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Patient Safety Leadership Walkarounds: How Organizations are Enhancing Patient Safety Culture

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Patient Safety Leadership Walkarounds: How Organizations ... Brigham & Women's Hospital 2002. Adaptation of Executive Walkrounds. The Process/The Timelines ... – PowerPoint PPT presentation

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Title: Patient Safety Leadership Walkarounds: How Organizations are Enhancing Patient Safety Culture


1
Patient Safety Leadership Walkarounds How
Organizations are Enhancing Patient Safety Culture
  • QHN 2008 Open House Series
  • Tuesday May 28th, 2008

2
A Frame of Reference
  • Cathy ONeill, Patient Safety Specialist
  • Sunnybrook Health Sciences Centre

3
Building Safer Hospitals
  • Key Ingredients
  • Culture of Safety
  • Reliable design
  • Measurement
  • National Steering Committee on Patient Safety,
    Building a Safer System (RCPSC) 2002
  • Baker Norton. Healthcare Papers 20012(1)10-31

4
Origination of WalkArounds
  • Other highly reliable organizations and
    industries
  • Aviation
  • Nuclear power plants
  • Air traffic control systems
  • Adopted by health care
  • Numerous hospitals in USA
  • Now being adopted as best practice in Canada

5
Theory
  • A tool to connect senior leadership to patient
    safety and to inculcate safety ideas into the
    health care system.
  • (Dr. Allan Frankel, Partners Healthcare System)
  • Improve patient safety
  • Foster trust and communication
  • Proactive response to patient safety issues

6
What Do Walkarounds Accomplish?
  • Promote a Culture of Safety
  • Alignment
  • Commitment
  • Commiseration

7
Objectives
  • Increase awareness of patient safety issues by
    all clinicians and senior leaders
  • Make it apparent that patient safety is a high
    priority for senior leadership
  • Obtain and act on issues elicited from staff
    about patient safety concerns
  • Provide a forum for commiseration

8
Who, What, Where, When How?
  • Multiple iterations
  • need to find the right fit
  • Common goals
  • Build a culture of safety
  • Improve the safety of our patients

9
The Sunnybrook Journey Chapter 1
  • Guna Budrevics
  • Performance Improvement Specialist

10
Background
  • Brigham Womens Hospital 2002
  • Adaptation of Executive Walkrounds

11
The Process/The Timelines
12
Our Vision
  • Fast turnaround of the priority issues is
    essential to building the momentum for patient
    safety walkarounds

13
Indicators
  • Priority issues addressed
  • Turnaround times for priority issues
  • Identification of trends across the units
  • Feedback on the process by
  • the participants
  • the senior leaders

14
Our Experience
  • A good balance of representation from the patient
    care team is essential
  • Environmental issues invariably arise as part of
    the discussion

15
Our Experience
  • The importance of staying on the topic of patient
    safety
  • How does this affect the safety of your
    patients?
  • Discussion of other issues or organizational
    priorities minimizes the patient safety focus

16
Findings
  • Newer Infection Prevention and Control standards
    affect teams ability to deliver care processes.
  • SARS, MRSA, and other nosocomial infections have
    increased the time and complexity of safely
    caring for patients

17
Findings
  • Multi-campus organizations struggle between
    standardizing policies and procedures yet
    encouraging the spread of innovative best
    practices

18
Findings
  • Organizations must balance the need for patients
    autonomy (patient focused care) and the safety of
    staff and others within an increasingly assertive
    and sometimes violent society

19
Findings
  • Aging facilities are not designed to deliver safe
    and optimal care
  • Need for ergonomic solutions
  • Integrating human factors fundamentals
  • Engineering solutions
  • Safe and secure storage of materials
  • Design of space and furniture

20
Findings
  • Difficulties in integrating all information
    systems, databases, and other sources of patient
    information
  • EPR
  • CPOE
  • Patient Care Systems
  • Results from external labs

21
Challenges
  • Senior leaders experience as patient safety
    advocates
  • Leading the conversations to focus on patient
    safety
  • Learning the language of patient safety
  • Tendency for teams to focus on environmental/struc
    tural issues

22
Challenges
  • Communication with the participants is
    inconsistent
  • Systemic processes defects are challenging to
    address and fixes are time consuming to spread
  • Gaps in knowledge in how to request support
    services

23
Chapter 2
  • A new database
  • Engaged rL Solutions to automate the data and
    communication processes
  • Bringing Board Members on-board
  • Creating funding for patient safety WA solutions
  • Walkarounds in interface locations MI,
    laboratories, ambulatory settings

24
Chapter 2
  • Patients and Families
  • Moving from asking staff
  • Do patients and families voice any safety
    concerns?
  • to
  • Asking patients/families
  • What are your concerns in terms of your own
    safety and the safety of your family?

25
Moving Forward
  • Priming Senior Leaders for their visits with
    summaries of local incidents
  • How will we share this work with the LHINs?

26
Thank You!
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