Patient Safety Leadership Walkarounds A View from Hamilton Health Sciences

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Patient Safety Leadership WalkaroundsA View from
Hamilton Health Sciences

• Rosanne Zimmerman, Manager Patient Safety
  Clinical Resource Management
• Lori MacCullouch, Clinical Manager Nursing
  Resource Team

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The patient safety movement is striving to
develop a culture of safety whereby each
individual, whether on the receiving or delivery
end of care, is preoccupied with safety, is armed
with the skills to evaluate his or her
environment for potential harm, and is supported
and rewarded for making appropriate changes.

-Frankel et al. 2003
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Hamilton Health Sciences

• Four Sites, Five Hospitals
• Tertiary, Acute, Rehab
• 1000 acute care beds
• Almost 11,000 staff

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What do we do differently?

• Everywhere, Every Month
• All Clinical, Clinical Support and Non Clinical
  Areas
• Central Shared Access Schedule
• Scripting Script Dictionary
• 4 questions
• Organizational, General, Specific, Engagement

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What do we do differently?

• Local Accountability for follow-up
• Integration of Patient Safety Champions into
  process - Staff identify the areas to improve
• Reporting Cascade
• Feedback Loops

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Results

• 984 PSLWA completed in first year alone (March
  2006-March 2007)
• 1351 Patient Safety Issues were identified-
  64-80 of them are resolved or had active
  improvement work in progress
• Evaluation-
• 93 PSLWA enhanced awareness of patient safety
  issues and felt comfortable openly/honestly
  discussing PS issues
• 70 felt always heard

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"Motivation is everything. You can do the work of
two people, but you can't be two people. Instead,
you have to inspire the next guy down the line
and get him to inspire his people. "
-Lee Iacocca
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Lessons Learned Strategic Level

• Dont get lost in process- it is about the
  conversation
• Senior Leader Support is a MUST
• Evaluation of process is key
• Listening and responding at process level and the
  local level

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Lessons Learned- Reporting

• Reporting structures need to be considered very
  carefully (Governance, databases, feedback loops)
• Risk Matrix
• Vincent themes were difficult for users

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Lessons Learned at Operational Level

• Dont be afraid..
• At the beginning, you are concerned about what
  you might hear.
• You worry that you might not have the answers
  that staff are looking for.
• We are all in this together
• Patient safety is everyones business as a
  leader, you are not responsible for solving every
  problem on your own. Once you believe this, the
  anxiety about what you may hear starts to
  dissipate.
• You become more skilled at collaborating with
  staff to generate solutions.
• With experience, you become more comfortable
  acknowledging when you need to go to the next
  level.

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Lessons Learned at Operational Level

• Psychological safety
• Leaders model and set the tone for psychological
  safety you want people to feel safe to speak up
  and express concerns and ideas for improvement
• We always begin by thanking staff for taking the
  time to participate and go around the table to
  introduce ourselves
• Timing is Everything
• Our PSLWA occur between 1430-1530 knowing that
  the morning rush and lunch is over. It is easier
  to find coverage for the patients so staff can
  participate.

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Lessons Learned at Operational Level

• Feedback is vital
• We share what we have learned so far and what has
  been done to improve patient safety within our
  teams and the organization
• Recognition
• A follow-up email thanking staff for
  participating goes a long way
• Celebrate the teams contributions to improving
  Patient Safety a few times a year tea,
  newsletters, posters

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They make me feel that we are a team meaning
all of us can make a difference regarding how we
work together to improve all aspects of care.
When you feel you are making a difference daily
workload no longer feels like workload but a
service done and I feel good about how the day
goes HHS Staff Member (PSLWA Evaluation)
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