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 coordinator’s 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. Culture change takes a multi-pronged approach In some situations safety program reorganization needed Maintaining an internal focus and champion “Integrating” into current initiatives Strategies / Activities

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. Self’s 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 individual’s 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 “P’s” – 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