Walking the Talk at Toronto Rehab

2. Our goals�What might a transformed safety culture look like? Leadership meetings were held in June and September 2006 to identify and validate the focus areas for safety and to develop our plan of action. The Safety Steering Group developed a plan based on the feedback from these meetings Leadership meetings were held in June and September 2006 to identify and validate the focus areas for safety and to develop our plan of action. The Safety Steering Group developed a plan based on the feedback from these meetings

3. Six areas of focus for creating a strong Safety Culture

4. Leadership Role Develop clear communication lines for reporting safety issues and incidents Launch leadership walks to demonstrate senior commitment to safety, generate dialogue with staff, nurture openness and build trust Support front line leaders to model a safety culture (e.g. leadership resource toolkit; incident reports on RAD; �watch list�; escalate major safety issues and follow more minor improvements; local interim solutions in a timely manner)

5. Phase 1-Prep Work Leadership meetings were held in June and September 2006 to identify and validate the focus areas for safety and to develop our plan of action. The Safety Steering Group developed a plan based on the feedback from these meetings Leadership meetings were held in June and September 2006 to identify and validate the focus areas for safety and to develop our plan of action. The Safety Steering Group developed a plan based on the feedback from these meetings

6. Phase 1-Walk Process (During) Leadership meetings were held in June and September 2006 to identify and validate the focus areas for safety and to develop our plan of action. The Safety Steering Group developed a plan based on the feedback from these meetings Leadership meetings were held in June and September 2006 to identify and validate the focus areas for safety and to develop our plan of action. The Safety Steering Group developed a plan based on the feedback from these meetings

7. Phase 1 : A Closer Look CHALLENGES Moving beyond merely �venting� to the real patient safety issues; Critical self analysis of practice as well as support services; Involving support staff (non-clinical staff); Staff were waiting for a walk to raise concerns that resulted from processes either being poorly designed or poorly understood; Follow-up: Accountability (two-fold); Issue Repository; Feedback to staff. SUCCESSES Staff were openly communicating about their concerns; Identified many process barriers that were stalling improvement work; Identified some more major issues which required escalation and a corporate response (i.e. falls); Allowed senior leaders to engage with front-line staff in their environment; Allowed senior leaders to gain a better understanding of safety concerns.

8. Phase 2 Enhancements Developed escalation policy; Developed e-Alert process Developed Excel database (while exploring other possibilities); Developed a shared drive and safety leadership distribution list; Refined the Follow-up process; Provided Pre-Walk Summaries (of the resolution of issues from the 1st phase of walks); Scheduled walks in non-clinical areas (maintenance, nutrition, CPD), while reiterating importance of the inclusion of housekeeping staff in clinical walks; Revised manager guides (creation of non-clinical manager guide); Senior Leader's Tool to Promote Dialogue at Walks. Format: 20-25 minutes with 5 minute debrief to review the follow-up plan (included travel time); bi-annual (excluding December and summer months).

9. Phase 3 Enhancements More narrow focus on issues only regarding patient or staff safety; Revised escalation process and e-Alert process Move to database using Feedback Monitor Pro from rL Solutions; Increase the content on the shared drive; Better align and communicate the follow-up process with existing lines of accountability; Revise the scribe form to include a section outlining the issues and plan of unresolved concerns raised at past walks; Add pharmacy to the list of non-clinical areas; Support services to be visited annually; Secured time for walks in corporate calendar every April and October.

10. Take Home Messages Authentic support from the top-down is absolutely required (both for conducting the walks and consistently and insistently overseeing progress to resolution of issues and sustainability of improvements); Leadership walkabouts are one way by which senior leaders �walk the talk� (model the attitudinal shift required of other leaders and staff); Leadership walks do help uncover issues while showing a strong commitment to the values underlying culture (most notably, the concept of the learning organization).

11. Contact Me Katarina Stanisic 550 University Avenue 11th Floor, Suite 11036 416-597-3422, Extension 3815 Blackberry 416-457-7587 Pager 416-372-4992 Stanisic.Katarina@TorontoRehab.on.ca