Establishing a Culture of Safety

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Establishing a Culture of Safety

• Everybody Speaks Up

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Evolution of Everybody Speaks Up (ESU) Training

• Evidence has shown that high-reliability
  organizations (those with superior safety
  records) share a commitment to open communication
  and transparency with respect to safety concerns
• Edward Hospital has experienced a number of
  events in which failure to effectively
  communicate a concern lead to an adverse outcome
  or a near miss.

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Evolution, continued

• Summer, 2003 - Edward Hospital Culture of Safety
  Committee
• Identified need to provide awareness and skills
  training to all staff regarding the relationship
  between speaking up and patient safety
• September, 2003 Small Steering Committee was
  formed to develop Everybody Speaks Up program
• Chair Marcie Heppermann
• Members human resources, nursing, risk
  management and quality
• Reviewed literature and unusual occurrences data
• Conducted physician focus groups
• Produced video

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Focus Group Discussion Questions

• What gets your attention when a nurse contacts
  you with a patient concern?
• How can nurses best communicate a serious concern
  about a patient?
• What information would you expect the nurse to
  have available when he or she contacts you with a
  concern?
• Can you tell us about a time you were thankful
  that a nurse brought something to your attention?
• What additional advice can you offer to nurses
  regarding when and how to speak up about a
  concern?

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Themes from Focus Groups

• Calls from nurses are generally appropriate, but
  information is not
• Physician must often probe for concern
• Nurses not always prepared
• Need to put vitals and other pertinent
  information into context
• Nurse needs to state his/her impression
• Dont assume physician is familiar with patient

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Objectives of the ESU Program

• Set the expectation for all employees to speak up
  about safety concerns
• Identify and discuss barriers to speaking up
• Identify the various ways in which employees can
  speak up at Edward
• Introduce specific skills for effectively
  communicating concerns to the physician
• Emphasize the use of chain of command as a
  patient safety tool

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Program Format

• Developed content for four different audiences
• Management
• Nursing
• Other Staff with Patient Contact
• Staff without Patient Contact
• Used a core set of facilitators who received
  training in both program content and basic
  facilitation skills
• Used small group format to encourage discussion
  (lt30)

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Program Format - Nursing

• 1 ½ hour sessions
• Began with video testimonial to introduce emotion
  and familiarity
• Facilitated discussion of barriers using flip
  chart
• Used video scenarios to illustrate skills,
  concepts and chain of command

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Program Format - Nursing

• Emphasized two-way communication speaking and
  listening
• Encouraged using and being a resource
• Developed a prompting tool for nurses to use when
  communicating patient concerns with physicians
• Closed with senior staff commitment to speaking
  up on patient safety

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Evaluation

• Held April through June 2004
• Over 120 sessions
• Mandatory for all staff (approximately 4,000)
• Average evaluation scores
• 3.8/4.0 overall program score
• 3.9/4.0 facilitator score
• Plan to evaluate ongoing impact through employee
  and physician surveys

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Keeping Everybody Speaks Up Alive

• Added safety to our values performance reviews
• Added content to new employee general orientation
  and nursing orientation
• Senior staff safety rounds
• Additional questions added to employee survey
  related to speaking up
• Acknowledge and thank staff who speak up
• Incorporate safety into facility design
• Assistance from marketing department

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Edward Values

• We will
• Welcome You
• Care for You
• Promote Safety
• Provide Great Service

• Together, we will
• Work as a Team
• Communicate Openly
• Promote a Safe Environment
• Strive to Be the Best

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Facility Design Team Kick-Off
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Keynote Speaker John Reiling, MBA,
MHA President/CEO St. Josephs Community Hospital
SynergyHealth Inc.
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Lessons Learned

• Keep groups small! Allow ample time for
  discussion
• Very important to deal with issues of physician
  behavior before embarking on this journey
• Be prepared to respond when staff speak up
• Support of Senior Leaders a must
• This is just the beginning!

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Safety Leadership
Pamela Meyer Davis President CEO
Trish Anen Vice President, Operations and CNO