Julie Apold

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Laying a SAFE Foundation

• Julie Apold
• Sr. Director of Patient Safety
• Minnesota Hospital Association

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MHA Calls-to-ActionBrief History

• AHE Law went into effect July 2003
• Report any of the 28 National Quality Forum
  Serious Reportable Events
• Event types with highest of reports
• Wrong Body Part Surgery
• Retained Foreign Objects
• Falls
• Pressure Ulcers

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Focused Approach to Improvement

• Focus on top events
• Determine best practices
• Implement best practices
• Convened advisory groups
• Reviewed national and local best practices
• Reviewed AHE data
• Developed implementation best practices

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Patient Safety Road Maps
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MHA Statewide Calls-to-Action
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Road Map Structure

• SAFE
• Topic-specific Gap Analyses

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SAFE
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SAFE S (Safety Teams/Org Structure)

• Action 1 Secure endorsements and resources for
  XX Prevention Program
• Leadership
• Endorses the work
• Clearly communicates goals
• Regularly reviews progress toward goals
• Supports adding resources as appropriate
• Designates a senior leadership sponsor

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SAFE S (Safety Teams/Org Structure)

• Action 2 Promote XX prevention
  representation/champions/liaisons throughout the
  facility
• Regular Interdisciplinary team
• Champions
• Liaisons
• Ad-hoc for specific projects
• Designated coordinator(s)
• With designated time!

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SAFE S (Safety Teams/Org Structure)

• Action 3 Identify gaps and develop action plans
• The interdisciplinary team
• Reviews and updates the XX prevention program
• Reviews data results at least quarterly and
  identifies strengths and opportunities
• Develops a plan to prioritize and address
  improvement opportunities
• Commissions subgroups as needed

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SAFE A (Access to Information)

• Action 1 Track progress on process and outcome
  measures
• Observational audits
• Inter-rater reliability
• Capture adverse event details

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SAFE A (Access to Information)

• Action 2 Review and analyze data for improvement
  opportunities
• Routinely review and analyze data
• Track progress against established targets
• Run charts, control charts, dashboards,
  scorecards
• Prioritize and act upon identified issues

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SAFE A (Access to Information)

• Action 3 Data is shared on a regular basis to
  promote system-wide learning and transparency
• Share vertically and horizontally
• A story with worth 1,000 data points

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SAFE F (Facility Expectations)

• Action 1 Leadership establishes and communicates
  clear expectations
• All staff informed of expectations
• Culture supports speaking up/stopping the line
• The stop the line process clearly outlines
• When to stop the line
• How to stop the line (verbal/non-verbal cue)
• The chain of command to follow if not supported
  in stopping the line
• Clear communication to staff from managers and
  leadership that staff will be supported if they
  speak up

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SAFE F (Facility Expectations)

• Action 2 Education for staff and physicians
• Orientation 
• Annually

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SAFE F (Facility Expectations)

• Action 3 Establish a structured communication
  process
• Structured communication tools, e.g., Situation,
  Background, Assessment, Recommendation (SBAR)
  isolation signage
• A structured hand-off process (what should be
  communicated how?)
• During shift change
• Between departments/units
• To other facilities

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SAFE F (Facility Expectations)

• Action 4 Disclose unanticipated events
• Promptly inform patients/families when an
  unanticipated event occurs
• Establish who should discuss with the
  patient/family and how
• Provide training and support to staff on
  effective disclosure strategies
• Keep patient/family updated

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SAFE E (Engagement of Pts/Families)

• Action 1 Educate and empower patient/ families
• Address any barriers to patient/family
  understanding their role in HAI prevention
• Cultural, language, hearing impairment, health
  literacy
• Educated on their role and what
• they can expect to see from caregivers
• Assess patient/families level of
• understanding e.g., teach back
• Encourage speaking up

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The MAPS Journey to Developing the Culture
Road Map
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• Timeline of Culture Initiative

• Late 2009
• Operations Committee commissioned Culture
  Exploratory Work Group
• MAPS Topic Criteria
• ? Topic expands across multiple health care
  settings
• ? Topic success requires collaboration among a
  multi-stakeholder work group
• ? Work on the topic will have an impact on the
  safety and quality of care in MN
• ? Organizations are willing and able to
  participate in and carry out the necessary work.
• Exploratory Work group members

Julie Apold and Tania Daniels MHA Steve Meisel, Fairview Health Services
Diane Rydrych, MDH Cally Vinz, Gary Oftedahl, ICSI
Marie Dotseth, Dotseth Consulting Susan Peterson, Anoka Metro Regional Treatment Center
Jennifer Lundblad, Kelly ONeill, and Denise White, Stratis Health Rob Welsch, VHA Upper Midwest
Becky Schierman, MMA
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• Timeline of Culture Initiative

• 2010 Exploratory Work Group
• Took into consideration current Culture work in
  Minnesota
• VHA/AHRQ findings and gaps
• Stratis Health findings and gaps
• ICSI findings and gaps
• Identified project/focus
• Identified three phases of addressing culture
• Data collection (Initial Phase)
• Data analysis/interpretation identifying the
  gaps (Planning Phase)
• Implementation work to address gaps (Action
  Phase)
• Discussed existing data
• Survey tools AHRQ, VHA, ICSI, HLCAT
• Identified list of attributes for a safety culture

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• Timeline of Culture Initiative

• 2010 Exploratory Work Group Recommendations
• There is a role for MAPS to address a culture of
  safety that expands across health care settings
• Provide a framework of best practices,
  implementation support, and measurement
• Develop best practices road map and guide health
  care providers who are embedding a culture of
  safety within in their organizations
• Create a community standard through a statewide
  call-to-action across all settings of care
• 2010 MAPS Governance Decisions
• July 14th MAPS Steering Committee approved
• MAPS moving forward with Culture Roadmap and
  budgeting for a project manager

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• MAPS Patient Safety Culture Workgroup

• Co-Chair Nancy Kielhofner, Allina Hospitals
  Clinics
• Co-Chair Kate Peterson, Stratis Health
• Julie Apold, Minnesota Hospital Association
• Karyn Baum, University of MN
• Sandy Berreth, MNASCA representative
• Shirley Brekken, MN Board of Nursing
• Tania Daniels, Minnesota Hospital Association
• Stan Davis, Fairview Health System
• Marie Dotseth, Dotseth Consulting
• Ruth Edwards, MN Council of Health Plans
  representative
• Kris Ehlers, Fairview Health System
• Marilyn Grafstrom, LifeCare Medical Center
• Karen MacDonald, MOLN representative

• Ruth Martinez, Minnesota Board of Medical
  Practice
• Christine Milbranth, Metro State University
• Christine Norton, Minnesota Breast Cancer
  Coalition
• Gary Oftedahl, ICSI
• Nancy Page, Orthopaedic Institute Surgery Center
• Susan Peterson, Anoka Metro Regional Treatment
  Center
• Diane Rydrych, Minnesota Department of Health
• Becky Schierman, Minnesota Medical Association
• Liz Sether, Aging Services of Minnesota
• Cally Vinz, ICSI
• Rob Welch, MD, VHA Upper Midwest
• Linda Zespy, Project Manager

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• MAPS Patient Safety Culture Workgroup

• Goal
• To develop a safety culture road map using known
  best practices, emerging national standards, and
  previous work of MAPS and its members
• For these best practices to become a community
  standard through a statewide call-to-action
  across all settings of care

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• Timeline of Culture Initiative

• 2010 continued
• Culture Workgroup chooses domains to develop
  into road maps, using key safety subcultures
  identified in a meta-analysis.
• What is Patient Safety? A Review of the
  Literature, Christine Sammer et al Journal of
  Nursing Scholarship 2010

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• Timeline of Culture Initiative

• 2011
• Domains assembled into one overall road map
• Audit questions developed for each domain
• Key stakeholder groups identified to review the
  full road map draft
• Tools/resources gathered for each domain

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• Timeline of Culture Initiative

• 2012
• Final feedback received
• Road map finalized
• Kick Off meeting May 1

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• The MAPS Safety Culture Road Map
• A Birds Eye View

GETTING STARTED Endorse culture effort Analyze survey results Develop steering committee Develop plan Identify champions Provide education on safety Conduct culture survey GETTING STARTED Endorse culture effort Analyze survey results Develop steering committee Develop plan Identify champions Provide education on safety Conduct culture survey GETTING STARTED Endorse culture effort Analyze survey results Develop steering committee Develop plan Identify champions Provide education on safety Conduct culture survey GETTING STARTED Endorse culture effort Analyze survey results Develop steering committee Develop plan Identify champions Provide education on safety Conduct culture survey GETTING STARTED Endorse culture effort Analyze survey results Develop steering committee Develop plan Identify champions Provide education on safety Conduct culture survey
LEADERSHIP Strategies/tactics for these leaders to set clear patient safety expectations Governance Clinician leaders CEO/administrator Managers LEADERSHIP Strategies/tactics for these leaders to set clear patient safety expectations Governance Clinician leaders CEO/administrator Managers LEADERSHIP Strategies/tactics for these leaders to set clear patient safety expectations Governance Clinician leaders CEO/administrator Managers LEADERSHIP Strategies/tactics for these leaders to set clear patient safety expectations Governance Clinician leaders CEO/administrator Managers LEADERSHIP Strategies/tactics for these leaders to set clear patient safety expectations Governance Clinician leaders CEO/administrator Managers
COMMUNICATION Structured communication process Structured handoffs Stop-the-line policy JUSTICE MAPS statement of support Key stakeholder groups Just/accountable education HR practices RCA process Clinical practices Hardwiring/ sustaining TEAMWORK Readiness assessment Facilitator recruitment Team training Gap assessment Workplans LEARNING Reality rounding Reporting system RCA process Use of report data Patient/Resident/Client and Family ENGAGEMENT Soliciting input Pt/family empowerment processes Effective disclosure Health care literacy and cultural competence
SUSTAINING THE OVERALL CULTURE INITIATIVE Measurement Review of plan Metrics analysis Education Course corrections/new actions Evaluation of performance Dissemination of data/findings/actions SUSTAINING THE OVERALL CULTURE INITIATIVE Measurement Review of plan Metrics analysis Education Course corrections/new actions Evaluation of performance Dissemination of data/findings/actions SUSTAINING THE OVERALL CULTURE INITIATIVE Measurement Review of plan Metrics analysis Education Course corrections/new actions Evaluation of performance Dissemination of data/findings/actions SUSTAINING THE OVERALL CULTURE INITIATIVE Measurement Review of plan Metrics analysis Education Course corrections/new actions Evaluation of performance Dissemination of data/findings/actions SUSTAINING THE OVERALL CULTURE INITIATIVE Measurement Review of plan Metrics analysis Education Course corrections/new actions Evaluation of performance Dissemination of data/findings/actions
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• Road Map Design

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• Road Map Data Submission

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• Toolkit and Resources

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Domain (questions) Best Practices
Getting Started (46) 65
Leadership (58) 63
Communication (16) 53
Justice (29) 53
Teamwork (23) 18
Learning Environment (37) 71
Engagement (29) 65
Sustainment (41) 61
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• Next Steps

• MAPS Conference
• October 24-26, 2012
• AHRQ Survey Group 1
• Culture Webinars (AHRQ survey groups 2 3)
• September 25, 2012 AHRQ Getting Started
• November 20, 2012 Interpreting AHRQ results,
  Creating an Action Plan
• December 10, 2012 Leadership
• January 8, 2013 Non-Punitive Culture
• February 6, 2013 Organizational Learning
• AHRQ Survey Group 4 starting January, 2013
• TeamSTEPPS Training

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• Questions?