Yearly Archives: 2012

Document & Share Patient Safety StoriesPosted on December 30, 2012

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 SafetyPosted on December 23, 2012

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 SafetyPosted on December 16, 2012

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 SafetyPosted on December 16, 2012

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 CulturePosted on December 2, 2012

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?


Create a Flexible Environment to Support SafetyPosted on November 25, 2012

Leeann Sammons 

What are the barriers to doing this?

There is an assumption that high reliability organizations must have standardization to minimize the risk of system failure.  Hardwiring processes reduces uncertainty, complexity and variability.   The need to create, respond and quickly adapt to change may not be an organizational priority.   Leaders and employees may be hesitant to go outside established boundaries or rules to alter processes and protocols.  Leaders may feel powerless or not know how quickly “turn on a dime” and deviate from expected processes.  Finally, changing behaviors, practices and processes is uncomfortable and humans naturally resist change.

Why should we do this anyway?

Flexibility is a competitive advantage, a recruitment and retention strategy and a critical link to employee satisfaction and work/life balance.   A flexible organization gives leaders and employees the ability to quickly and effectively adapt to various demand and challenges.    Pursuing and creating a flexible culture encourages and supports non-hierarchical decision-making.  Leaders and employees are empowered to use their knowledge, make continuous adjustments and move those with the needed skill set into the situation at-hand to reduce risk and prevent errors.

How can we do this?

  1. Field the best team.  Building and assembling a team with varying tenure, experiences, skills, the willingness to speak up, defer to others and with the shared goal of patient-centered perfection is hard work and never ends. Leaders should never ever give up on creating the best team and trading up when necessary.
  2. Support non-hierarchical decision-making.  Every level of leadership has the opportunity to defer to those who have the most expertise for a given subject or situation.  Leaders can support non-hierachical decision-making by deferring to these employees who are actually performing the work and closest to the patients.
  3. Implement flexible systems.  The Hospital Incident Command System (HICS) is an incident command system used for emergency and non-emergent situation that also provides flexibility within structure.
  4. Hire for flexibility.  Selecting the right person for the right position is critical to the new employee’s success and yours.  Recruiters and leaders should effectively present the organization’s safety culture and how it translates to everyday work. 

 How have you created a flexible environment to support safety?


Provide Information to Support a Culture of SafetyPosted on November 18, 2012

Leeann Sammons

What are the barriers to doing this?

Senior leaders may not view safety as an organizational priority.  If this is the case, it will be an uphill battle creating and deploying processes to collect safety events and concerns.  Without a reporting process, trending data is not an option.  Leaders are left in the dark with information or direction on how to improve patient safety in their area of responsibility.   Even if safety is a priority, the organization may not timely and freely share information with leaders and employees.  There may not be a structure in place to support organization-wide communication of safety data and events.  Employees may be disinterested or in denial that the information even applies to them.

Why should we do this anyway?

Informed and knowledgable employees provide the foundation of a just culture.  In order to deliver safe, and exceptional quality care, organizations must openly share information, good and bad, with leaders, employees and physicians.  Everyone, clinical and non-clinical staff, must be aware of the hazards and risks in their areas of operation that adversely impact safety systems and processes.  Leaders play a key role in providing employees with this information and for holding employees accountable for following procedures and protocols designed to prevent adverse events.

 How can we do this?

  1. Create a culture of reporting.  An informed culture depends and relies upon a culture of reporting.  
  2. Inspect what you expect.  Safety leaders and department leaders must conduct inspections, audits and behavioral observations to ensure that staff are completing key process steps. Safety leaders should collect, compile and analyze this information and provide positive feedback and coaching opportunities to staff and leaders.
  3. Create a communication plan.   Leaders must share indicator results, survey results, changes made as a result of reported events and concerns.  It is important to remember that critical information needs to be communicated repeated in a variety of ways. Email, personal letters, newsletters, unit/department educators, staff meetings, safety champions, one-on-one or small group meeting, video and SBARs are just a few of the communication methods leaders can use to share critical information.

 How have you created an informed workforce to support a culture of safety?


Conduct Focus Groups to Improve SafetyPosted on November 11, 2012

Leeann Sammons

What are the barriers to doing this?

Personalities and behaviors of focus group participants make the work of the facilitator easy or hard.  The dominating, negative person causes the other participants to become silent and uncomfortable.  Participants that are preoccupied and uninterested are distracting to those who are genuinely engaged.  The focus group conversation may lead to a debate of opinions, a problem solving session or worse, a gripe session with group therapy if led by an unprepared or unskilled facilitator.

Why should we do this anyway?

Focus groups give employees the opportunity to provide input, be involved with developing and planning systems, and identifying solutions to problems.  When employees are involved, they are more apt to support and commit to the end result.  Safety leaders need to know employees’ current safety concerns and how they would resolve them, their understanding of what must be reported, how employees’ would like to make reports and employees’ preferences for receiving feedback as to actions taken and changes made as a result of reports. 

How can we do this?

  1. Invite net positive employees.  Employees who are passionate about safety, are respected by their peers, have positive attitudes and are willing to speak the truth are ideal focus group participants. 
  2. Select a skilled facilitator.   The facilitator must be able to listen and think simultaneously, handle delicate or controversial comments appropriately and manage challenging group dynamics.
  3. Select a neutral facilitator.  Facilitators are in a position of perceived influence and must remain neutral.  They should not share their personal views,  agree, or disagree with the employees’ participating.  They must also be aware of the message non-verbal body language such as nodding, eyebrow raising and facial expressions might send.  
  4. Select a respectful facilitator.  Successful facilitators believe that all participants have something to offer no matter what their job, education level, experience, or background.  The facilitator should welcome the employees, introduce themself, explain the purpose of the focus group, describe how the process works and the expectations for those participating. 
  5. Ask open-ended questions. The facilitator should ask questions that generate discussion, ideas, opinions and spurs the employees to participate.  Clarifying questions such as “Can you talk about that more?” and “Can you give an example?”  are excellent ways to gather additional feedback.
  6. Summarize themes.  The facilitator demonstrates active listening and the desire to accurately capture the employees’ feedback when discussion, ambiguous statements and complex comments are summarized for the focus group.
  7. Conduct multiple focus groups.  Multiple focus groups across all shifts should be conducted to get robust feedback and to give as many employees as possible the opportunity to participate.
  8. Summarize the feedback and report next steps. Once the safety leaders receive the focus group summaries from the facilitators, a feedback report and next steps need to be communicated to the participants and all leaders.

 How have you used a focus group to improve safety?


Implement a Successful Incident Reporting SystemPosted on November 4, 2012

Leeann Sammons

What are the barriers to doing this?

The attitudes and perceptions of employees and physicians determine the success of the incident reporting system. Employees and physicians might be skeptical.  Some employees want confidential reporting.  Physicians want legal protection.  Systems that are complicated and difficult to access sabotage a reporting system.  Finally, leaderships’ failure to explain what should be reported and how reports lead to process improvement are significant barriers to succcessfully implementing an incident reporting system.

Why should we do this anyway?

Implementation of an incident reporting system helps safety leaders identify hazards, risks and process breakdowns in individual events. More importantly, it gives safety leaders the opportunity to move the organization from a reactive stance to proactively looking for process and system failures and improvement opportunities.  Leaders can perform a broader analysis of events to identify trends and common causes at the department and organization level.  This information can then be used to develop proactive action plans to create change and reduce the likelihood of reoccurrence of harm. 

How can we do this?

  1. Conduct focus groups.  The facilitator will ask employees key questions to find out their current understanding of what must be reported, how they would like to make reports and their preferences for receiving feedback as to actions taken and changes made as a result of their report.
  2. Assemble an implementation team.  Invite key leaders and frontline staff to be part of the group that decides  how best to launch the reporting system and related processes. This team must pay particular attention to and consider the focus group feedback.
  3. Create an implementation plan.  Implementing a reporting system is no small task.  The team must have a detailed plan with a task list to give implementation of the reporting system the best chance of successful.
  4. Make reporting easy.  Employees at every level are busy.  There are never enough hours in the day.  Reporting concerns, near misses and events must be quick, easy and allow any employee to choose to identify themselves or remain anonymous.
  5. Provide education and training.  Employees need to know what to report, how to report it,  what leaders do with the information reported and what feedback to expect after they have made the report.
  6. Communicate changes. Most employees want to know that the report they made was in fact received. Leaders need to personally follow-up with the employee reporting to thank them for making a report and let them know what action was taken to correct the problem.  

 How have you successfully implemented an incident reporting system?


Build a Reporting CulturePosted on October 28, 2012

Leeann Sammons

What are the barriers to doing this?

Employees are often afraid to report safety concerns and errors.  They are afraid they might lose their job, that co-workers will retaliate, ignore them or make fun of them leading to humiliation and embarrassment.  Some employees believe that their observations and concerns are not valued because they are not clinical or because of their job title and rank in the organization.  Physicians are reluctant to report because they do not want to implicate fellow physicians, they are embarrassed and because reporting may lead to lawsuits.  Complex reporting systems and processs, not enough time and communication are also barriers to building a culture of reporting.

Why should we do this anyway?

All employees are morally and ethically responsible for identifying, reporting and reducing the risk for events and errors to occur.  Reporting safety concerns before an error occurs gives leaders the opportunity to proactively take steps to prevent harm from reaching patients.  Some staff are legally required to report to their organizations, licensure boards or to state and federal authorities.  Without this valuable information, leaders cannot improve the systems and processes that healthcare workers depend on to deliver care to their patients.

How can we do this?

  1. Adopt a just culture.  Physicians and frontline staff are more likely to report concerns, near misses and events when it is safe to report.1  These reports are gifts.  In order to receive these gifts, it is critical to create an environment of trust so employees are comfortable reporting and discussing their concerns.
  2. Implement an incident reporting system. The reporting system must be easy to use, provide anonymity, allow any employee, regardless or job title, responsibility or rank, access to report.  The system must also allow for timely dissemination of event information and facilitate event review, development and monitoring of action plans.
  3. Recognize staff.  When leaders acknowledge, recognize and thank staff for reporting safety concerns and errors, staff are more likely to report future safety concerns and errors.
  4. Provide feedback.  Patient safety leaders must provide timely and meaningful feedback to department leaders and staff on concerns and errors that are reported.  The status of the event review, the review findings, action plans  and any changes made as a result of the concerns are important pieces of information that  can be shared.

How have you built a culture of reporting?


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