocates
• Leading the conversations to focus on patient
  safety
• Learning the language of patient safety
• Tendency for teams to focus on environmental/struc
  tural issues

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Challenges

• Communication with the participants is
  inconsistent
• Systemic processes defects are challenging to
  address and fixes are time consuming to spread
• Gaps in knowledge in how to request support
  services

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Chapter 2

• A new database
• Engaged rL Solutions to automate the data and
  communication processes
• Bringing Board Members on-board
• Creating funding for patient safety WA solutions
• Walkarounds in interface locations MI,
  laboratories, ambulatory settings

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Chapter 2

• Patients and Families
• Moving from asking staff
• Do patients and families voice any safety
  concerns?
• to
• Asking patients/families
• What are your concerns in terms of your own
  safety and the safety of your family?

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Moving Forward

• Priming Senior Leaders for their visits with
  summaries of local incidents
• How will we share this work with the LHINs?

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Thank You!