Quality and Safety Initiatives at Naval Hospital Jacksonville

1. Quality and Safety Initiatives at Naval Hospital Jacksonville Caring Community Conference University of North Florida 16 SEPT 2009 CAPT Bruce Gillingham, MC, USN Commanding Officer

2. Naval Hospital Jacksonville Stellar Care For Our Military Community

3. General Statistics 4,281 Admissions 539,919 Outpatient Visits 34,072 ED Visits (32% pediatric) 3,879 Ambulatory Procedures 929 Deliveries 1,310,886 Prescriptions 1,048,045 Lab tests 158,902 Radiological studies Annual Workload (FY08)

4. Recent Patient Safety Initiatives • Quality Council • Disclosure/Mediation Program • Electronic Quality of Care Reports • Interactive Customer Evaluation Kiosks • Outpatient EMR on Wireless Tablets • Rapid Response Team • TeamSTEPPS ™

5. Planned Patient Safety Initiatives • National Surgical Quality Improvement Project • Inpatient Electronic Medical Record/CPOE • Patient Advisory Council • Participation in Institute for Healthcare Improvement “Passport” Program • Leadership “Walk Rounds” using Appreciative Inquiry

6. Our Goal • To become a High Reliability Organization (HRO) • HROs share these characteristics : • Preoccupation with failure and its causes • Reluctance to simplify interpretations • Sensitivity to operations • Commitment to resilience • Deference to expertise Weick and Sutcliffe, 2001: Managing the Unexpected

7. Our Patient Safety Philosophy • Three Tier Approach • I: Identification of systemic faults • II: Anticipation of error and creation of multiple buffers • III: Assumption of fallibility and adoption of a “prove it” mindset John J. Nance, JD 2008: Why Hospitals Should Fly

8. Our Patient Safety Philosophy • Commitment to face the “brutal facts” when care is less than optimal • Strong response to weak signals to identify problems and trends early • Emphasis on rapid feedback • Anticipation of predictable surprises • Focus on effective teamwork

9. TeamSTEPPS™ “Communication failures and lack of teamwork are major contributing factors to patient injury and harm.” Carolyn Clancy, MD Director, Agency for Healthcare Research and Quality Department of Health and Human Services

10. Hospital Teamwork • TeamSTEPPS Initiative • “Team Strategies and Tools to Enhance Performance and Patient Safety” • Collaboration between DoD Patient Safety Program and AHRQ • Evidence based system founded on teamwork and communication principles identified in HROs and aviation crew resource management (CRM)

11. TeamSTEPPS Naval Hospital, Jacksonville Integrated into OR, L&D and ED daily operations All new staff taught fundamental concepts Encourages: Shared mental model Coordination Collaboration Active rather than passive participation of staff Real time feedback Twice daily huddle on Labor and Delivery

12. Appreciative Inquiry • A change in emphasis from problem solving to capacity building by identifying and doing more of the “right thing” • Focus on successes not weaknesses Sue Hammond: The Thin Book of Appreciative Inquiry, 1998.

13. Appreciative Inquiry • “SOAR” not “SWOT” • Strengths  What are we doing well? • Opportunities  How can we do more of it? • Aspirations  What does perfect look like? • Results  How we know we’ve gotten there • Best practices and “ideal world” suggestions identified on leadership walk rounds and are shared throughout the enterprise

14. Community Opportunity http://navalhospitaljax.med.navy.mil/conference