Using Occupational Safety models to Enhance Patient Safety in a Hospital System

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Using Occupational Safety models to Enhance
Patient Safety in a Hospital System

• Why Occupational Safety?
• OSHAs Voluntary Protection Program
• Progress in the Five Elements
• JCAHOs Patient Safety Standard
• Set backs, Lessons Learned, Conclusions

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Preventable Medical Error Deaths (estimated for
1997 hospital volume)
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Injury due to Medical Care (percent of
discharges) (Brennan, TA 00)
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IOM Report (99) - To Err is Human

• A comprehensive approach to improving patient
  safety is needed. This approach cannot focus on
  a single solution since there is no magic bullet
  that will solve this problem. . . Large complex
  problems require thoughtful multifaceted
  approaches

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IOM Report (99) - To Err is Human

• Occupational Safety and Health
• Between 1970 and 1996, the work place death rate
  was cut in half. Health care has much to learn
  from other industries about improving safety.

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Unintentional Death Rate, 1933-1995 (per 100,000
workers)
Creation of OSHA
years
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OSHAs Voluntary Protection Program

• Management Leadership
• Employee Participation
• Worksite Analysis
• Hazard Prevention and Control
• Safety and Health Training
• Comprehensive Safety Plan

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Current Status - Does VPP work?Department of
Labor Statistics as of 7/31/2000

• 513 Sites - 239 Companies - 176 Industry Types
• 306,622 Workers - 56,011 Contractors
• 52 below expected lost workdays
• 3,982 Injuries avoided in 98
• 107,514,000 in Savings
• (Workmans Compensation Costs).

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Lost Workday RatesMobil's Joliet Refinery
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Star Awarded
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1987
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1993
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Shore Health System Inc.Exceptional Care Every
Day

• 2 Hospitals (95 159/33 Beds)
• Shore Home Care
• Shore Nursing Rehabilitation
• Shore Clinical - Physician Networks
• Shore Behavioral Health Services
• Shore health Laboratories

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Shore Healths Safety Program

• Based loosely on OSHAs VPP
• Integrates Occupational Patient Safety
• Builds on Hazard Communication
• Seeks to develop a Safety Culture
• Worker / Grass Roots Based

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Shore Health Systems Management
LeadershipMaking a safe system safer

• Chief Operating officer - Champion
• VP for Medical Affairs - Supportive
• Director level - Implementers
• Trainings Safety Committee
• Executive walkarounds
• Safety thank you notes from COO

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Shore Health Systems Employee Participation

• 53 Safety liaisons identified
• 1 Day train the trainer for liaisons
• Employee safety suggestion system
• Employees conduct FMEAs

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Shore Health Systems Worksite Analysis

• Monthly safety walkarounds
• Biweekly executive walkarounds
• Safety Suggestion System
• Failure Modes Effect Analysis (FMEA)
• Safety Committee review

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Shore Health Systems Hazard Prevention and
Control

• Medication Safety Data Sheets
• Medical Device Safety Cards
• Safety Suggestion Tracking System

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Shore Health SystemsSafety and Health Training

• Intro - COO VP for Medical Affairs
• Medical error - is it real?
• Systems thinking - lessons learned from occ.
  safety and aviation
• Hazard identification methodologies
• Reporting near misses/sentinel events/root cause
  analysis

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Shore Health SystemsSafety and Health Training

• Medication safety
• Communication exercises
• Patient education empowerment
• Infection control
• FMEA exercise - getting to work
• Dealing with difficult patients

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Safety Culture An ethic that pervades an
organizations workforce in which everyone
assumes responsibility for every aspect of safety
in their work environment and beyond.
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Safety Culture - Making a Safe System Safer

• Blame Free - Systems Approach
• Suggestions are acted upon
• Ownership of safety is Ubiquitous
• You found (know) it, you own it!
• The Thank-you-Attitude
• Safe Behavior is Reinforced

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Shore Healths Comprehensive Safety Plan

• A work in progress, components
• Environment of care
• Emergency response plan
• Bloodborne pathogens plan
• Hazard communication plan
• JCAHOs Patient Safety Standards

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JCAHOs Patient Safety StandardsJuly 1, 2001to
improve patient safety and reduce risk

• Leadership - ensure integrated program
• Improving Performance - FMEA
• Management of Information - track closure
• Education - Patients Responsibilities
• Management of Human Resources
• Patients Rights - disclosure/recovery

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Failed Attempts / Challenges

• Patient Education Letter
• Employee safety suggestion incentive program
• CEO / MD Staff buy-in, continued support
• Personnel changes / FTE reassignment
• Maintaining momentum

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Medical Errors
Medical Errors May not be the problem the IOM
purports them to be. However - they still merit
our attention!!
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Medical Errors

• A comprehensive approach to improving patient
  safety is needed.
• Its the systems - not the people
• OSHAs VPP - A comprehensive approach
• Develop a safety culture
• Employee Suggestions and Positive Reinforcement
  Systems are key!

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Measurement?

• Dirty word 3 you cant manage it if you cant
  measure it. Don Berwick, CEO IHI
• It feels right
• Measurement to come
• Employee suggestions / reporting to be tracked -
  anecdotally on the upswing

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We envision a system of care in which those who
give care can boast about their work, and those
who receive care can feel total trust and
confidence in the care they are receiving.

• Don Berwick MD, CEO, IHI