‘Patient Safety’ Category


Implement Patient Rounding to Support a Culture of Safety

Leeann Sammons

What are the barriers to doing this?

The culture of healthcare has been to “cover up” and make excuses for attitudes, behaviors and systems breakdowns leading to errors and a culture lacking a focus on patient safety.  Technology to support patient safety is expensive. Internal competition for financial and other resources occurs when organization priorities are not effectively communicated. Leaders who aren’t facing reality assume that care is already safe.  Rounding forces leaders out of their office and comfort zone.  Although patients and families will share positive stories and experiences, there will likely be just as many complaints and serious safety issues shared as well. Leaders may not be sure how to respond to patients and their families. 

Why should we do this anyway?

Patient and family rounding demonstrates a commitment to patient safety and patient-centered care.  It is an additional opportunity for patients and families to speak up and be involved in their care.  Leaders are obligated to listen to and share, with staff, physicians and other leaders, the perceptions of patients and families. Rounding also give leaders the opportunity to proactively “manage up” physicians, staff and the processes in place to keep the patient safe.  Sharing this information comforts, educates and reassures the patient and family. Patients and families are eager to share success stories and tell about staff that made a difference during their stay.  Rounding, when sincere, isn’t just about patient safety failures and success.  It shows that we truly care.

 How can we do this?

  1. Implement scheduled tasks at specific intervals.  Studies show that falls and decubitus ulcers can be significantly reduced when nurses perform specific tasks, such as turning the patient, assisting them to restroom, addressing pain issues, checking/re-setting bed alarms and placing personal items within reach.
  2. Involve, educate and communicate with the patient and the family.  Achieving patient-centered perfection means putting and keeping patients and their families at the center of care; encourage them to speak up if they don’t understand something or have questions, refrain for using medical lingo and acronyms, listen to their concerns, ask them if they have questions, tell them what interventions and safety precautions are in place or available to protect them, use the teach-back method with them, ask if they have any safety or care concerns, talk at their level. 
  3. Take action and follow-up.  When a patient or family member raises a concern, make contact with the appropriate person, let the patient and family know what action you have taken and what will happen next.

How have you used patient rounding to support a culture of safety?

 

Resources

Barriers to implementation of patient safety systems in healthcare institutions: leadership and policy implications. Akins RB, Cole BR. J Patient Saf. 2005;1:9-16.

http://www.bed-check.com/sites/www.bedcheck.com/files/pdf/Clinical_Spotlight_Spring_2011.pdf

Implement Employee Rounding to Support a Safety Culture

Leeann Sammons

What are the barriers to doing this?

Lack of trust between staff and leaders may prevent meaningful discussion during rounds.  Staff engagement and involvement might be a concern when leaders do not communicate when and where the rounds take place and the intent of the rounds.  Even when leaders do communicate, staff may not attend because they can’t leave their patients or they simply aren’t interested.  Staff may view the rounds as an inspection or just another meeting that is all talk and no leader follow-up with resolutions to their concerns.  Non-clinical leaders rounding in clinical areas may feel uncomfortable because they lack clinical knowledge.  Senior leader rounding with front line staff could create apprehension and be viewed as undermining the managers’ leadership of their units.

Why should we do this anyway?

Rounding is a platform for leaders to meet with employees and discuss patient safety issues, concerns, events, as well as successes.  It sends the message that patient safety is a priority for all staff at every level of the organization.  Leaders have the opportunity recognize staff who speak up or prevent an error from reaching the patient. Employee rounding is also a way to deliver education on patient safety concepts such as incident reporting, identifying process improvement opportunities, gathering potential solutions and following-up with changes.  Leaders who commit to formal and informal employee rounding are more visible, and have more opportunities to observe behaviors and provide just in time coaching and positive feedback to staff.

 How can we do this?

  1. Schedule, communicate and commit to scheduled rounding.  Staff need to know when leaders will be in their department.  This allows the manager to manage the workload so staff can attend the rounding.  
  2. Explain the purpose of rounding.  Everyone is busy and time is valuable. Staff wants to come prepared.  They can only do this when they know why they are meeting with the leader and what is expected of them.
  3. Take notes.  Taking notes demonstrates that the leader is really listening and it holds them accountable for resolving issues.  The notes can post or distribute the notes for the entire unit and give those who couldn’t attend the rounding a chance to see what was discussed.
  4. Ask open-ended questions.  Questions such as “Can you think of a patient we harmed recently while delivering care?”, “What is the next accident waiting to happen?”, “What processes or systems can be improved?” and “Can you describe a time where harm was prevented from reaching the patient?” require more than just yes or no responses. Open-ended questions generate discussions and additional questions that result in receiving a wealth of information.
  5. Provide information and updates.  Rounding is an excellent forum to follow-up on concerns voiced in previous rounding sessions, new information related to patient safety and just in time patient education briefings.
  6. Recognize staff. There are many opportunities to recognize staff for demonstrating that patient safety is a priority.  Thank those who speak up, take the initiative to change a process or share a lesson-learned or personal story.  Paying it forward helps foster a positive environment.

How have you used employee rounding to support a culture of safety?

Implement Rounding to Support a Culture of Safety

Leeann Sammons

What are the barriers to doing this?

There are many ways to conduct rounding. Some ways are better than others based on the rounding purpose and audience.  Leaders and staff view this as another task to add to their list.  Change is hard.  We want to do what we enjoy and some leaders won’t like this.  It forces leaders to get out of their offices and out of their comfort zones.  Although positive stories and experiences will be shared, there will likely be just as many complaints and serious safety issues shared as well.  Hearing about these breakdowns triggers embarrassment, denial, anger and other feelings.  Investigating and following back up with all of those involved can be time consuming.

Why should we do this anyway?

Rounding supports building and sustaining a culture of safety.  It is one way to identify actual and potential safety issues, engage patients, families and staff about their patient safety concerns. Observations and audits of clinical processes, interactions with patients and families and key safety behaviors can be accomplished while rounding.  Rounding is also one tactic to achieve compliance with The Joint Commission standard requirements and their National Patient Safety Goals.

How can we do this?

  1. Create a concept presentation.  The concept presentation should include a high level description of rounding, how it will work and evidence that it will improve organization results.  Getting buy-in and support of the executives and key organization leaders is critical to the success of the program.  
  2. Identify leader champions. There are leaders who will embrace this concept.  Heck, they may already have a form of rounding going on in their unit.  Either way, find these folks, share the concept, ask for their support and give them the opportunity to be part of the design team.
  3. Design the rounding program.  The team should consider the goal of the rounding, who the rounds focus on, the frequency and length, how positive feedback, concerns and opportunities will be captured and followed-up on.  The team may want to develop rounding expectations that includes how often and what time of day rounds will be conducted. 
  4. Conduct a trial.  Trials help identify what works well, what doesn’t and what wasn’t included that should have been.  They also allow for tweaks before organization-wide implementation.
  5. Measure for success: Leaders exist to produce results.  Indicators must be identified and monitored to ensure that rounding is making a difference and driving results in the right direction.

How have you used rounding to support a culture of safety?

Comprehensive Unit-based Safety Briefings: Implementation in Non-clinical Settings

Leeann Sammons

What are the barriers to doing this?

Non-clinical support departments are one, two, three or more layers away from direct patient care.  The leaders may not understand, realize or even care about the impact their department’s work has on patient safety.  It is safe to say that if the leader doesn’t connect the dots and get it, then the employees won’t get it either.

Why should we do this anyway?

Patient safety must be the number one priority of every leader and employee. Our patients expect nothing less.  The work of every leader and employee can positively or negatively impact the safety of patients.  Leaders must understand how the function and work of their department, either directly or indirectly, impacts patient safety and then “connect the dots” for their employees.  Safety briefings set the foundation to improve planning, communication and teamwork within the department and for the departments they serve, allowing for a scalable response to issues and concerns.

How can we do this?

  1. Collect specific information. The “Safety Briefing Leader” uses a form to collect specific information.  The information might include the hospital census, equipment failures/breakdowns the past 24 hours, the repair plan, high priority work for the day, and preventative maintenance, high risk tasks, equipment testing and planned work for the day, work requiring permits, special personal protective equipment (PPE) and/or inspections, employee and safety events in the last 24 hours, potential issues for the next 24 hours and identification of issues that need resolution.
  2. Connect the dots. This is the “Safety Briefing Leader’s” chance to explain how the work being performed during the shift impacts patient safety. For example, when there is a supply shortage that has not been communicated, nurses may spend more time away from their patients’ bed-side looking for what they need.
  3. Create an emotional hook. Although it takes extra preparation, the “Safety Briefing Leader” can tell a brief personal story to engage the staff to help them understand just how significant they are to keeping patients safe.
  4. Find support one employee at a time. The concept of safety briefings may be foreign to some employees.  Some will be interested and supportive while others will resist this change.  Find the employees who support the concept and let them know they are vital to holding meaningful safety briefings.
  5. Meet at the beginning of each shift. The safety briefing is held at the beginning of each shift.  The manager reports specific information to the on-coming shift.
  6. Keep the briefings short. The briefing must be concise, succinct and to the point.  It should not last more than 5 to 7 minutes and should only take as long as necessary to report the required information and determine follow-up action.

How can you implement safety briefing in non-clinical support departments to further the culture of safety?

Comprehensive Unit-based Safety Briefings: Implement in Clinical Settings

Leeann Sammons

What are the barriers to doing this?

Designing and implementing comprehensive unit-based safety briefings is a huge undertaking that requires an organized plan, focus and leadership commitment.  Staff and leadership buy-in will be a challenge.  Practices and routines will have to change for leaders and staff.  New or different information will be collected, reported and followed-up on.  Leaders may not see the process as a priority.  They may actually believe that the status-quo is just fine and that it adequately supports the organization’s safety culture.

Why should we do this anyway?

Comprehensive unit-based safety briefings create increased safety awareness.  Front line staff has the opportunity to voice patient safety concerns, resolutions and successes.  Teamwork is enhanced, there is improved communication, and patient safety and the safety culture is taken to the next level.  Unit-based safety briefings allow for a scalable response to concerns.  Leaders and staff learn about potential patient safety issues before they occur and can respond quicker.  The patient obviously benefits from this.

How can we do this?

  1. Identify the leader. Typically, the manager or charge nurse leads the briefings.  She collects the information from the out-going shift, reports it to the on-coming shift and to her director.
  2. Collect specific information.  The “Safety Briefing Leader” uses a form to collect consistent information.  The information might include the unit census, admissions, discharges, planned procedures, employee and safety events in the last 24 hours, potential issues for the next 24 hours and identification of issues that need resolution.
  3. Meet at the beginning of each shift. The safety briefing is held at the beginning of each shift change.  The manager or charge nurse reports the specific information to the on-coming shift.  The on-coming staff then goes out for bed-side or individual report.
  4. Keep the briefings short.  The briefing must be concise, succinct and to the point.  It should not last more than 5 to 7 minutes and should only take as long as necessary to report the required information and determine follow-up action.

How can you implement safety briefings to support a culture of safety?

Document & Share Patient Safety Stories

Storytelling Part IV

Leeann Sammons

What are the barriers to doing this? 

Patients may be reluctant to share their experience.  They may have mixed feelings about revealing their identity and their story to large audiences. Some patients feel guilty even though they did nothing to cause the event.  Anger also prevents patients and their families from telling their story in a helpful way.  In the end, the patient or the family may change their mind and withdraw the consent.  As leaders,  we may have a hard time accepting their feelings or even believing what occurred.  We may be afraid of going public because it puts an even higher focus on the opportunities and the accountability we have to make change.

Why should we do this anyway?

Stories are powerful when told effectively.  Story telling truly puts the patient at the center and empowers them and their family.  It gives them a voice and a chance to be heard. Patients provide an insight and perspective that we may not notice.  Not only do we learn about what went wrong, we also learn about what went well.  This positive feedback allows us to recognize staff.  We become immune to the environment, the equipment, the disjointed processes, the fast pace and the “healthcare lingo”.   Documenting and publicizing stories, internally or externally, increases focus and accountability to make improvements that reduces the possibility of harm reaching future patients.

 How can we do this?

  1. In person.  The patient may want to share their story in person with various groups and teams throughout the organization.  You and the patient will have to work together to carefully plan how this approach will flow in order to get the outcome you are looking for.  It is wise to schedule practice sessions before taking the show on the road.
  2. In writing. The patient or family may be most comfortable sharing their story in a written format, such as a letter, a blog, a book, or a timeline.  You should consider offering writing assistance if your organization has an internal resource.
  3. On video. Filming offers a variety of options for the patient and for the organization. The event can be re-enacted with voice-overs and narration, the patient, family and staff can be interviewed, and a video can be used over and over in many different organization settings.
  4. On audio recording. This approach is much more focused and is most suited for the patient who wants to remain anonymous.

How do you document and share patient safety stories?

 

Resources:

http://www.ssireview.org/blog/entry/how_to_gather_stories

http://www.wales.nhs.uk/sitesplus/documents/865/Gathering%20Patient%20Stories%20Guideline.pdf

https://www.gpc.eoe.nhs.uk/page.php?page_id=306

http://www.archi.net.au/documents/resources/patient_stories/patientcarer.pdf

http://tipsbuscom.blogspot.com/2006/08/why-document-processes.html

http://www.bizmanualz.com/blog/policies-and-procedures-can-help-ourorganization.htmlhttp://www.bizmanualz.com/blog/why-do-you-need-to-write-procedures.html

Create Patient Story Guidelines to Support Patient Safety

Storytelling Part III

Leeann Sammons

 What are the barriers to doing this?

Documenting guidelines and processes is hard work and time consuming.  Even the very best leaders do not like taking time to write process steps.  Most leaders see no value in it and perceive it as busy work that does not produce results.  When processes are documented, leaders often don’t realize they exist or they are just ignored.  Some leaders like to “fly by the seat of their pants”; others will disregard the process and do what they want.  Outsourcing this task is an expensive option.  Many organizations use software or databases to produce documented processes and guidelines that appear perfect and fancy.  This fluff is not necessary and it is expensive.

Why should we do this anyway?

Documenting guidelines and processes creates consistency and serves as a reference for leaders.  Written guidelines provide the building blocks to capture meaningful patient safety stories.  Creating guidelines and documenting processes prevents “re-inventing the wheel” and creates efficiency.  When followed, the organization and the leader are legally protected and the patient’s right are preserved.

How can we do this? 

  1. Identify the process owner.  The patient safety/risk management department is responsible for managing events involving patient harm.  These leaders should create the guidelines.
  2. Identify potential patients and stories.  There are usually conversations with patients during the investigation process that leads to discussions about the patient sharing their story.  Others in the organization may recognize a story or be approached by a friend or neighbor with a story they want told.  All leaders should work with the patient safety/risk management leaders in these situations.
  3. Explain what will happen.   The patient needs to understand the entire process; how their story will be collected, who in the organization will hear it, how it will be shared, the changes that have been or will be made and the results that will be impacted.
  4. Give the patient time.  You should not pressure the patient into telling their story.  They need time to consider the information and ask questions.
  5. Provide informational material.  The patient may not be comfortable making a decision on the spot.  The patient safety leaders and community relations department can work together to create material to give to the patient explaining the process and what to expect should they decide to share their story.
  6. Obtain consent from the patient.  Once the patient decides to share their story, written consent must be obtained.  The consent should specifically state how the story will be used.
  7. Be patient and show respect.    Some patients may want to remain anonymous, while others won’t mind sharing their identity.  It is ideal when the patient’s face and name is connected to the events.  However, the patient’s wishes should be respected and adjustments made in your plan to accommodate their request.
  8. Arrange support.  The patient may have difficulty recounting their story and may become emotional.  The social services and pastoral care staff are excellent resources to tap into should emotional support or counseling be needed.   

 How do you use patient story collection guidelines?

Resources:

http://www.ssireview.org/blog/entry/how_to_gather_stories

http://www.wales.nhs.uk/sitesplus/documents/865/Gathering%20Patient%20Stories%20Guideline.pdf

https://www.gpc.eoe.nhs.uk/page.php?page_id=306

http://www.archi.net.au/documents/resources/patient_stories/patientcarer.pdf

http://tipsbuscom.blogspot.com/2006/08/why-document-processes.html

http://www.bizmanualz.com/blog/policies-and-procedures-can-help-ourorganization.htmlhttp://www.bizmanualz.com/blog/why-do-you-need-to-write-procedures.html

Create Compelling Stories to Increase Organization Learning Around Safety

Storytelling Part II

Leeann Sammons

Last week’s blog entry, Tell Stories to Increase Organization Learning Around Safety, began the storytelling series.

What are the barriers to doing this?

Storytelling is a skill.  Not all leaders have the ability to develop a compelling story.  Storytelling may not be the best strategy or suited for the situation.  Poorly organized, emotionless, lack luster stories set the leader up for failure regardless of their talent at telling stories.  Assuming, incorrectly, that sophisticated, educated audiences will understand the importance and purpose of the story and make the connection to organizational indicators is a serious misstep.  Using acronyms and fancy medical lingo make it difficult for audiences to follow the story. Presentation style storytelling is boring and often dreaded by the audience.  It may send a message that the storyteller is insecure or unprepared.  Finally, revealing too much information about the event opens the organization up to legal action, even when the disclosure is for the purpose of sharing knowledge and information across the organization to improve patient safety.

Why should we do this anyway?

Safety stories that focus on both system failures and achievements, define the culture and values of an organization. They are inspiring and spur change.  They also teach important lessons, demonstrate trust, commitment, transparency and the willingness to be vulnerable to others.  Stories that are thoughtfully developed and well-told attract attention; trigger critical thinking and empathy through the narrator’s emotions of pain, fear, sadness or relief. Leaders can use compelling stories as a springboard to promote discussion and sharing of innovative ideas and process improvements.  Leaders can also use this strategy to break down working in silos.

How can we create compelling stories?

  1. Consider various storytelling methods. One size does not fit all.  Leaders should consider their audience and select the method that best suits the story to be told.
  2. Carefully craft the story. Using a narrative style, the storyteller should briefly describe what led to the event, state the causes or breakdowns of the event, describe the emotions experienced by those involved and conclude with the behavioral and system changes that have been or will be made.
  3. Create the emotional hook. The story must be brought to life.  The audience should be able to create images and see places and faces in their mind.  Intentional pauses, changes in voice levels and looking audience members directly in the eyes are techniques the storyteller can use to create appropriate discomfort.
  4. Connect the Dots. Leaders need to make sure that the audience understands why this particular story was selected and how it relates to the organization’s safety indicators.
  5. Use lay terms. Non-clinical leaders and employees may not be familiar with medical terms and acronyms. When possible use words that anyone can understand.

How do you create compelling safety stories?

Resources:

http://www.ihi.org

http://ehstoday.com/training/news/finding-safety-through-story-0901

http://www.ismp.org/newsletters/acutecare/showarticle.asp?id=4

http://www.innovations.ahrq.gov/content.aspx?id=2800

http://www.forbes.com/sites/danschawbel/2012/08/13/how-to-use-storytelling-as-a-leadership-tool/

http://www.forbes.com/sites/stevedenning/2011/06/08/why-leadership-storytelling-is-important/

http://www.nursingcenter.com/lnc/journalarticle?Article_ID=445933

http://valuesdrivenleadership.blogspot.com/2012/08/story-telling-as-leadership-tool-part-2.html

http://www.zurb.com/article/1080/3-ways-to-build-a-compelling-story

http://www.tlnt.com/2012/07/16/once-upon-a-time-remember-when-we-could-tell-a-story-without-slides

Tell Stories to Increase Organization Learning Around Safety

Storytelling Part I

Leeann Sammons

What are the barriers to doing this?

Employees are reluctant to share their experiences when there is a focus on people rather than systems, a lack of trust among their peers, and fear of being blamed and punished.  Story-telling may not be appropriate for every situation.  This is especially true if information needs to be shared quickly and concisely.  Some leaders aren’t natural story tellers.  Others struggle to let go of the traditional ways of sharing information, such as presentations, lectures and classroom style teaching.  Not getting to the point of the story, not knowing and not taking cues from the audience, and faking emotion are common mistakes leaders make when telling stories.

Why should we do this anyway?

Story telling can be extremely powerful.  There is no better story than real stories about real patients in your facility.  These events can’t be denied and will create an emotional hook that draws the audience in, especially when the story teller shares what she could have done differently to protect the patient from harm.  Stories can influence, persuade, focus on issues and problems, motivate and inspire everyone to do better.  Patient safety is complex.  Stories help employees and leaders recognize this and identify system issues, process opportunities and risky behaviors before patient harm occurs.

How can we do this?

  1. Create a library of stories. Safety leaders have hundreds of events reported every month.  Every event has a story to be told and a lesson to be learned.  All you have to do is ask the safety leaders to help you find the right story for the audience and situation you are working with.
  2. Get permission. Leaders often fail to get permission from those involved causing shock, embarrassment, guilty or hurt feelings.  This can be avoided by talking one-on-one with each individual or their leader.  You should never use employee or patient names. Employees and patients can be referred to as “Nurse 1” and “Patient A”.
  3. Identify the storyteller. It is best to have the person(s) who experienced the event tell the story.  If they are uncomfortable in front of an audience, consider pairing them up with someone who has experience and can take the lead.
  4. Be genuine. The best storytellers don’t use a script.  They tell the story using their own words with emotion, passion, and enthusiasm. The audience can see through storytellers who are not genuine.
  5. Be clear about the message. Stories have three main parts:  a beginning, middle and an end.  The story should be told as it happened, specifically including what was learned and what the take home lesson is for the audience.
  6. Pay attention to your audience. Stories that go on and on, never getting to the point do not engage your audience. They will be distracted and bored.
  7. Practice makes perfect. It is always a good idea to conduct several practice sessions.  This gives the storyteller the opportunity to make sure the story flows, that important points are emphasized and that it isn’t too short or too long.

How do you use storytelling to increase organization learning around safety?

Resources:

http://www.providersedge.com/docs/km_articles/storytelling_in_organizations.pdf

http://blogs.hbr.org/cs/2011/03/using_stories_as_a_tool_of_per.html

http://www.mindtools.com/pages/article/BusinessStoryTelling.htm

Create a Learning Organization to Support a Safety Culture

Leeann Sammons

What are the barriers?

Limited or no financial commitment from leadership, flavor-of-the-month programming and education, lack of interest, organization complexity and size are barriers to sharing knowledge and creating a learning organization.  Leaders often do not buy-in because they are afraid of change and how it will affect them personally.  They often fail to ask themselves and others difficult and uncomfortable questions.  They may be afraid to challenge their colleagues because of perceived “rank” in the organization, for fear of not being loved, of losing their job or of being viewed as a trouble maker.  Most leaders like to be comfortable and therefore resist change, even when the change is clearly a better way of doing things.  When we do finally admit that a change is needed, we lean toward the path of least resistance and take shortcuts to minimize the pain.  This is very short-sighted and is only a temporary, short-term fix to the problem.

 Why should we do this anyway?

Leaders and frontline staff are not the only beneficiaries when their employer invests in professional development.  The organization also receives a return on their investment.  Creativity, innovation and entrepreneurial spirit are several benefits learning organizations enjoy.   Open communication and teamwork between departments, leaders and employees occurs.  Learning organizations are more competitive, which leads to improved problem solving and collaboration.  Leaders are empowered to makes changes within the organization to improve broken or flawed processes.  Change increases at a swifter pace, is made at a lower level and embraced much quicker making the organization more flexible, efficient and effective.  Leaders and employees are better equipped to adapt to situations, prevent harm from reaching patients, respond to critical safety issues, and connects resources and processes to meet patient needs. 

 How can we do this?

  1. Create a safe learning environment.  Leaders and employees need an environment where they can openly but respectfully express their opinions, ideas and discuss situations and provide support to one another. Organization events and situations are gifts.  Leaders must accept these gifts, learn from them and use them to spur process improvement and change.
  2. Provide education and training.  Leaders are only as good as their weakest link.  Leaders need to invest in their employees’ development.  Employees need to have time, the tools and resources to perfect their skills and further their knowledge.
  3. Tell stories. There is no better story than real stories about real patients in your facility.   These events can’t be denied and will create an emotional hook that draws the audience in, especially when the story teller shares what she could have done differently to protect the patient from harm.
  4. Create discomfort.  Improvement and growth will not materialize if leaders continue to do what they have always done.  We must challenge our thinking, our process and ask hard questions of ourselves and our colleagues to improve processes.  Our patients deserve it.
  5. Take risks.  An organization has a culture of learning when leaders break the cycle of. “this is the way we have always done it”. Leaders are leading when they take chances, make a few mistakes, and learn from them.  Leaders who do not step out of their comfort zone are not leading; they are managing.

How have you created a culture of learning to support patient safety?