The Safety Dance

2. The Safety Dance Curriculum Development in a Pediatrics Residency Jeri Kessenich, MD September 20, 2011

3. Objectives • Learn how to engage busy residents in safety culture transformation • Gain new information on incorporating longitudinal, hands-on safety experiences into a residency curriculum • Learn how to add root cause analysis and error assignment to Morbidity and Mortality conferences

4. What we’re up against with resident education!

5. Engaging Residents! The process at HDVCH • Start early! We use a safety quiz and overview of safety behaviors during orientation • Just do it—start all morning reports, conferences, etc, with a safety moment, story, good catch, concern, review of a safety behavior. • Reinforce the non-punitive nature of open discussion around errors and the need for systems fixes (eliminate finger pointing, as residents are very nervous about this)

6. Engaging Residents • Use simulation to advance knowledge (just in time, communication skills, specific skills labs, handoffs) • Add a safety focus to M and M conferences • Assign residents to committees with a safety focus—they’ll come and they’ll have good ideas

7. Engaging Residents • Teach them to use incident reports. They will start to identify and discuss all the little things that have bugged them forever! • Solicit resident feedback on a daily basis and use it at a daily check in. Our residents now find us to pass along info for this! • Minimize “lectures”” on safety, unless they are case-based, interactive discussions

8. Engaging Residents • Most importantly, create longitudinal safety experiences in established rotations (so they learn it and believe it): • PGY-1: Advocacy Rotation • PGY-2: Advanced Skills Rotation • PGY-3 : Safety, Quality Improvement and Leadership Rotation

9. The Advocacy Rotation • PGY-1 year • 5 days spent in an underserved urban school giving educational presentations • 5 days spent with the child abuse and neglect team at HDVCH • The rest of the rotation is focused on an introduction to safety terminology, behaviors and processes

10. The Safety Experience in the Advocacy Rotation • Learn and use the lingo and behaviors (STAR, SBAR, ARCC, brief-execute-debrief, etc) • Read seminal literature on safety • Perform a safety huddle • Become familiar with infection prevention activities, early warning systems & high reliability unit activities • Analyze incident reports; participate in evaluating a precursor event or serious safety event (as applicable) • Direct safety behavior incorporation to fellow residents • IMMERSION IS KEY!

11. The Advanced Skills Rotation • PGY-2 Year • Focus is on gaining experience and expertise in procedures, sedation, and clinical experiences not easily obtained elsewhere in the rotation • The resident is responsible for scheduling the procedures and experiences s/he is interested in • All procedures must be logged and verified by a supervisor

12. Making Procedures Safer Making procedures safer

13. The Safety Experience in the Advanced Skills Rotation • Learn the details of procedures themselves (indications, contraindications, steps, etc) • Use brief-execute-debrief, checklist, time out around a procedure • Use simulation to communicate a complication of a procedure to a patient/family • Act as the “safety coach” for the monthly inpatient mock codes • Attend sedation and/or periop department morning huddles and safety meetings • Write a brief action plan for an adverse event that involved a procedure (real or simulated) • Pretest, readings and post-test

14. Safety, Quality and Leadership Rotation • PGY-3 year • Stand alone rotation (vs having the experience folded into another rotation) • Program requirement—residents can also do a second month as an elective, if desired • Run a just in time simulation • Present a cause analysis-based M & M • Teach safety training • Attend a PICU Brief-Execute-Debrief • Complete a QI project • Help develop an action plan after an RCA (as applicable)

15. Retooling the M & M Conference • The case is presented in a standard format, so the audience has a basic understanding of the background details • The Quality and Safety staff work with the residents ahead of time to help determine if standard of care was violated, if precursor or SSE, etc, and determine needed action plan/corrective actions

16. Using Simulation to Advance the Safety Curriculum • Interdisciplinary • Use a realistic clinical scenario (anaphylaxis, respiratory decompensation, etc) • Debriefing session is key • Dr. Jurecko will discuss this in detail!

17. “I would give all my fame for a pint of ale and safety” “I would give all my fame for a pint of ale and safety” William Shakespeare

18. Didactic Curriculum vs. Teaching “On the Go” Which is more effective? Lana Gagin, MD, MPH September 20, 2011

19. Workshop objectives • Identify effective methods for incorporating patient safety and quality improvement into resident education • Identify tools for engaging residents in patient safety and quality improvement activities

20. Benefits of didactic curriculum • Gives systematic knowledge • Helps with the attitude change • Serves as a guide to navigate effectively through the complex system

21. Benefits of teaching “on the go” • Patient Safety and Quality improvement is learned most effectively in the context of real life situations • Engages learners • Avoids overcrowding of the existing curriculum

22. Didactic curriculum vs. teaching “on the go”

23. The best of both worlds • Structured didactic curriculum combined with the reallife longitudinal experiences provides the best Patient Safety and Quality Improvement education.

24. Patient Safety and Quality Improvement education structure • 5 didactic lectures through out the academic year • Patient safety initiatives imbedded in daily patient care • Incorporating patient safety in Advocacy/Advanced Skills rotations, case presentations, M and M conferences • Personal Improvement and QI projects • Patient Safety/ Quality improvement elective rotation

25. Patient Safety and Quality Elective • A 1-month-long rigorous immersion in patient safety and quality improvement activities at Spectrum Health • Residents will be active participants of various QI initiatives • Residents are expected to complete a QI project • Each resident will have a dedicated mentor • Flexible curriculum tailored to the individual interests/career aspirations • Reading materials and didactics to improve systematicknowledge

26. Final words • “Residents who are taught quality improvement… will see the power and the necessity of interdisciplinary collaboration and will be a significant force for change in our nation’s academic health centers” • Lee Ann Riesenberg, PhD

27. Questions? • Thank you!