Worker / Patient Safety: Steps in a Culture Change

1
Worker / Patient Safety Steps in a Culture Change

• Mary Margaret Jackson
• Director, Performance Outcome Services
• Self Regional Healthcare

2
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

3
Process Steps

• Gain organizational commitment
• Measure safety culture
• Form coordinators group
• Identify commonalities as well as individual
  needs
• Gain consensus on next steps
• Begin organizational work groups

4
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

5
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

6
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

7
Additional Activities

• Training in Root Cause Analysis Common Cause
  Analysis
• Development of a Scorecard to consistently
  track results
• Enhancing communications organization-wide

8
Summary of the Key Activities

• Red Rules
• Behavior Based Expectations
• Accountabilities
• Scorecard

9
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

10
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

11
What makes a good Red Rule?

• Is the proposed Red Rule critical to patient
  and/or employee safety if not performed
  consistently and exactly?
• Can the proposed Red Rule be applied throughout
  the hospital?
• Is the proposed Red Rule specific enough so
  interpretation is not required?
• Is it possible to directly observe/measure
  compliance?
• Are you willing, as a leader, to endorse 100
  compliance as the minimum standard for the
  proposed Red Rule?

12
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

13
Selfs Red Rules

• I will always confirm patient identity using at
  least two hospital approved identifiers before
  any action.
• I will always perform hand hygiene before and
  after every patient contact and as specified by
  my department.
• I will always adhere to posted Personal
  Protective Equipment (PPE) requirements.
• I will always wear my hospital ID badge while on
  duty.

14
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

15
What might the Red Rules Do?

• Unify staff on safety- 100 expectation for ALL!
• Gain better understanding of individuals role in
  safety
• Build personal accountability
• Create formal accountability systems
• Hard to argue against

16
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

17
Translates into the Following

• Use Repeat-Backs Read-Backs and Seek Feedback
• Ask Clarification Questions
• Identify Self, Department, Purpose
• Hand-Off Effectively 5 Ps 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

18
How are Behaviors Introduced?

• Trainers developed
• Sessions grouped so communication improvements
  are emphasized
• Trainers carry the message
• Integrated into orientation and all safety
  training

19
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

20
Results
21
Results
22
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