Perinatal Patient Safety

1. Perinatal Patient Safety An interdisciplinary approach to improve performance J. Chris Carey MDDirector, Obstetrics and Gynecology, Denver HealthProfessor, Obstetrics and Gynecology

2. **High reliability organizations are those that operate highly complex and hazardous technological systems essentially without mistakes over long periods of time.High reliability patient care units are built on a solid foundation of timely communication and collegial teamwork to maintain patient safety as a top priority.** “Managing the Unexpected: Assuring High Performance in an Age of Complexity” K. Sutcliff, MSN, PhDSan Francisco: Jossey-Bass; 2001

3. In these units………… • Concise, real-time and constant communication is valued • Teamwork and collegiality characterize the professional relationships • Hierarchy is minimized • Safety is the hallmark of the organizational culture • Their operations are viewed as potentially dangerous • Emergencies are rehearsed and the unexpected practiced

4. Partnering Relationships Are……………….. • Collaboration and teamwork that is an authentic partnership in which power on both sides is valued • Each recognizes and accepts spheres of activity and responsibility • Each mutually safeguards the interests of each other • Each recognizes a commonality of goals • Based more on respect and contribution than power and dependency

5. Partnership is evidenced by …… • Communicating with patient’s family and healthcare providers regarding patient care and all providers’ role in the provision of that care • Collaborating in creating a documented plan, focused on outcomes and communication with families and others • Partners with others to effect change and generate positive outcomes through knowledge of the patient or situation

6. Strategies to achieve a strong partnership ethic include: • Thinking expansively • Being flexible • Challenging assumptions • Abandon the comfort zone • Redefine boundaries • Realize the vision

7. Think Expansively, become a “Totalist” • Always learning and supporting the changes that benefit the patient • Thinks beyond the confines of own experiences or knowledge • Sees the whole picture • Sees how people and processes work together

8. Be Flexible • Adapt to change • When situations are not controllable, your reaction to it is • Work together to manage the surprises, ambiguity, conflict or disorientation that are part of every change

9. Challenge Assumptions • Never blindly trust assumptions • Build on knowledge and understanding • Mistakes, errors, wrong turns and confusion are often built on assumptions • Knowing your partners is essential • Believing assumptions to be true encourages a lose-lose situation that fosters resentment, confusion, delays and waste. • Stop Making Stuff Up – check it out!

10. Abandon the Niche • Step outside of your personal comfort zone • Understand your team • Cannot continue to do things in the old way • Be willing to trust others • Be willing to stretch and share our expertise • Be willing to work on projects that involve others in the organization • Be willing to take risks

11. Redefine Boundaries • Let go of traditional roles • Eliminate “turf protection” • Remove barriers to cross-functional interactions • Think big and out of the box • Focus on patient needs

12. Key Elements for success • Partnership • Equity • Outcomes • Benefits • Barriers • Accountability • Ownership

13. Why Effective Communication and Teamwork ? • The overwhelming majority of untoward events involve communication failure • Somebody knows there’s a problem but can’t get everyone in the same movie • The clinical environment has evolved beyond the limitations of individual human performance

14. MD –RN: DifferentCommunication Styles • Nurses are trained to be narrative and descriptive • Physicians are trained to be problem solvers - “what do you want me to do” – “ just give me the headlines” • Complicating factors: gender, national culture, the pecking order, prior relationship • Perceptions of teamwork depend on your point of view

15. Effective Communication Requires: • Structured communication – SBAR • Assertion/ Critical Language – key words, the ability to speak up and stop the show • Psychological safety – an environment of respect

16. Situational Briefing Model S-B-A-R • Situation • Background • Assessment • Recommendation

18. SBAR in OB • S – Impending uterine rupture • B – VBAC, dense epidural, persistent breakthrough pain, complete • A – I’m concerned, something’s wrong • R – I think she needs a C-S. I need you now

19. SBAR • Situation – the punch line 5-10 seconds • Background – the context, objective data, how did we get here • Assessment – what is the problem ? • Recommendation – what do we need to do ?

20. * Assertion • Model to guide andimprove assertion inthe interest of patient safety

21. The Difficult Conversation • Focus on the common goal – high quality, safe care • 3rd person – depersonalize the conversation – it’s not about you and me • Avoid judgment; who’s right, who’s wrong is a loser • What needs to happen for us to do the right thing here? “Difficult Conversations”: Stone, Patton, Heen; Viking (1999)

22. Sustaining SBAR Use • “Give it to me in SBAR” • Use prompts and ticklers • Checklists • Phone labels • Pocket cards • “Thanks for using SBAR” • Reward and recognize