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E1 Leading and creating safer health care environments: The CEO & patient safety walkabouts

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E1 Leading and creating safer health care environments: The CEO & patient safety walkabouts Gren Kershaw Chief Executive Conwy and Denbighshire Trust – PowerPoint PPT presentation

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Title: E1 Leading and creating safer health care environments: The CEO & patient safety walkabouts


1
E1 Leading and creating safer health care
environments The CEO patient safety
walkabouts
  • Gren Kershaw
  • Chief Executive Conwy and Denbighshire Trust
  • Gerry Marr
  • Chief Operating Officer NHS Tayside
  • Pat OConnor
  • Head of Safety Governance and Risk NHS Tayside

2
We are Here
3
Overview
  • Understand the role of Executives in Patient
    safety
  • Identifying strengths and create leaders for
    patient safety
  • Design a patient safety walkround program for
    your healthcare system to promote cultural change
  • Share examples of safety walkround processes and
    outcomes

4
Why the Health Foundation chose to work on
improving patient safety
To Improve health, and the quality of healthcare
for the people of the UK
  • There is an identified need for patient safety to
    improve
  • There is a strong evidence base for what works
  • A focus on patient safety involves clinicians,
    managers, and patients

5
The Health FoundationsSafer Patients
Initiative
  • UK Program
  • 4 Healthcare Systems involved in 1st wave
  • 1 In each UK Country, Scotland England, Ireland
    and Wales
  • Whole system change package
  • Team driven from the board to the front line
  • 20 new hospitals joined Dec 2006

6
What were the aims and goals?
  • Create a culture that demonstrates Patient Safety
    as our highest priority
  • Reduce adverse events by 50
  • Build local capacity and capability for
    improvement
  • Develop highly reliable processes of care
  • Transform the organisational approach to Patient
    Safety Quality Improvement

7
Work Streams
  • 5 key Areas of patient safety work
  • Medicines Management
  • Operating theatres
  • Intensive Care
  • General Ward
  • Leadership
  • Detailed plan for spread throughout the
  • organisation

8
How did we make things happen?
  • Implementing evidenced based practice
  • Learning from the experts
  • Using small tests of change (PDSA cycles)
  • Using data and measuring change
  • Managing clinical resistance
  • Demonstrating active leadership

9
As leaders it was essential to
  • Promote patient safety at every opportunity
  • Put Patient Safety first item on every agenda
  • Manage the safety initiative as a project making
    sure things get done!
  • Manage the spread of good practice
  • Introduce Safety Walkrounds

10
Leadership
  • Patient Safety as a Strategic Imperative
  • Clear Goals and Measurement
  • Reduce variability, waste and harm
  • Skill building

11
The Key Elements of Breakthrough Improvement
  • Will to do what it takes to change to a new
    system
  • Ideas on which to base the design of the new
    system
  • Execution of the ideas

12
Patient safety program
  • Provide a focus
  • Celebrate success
  • Accelerate Improvements
  • Small test of change to build confidence and
    competence in improvement techniques

13
Patient Safety Walkround
  • AIM
  • Highly structured process to bring lead
    executives and front line staff together to have
    patient safety conversation with a purpose to
    prevent, detect and mitigate patient harm.

14
What are WalkRounds?
  • A carefully planned discussion between Frontline
    Staff and
  • A hospital leader (or two)
  • A Patient Safety Manager/Director/Specialist
  • A scribe.
  • Other (Managers, Pharmacists, Students, patients
    )
  • lasting about one hour and regularly repeated
  • As frequently as weekly, but at a minimum
    monthly,
  • located wherever frontline staff do their work,
  • fully supported by back office quality analysis,
  • fully integrated into organisational committees,
  • requiring rigorous application to detail in every
    step.

15
History of Walkrounds
  • 1997
  • IHI Collaboratives - Hospital teams work on rapid
    cycle improvement Leadership support tool
  • 1999
  • WalkRounds concept is born in IHI Idealised
    Design meeting
  • Many hospitals in IHI Collaboratives begin to
    implement
  • 2000-3
  • Piloted in several US Hospitals
  • 2003
  • JCAHO Journal publishes first article on
    WalkRounds WalkRounds in controlled trial
  • 2004 Safer Patients Initiative

16
How can patient safety walkrounds help?
  • The Patient Safety Walkround process seeks to
  • Increase the awareness of safety issues by
    clinicians
  • Make safety a priority for senior executives
  • Educate staff about patient safety concepts such
    as non-punitive reporting and
  • Obtain and act on information elicited from staff
    about safety problems and issues
  • Close the gap between those who make or prevent
    error and those who make decisions to change the
    systems

17
What it is for ?
  • Safety quality, efficiency, effectiveness,
    timeliness, and equity
  • are equal parts of the conversation.
  • A comprehensive management tool designed to
  • Help Leaders lead better,
  • Ensure ever safer and more reliable systems,
  • Help align frontline and leadership perspectives

18
What its not about
  • Parading senior leadership around the hospital.
  • A relaxed conversation with frontline employees.
  • Specifically about employee or patient
    satisfaction.
  • Designed to solely address safety issues.
  • Risky conversations.
  • A soapbox for voicing opinions..
  • However, these may periodically be attributes of
    WalkRounds

19
Who will participate?
  • Senior Executives (President, Chief Nurse, Board
    Members,Chief Medical Officer, Clinical Chairs)
  • Patient. Safety, Quality, Risk Manager
  • Managers/Administrators/Physician leaders
  • Frontline Staff
  • Doctors,Nurses,Pharmacists
  • Students, unit administrators, cleaners, porters
  • Whoever is available and involved in clinical
    care

20
When and where?
  • Weekly
  • Varying times
  • Nighttime shifts
  • Everywhere
  • Patient care floors
  • Labs
  • Radiology
  • Pharmacy
  • Non-Clinical areas

21
The Process
  • Schedule one year in advance.
  • Base dates and times on staff availability and
    executive availability. Take into consideration
    shifts, lulls in activity and doctor/ team
    rounds.
  • Schedule WalkRounds weekly.
  • Frequency of WalkRounds will vary based on the
    size of the organisation, but one round per week
    is a good rule of thumb.
  • Rounds should occur at any site where employees
    and clinicians are involved in patient care but
    you may include non-clinicial services.

22
Detailed Process
  • Develop an introduction
  • Highlight
  • Confidentiality
  • What happens with the information
  • Develop closing remarks Thank all for
    participating
  • Summarise key issues
  • Ask that all staff talk to their colleagues about
    the WalkRounds
  • Remind all staff that this is not the only forum
    for discussing safety issues offer contact
    information

23
Example Questions
  • How will the next patient be harmed in your area?
  • How does the environment fail you?
  • How was the last patient harmed in this area
    what happened ?
  • What prevents you from keeping your patients
    safe?
  • What can senior leaders do to help?

24
Picture
25
Getting Started
  • Developing an outline
  • Get buy-in from senior executives align
    expectations
  • Time commitment
  • Expected level of participation on rounds
  • Level of responsibility with follow up
  • Resources required
  • Be clear about the process
  • Peer review protected
  • Time commitment
  • Expectations for those who participate
  • Promote the value of WalkRounds to nursing and
    medical staff
  • Reassure middle management that WalkRounds will
    support them, and will not be an avenue to bypass
    them.

26
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27
Getting Started
  • Planning
  • Discuss optimum time for rounds with nurse
    managers and executives
  • Avoid shift change
  • Offer off-shift visits
  • Develop a hospital map to keep track of visits
  • Create a 3-6 month schedule and distribute
  • Develop questions to ask
  • Prepare senior executives

28
Collect and Analyse Data
  • Track all individuals who participate date,
    time, and location, comments heard.
  • Classify each hazard/event by its contributing
    factors.
  • Record frequency of each hazard/event
  • Record severity of potential or actual impact on
    patients and prioritise.
  • Priority informs actions for senior leadership

29
Assign Action Items
  • Produce reports WalkRounds comments, and
    distribute the reports to senior executives,
    patient safety committees, and the Hospital
    Board.
  • Determine action
  • On a monthly basis review monthly reports of both
    open and closed action items.

30
Give Feedback to Board, Leadership, Management,
and Staff
  • Develop a plan for feeding information back to
    rounds participants, senior leaders, committees,
    and the Board within your organisation.
  • Share good practice in addition to the issues
    that are identified and addressed newsletters,
    roadshows,presentations
  • Be rigorous!

31
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32
Example of WalkRounds Report to Executives
  • Update
  • Challenges with the process cancelations/attendee
    s
  • List of prioritised concerns raised during
    patient safety WalkRound for senior management
    attention
  • Whole systems concerns
  • Unit concerns
  • Environmental concerns
  • Individual service issues

33
Outline Feedback to Frontline
  • Point of contact
  • Thank you
  • Date
  • Participant role or identification.
  • Recognition that this process is helping the
    whole organisation to improve
  • Key priorities discussed /Actions agreed
  • E.g.
  • Large number of new on staff .
  • Difficult to get enough experienced RNs on nights
    and weekends.
  • Not enough equipment
  • Any further information contact

34
Picture
35
Measure Your Progress
  • Refer to actions taken as the result of
    WalkRounds during later visits to each unit.
  • Measure safety climate changes periodically,
    using the Safety Attitudes Questionnaire.
  • Continually track follow-up comments, time to
    complete action items, frequency scores, and
    other indicators recorded in the WalkRounds
    database.

36
Key Learnings
  • Surprisingly, it is not difficult to elicit
    comments from staff
  • Important to have multi-disciplinary
    representation
  • Important for leadership participants to be
    well-versed in on-going quality/safety
    initiatives
  • Can provide feedback at time of WalkRound

37
Key Learnings
  • Managing the large amount of information is the
    challenge
  • Prioritisation
  • Levels of action
  • Reporting and sharing
  • In a large institution, coordinated quality and
    safety groups are essential
  • To assign accountability
  • To receive updates on follow-up

38
Examples of success
  • Lead Nurse spending too much time on
    Administration
  • Actions
  • Local review of unit activity
  • Introduced new hospital processes for bed
    management system
  • Whole hospital review
  • National review of Senior Charge Nurse Role

39
Example
40
Summary
  • Make a plan
  • Tell staff what its for
  • Listen to the discussion
  • Agree key priorities
  • Assign action and
  • Follow up
  • Revisit and make sure its happened
  • Leadership engagement

41
Further Information
  • pat.oconnor_at_nhs.net
  • NHS Tayside
  • Kingscross
  • Clepington Road
  • Dundee
  • Scotland ,UK
  • DD3 8EA

42
Refs and other helpful resources
  • Frankel A, Graydon-Baker E, Neppl C, Simmonds T,
    Gustafson
  • M, Gandhi
  • TKPatient Safety Leadership Walk Rounds. Jt
    Comm J Qual
  • Saf 2003, 2916-26.
  • Thomas E.J The effect of executive walk rounds on
    nurse
  • safety climate attitudes A randomized trial of
    clinical
  • units.BMC Health Services
  • Research 2005, 528 doi10.1186/1472-6963-5-28
  • www.ecri.org/Patient_Information/Patient_Safety
  • www.aha.org
  • www.ihi.org
  • www.npsf.org
  • www.ahcpr.gov

43
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