Culture Change: The Patient as the Priority Rush Memorial Hospitals Patient Safety Journey Linda Noble, CPUR, CRM and Deborah Hummel, RN, CNA, BC

Culture Change:The Patient as the Priority

Rush Memorial Hospital’s Patient Safety Journey

Linda Noble, CPUR, CRM and Deborah Hummel, RN, CNA, BC

RMH - Committed to You, Close to Home

Rush Memorial Hospital

Critical Access Hospital status in August 2000

250 full-time, part-time and PRN team members

25-bed Medical/Surgical Department houses all acute care, swingbed, and observation patients


The Patient Safety Culture

SurveyProcess

And so it begins . . .


Hospital Survey on Patient Safety Culture – Agency for Healthcare Research and Quality (AHRQ)

Rush Memorial partnered with Health Care Excel to administer survey in April 2006

Participants evaluated statements on a 5-point Likert Scale

This was considered baseline survey and will resurvey the same population in 2008


110 employees directly involved in patient care processes were invited to participate in the survey process

81% response rate

No incentive was offered other than the opportunity to identify issues that affect the patients and their own work environment

Patient Care Departments ONLY


Who Participated?

Medical/Surgical Home Health Emergency Surgical Services Cardiology Services Oncology/Hematology Pharmacy

Rehabilitation Therapy

Respiratory Therapy Laboratory Imaging Primary Care

Physician Practices


Survey Results and Key Findings


Solid Foundation

Over 90% of the respondents strongly agreed with the statement

“Hospital management provides a work climate that

promotes patient safety”


Over 90% of the respondents strongly agreed with the statement

“When a lot of work needs to be done quickly, we work

together as a team to get the work done”


However . . .

87% agreed “staff will freely speak up if they see something that may negatively affect

patient care”

32% agreed “staff worry mistakes they make are kept in their employee files”

27% agreed “problems often occur in the exchange of information across hospital

departments”


Opportunities Identified

Non-punitive work environment Frequency of patient safety event reporting Hospital handoffs and transitions Encouraging employees to speak up Improving teamwork across the hospital

In other words...addressing the CULTURE!


“The Plan”


Crafting the Document

All patient care department managers attended planning sessions to develop a simple 2-page document to be used as a guideline

Managers were charged with the responsibility to discuss the plan and reinforce with teams

Administration supported the efforts of the team and allocated resources necessary to implement


Part 1

Continue to develop a work environment that is non-punitive in nature Survey results revealed employee concerns about

the extent in which our work environment is non-punitive

Corporate Compliance Officer Linda Noble and Human Resource Director Pam Rennekamp distributed a hospital-wide policy which includes the elements of a non-punitive work environment

Department Managers are coached to reinforce the non-punitive work environment elements in their departments in partnership with their employees


Part 2

Increase the frequency of patient safety event reporting to include both actual “misses” and “near misses” Survey results indicated “misses” and “near misses”

are occurring, but were not all reported within the established system

A review of the current event reporting system and associated documentation for possible improvements was completed – a Risk Variance Reporting Tool was created to capture “near misses”

All employees receive training and education regarding proper use of the event reporting system


Part 3

Improve hospital handoffs and transitions and associated communication

Patient care department managers participated in a 3-part seminar on handoff communication utilizing the SBAR system

Managers coached employees on appropriate handoff and transition communication expectations

A universal documentation form for the “top 3” invasive procedures performed in all clinical care areas was put in place (urinary catheterizations, peripheral IV initiation and blood collection/IV access via ports)


Part 4

Encourage employees to speak up and develop ways managers can encourage and support their employees when questions arise Survey results indicated department managers

support patient safety efforts and the work of their employees – however, some employees don’t necessarily feel comfortable questioning decisions made by those in authority

Department managers encourage employees to speak up and question during informal (day-to-day interactions) and formal (staff meetings) settings within their departments

Department Managers develop department-specific strategies in partnership with employees to address this issue


Part 5

Improve teamwork across departments The CQI Team which included managers of the

departments with our largest patient volumes was the “pilot group” for teamwork initiatives

The Human Resource Department has the responsibility for the creation and implementation of a hospital-wide teamwork program – R.U.S.H. – which stands for “Respect and Unity Start Here”


Meanwhile . . .


The Patient as the Priority

Key patient care managerswere challenged to put in writing

how their departmentdemonstrates their patients and

their patients’ safety are the#1 priority


Other Initiatives


Banding Together for Patient Safety

This patient safety program uses different colored bands worn by the patient to communicate a patient’s special needs to our multidisciplinary hospital team members

DNR (BLUE) - Patient has a documented DNR order while a patient of Medical/Surgical Department

Latex Allergy (PINK) - patient has a suspected or known latex allergy or sensitivity

Fall Risk (YELLOW) - patient has been identified as having high potential for falls

“Go” for Surgery (GREEN) - will be used in surgical services department only

Allergy (RED) - patient allergies will be written directly on the band Patient Identification (WHITE or CLEAR)

paper (outpatients) plastic (MS and surgery patients)


Medication Administration Error Reporting Survey1. In the last 6 months, have you witnessed an error in the administration of a medication, adult

immunization, contrast and other diagnostic substance to a patient in your department?_____ Yes _____ No

An error would include any of the following: the wrong medication, contrast, serum or substance was given the wrong dose was given the wrong route was used when given it was given to the wrong patient it was given at the wrong time the substance was “missed” and was not given the substance was given and there was no order for it to be given

2. If you answered “Yes” to question #1, please circle the choice that applies:The administration error(s) I have witnessed in my department within the last 6 months have been reported on Incident Reports ___ % of the time.

a. 90-100% b. 80-89% c. 70-79% d. 60-69% e. 50-59% f. < 50%3. In the last 6 months, have you witnessed any “near misses” in your department where an error

could have occurred, but action was taken before the error reached the patient?_____ Yes _____ No

4. If you answered “Yes” to question #3, please answer the following: Did you ever discuss how the “near miss” could be avoided in the future with your co-workers?

_____ Yes _____ NoDid you ever discuss how the “near miss” could be avoided in the future with your manager?

_____ Yes _____ NoHave changes been made in your department to help avoid similar “near misses” in the future?

_____ Yes _____ No5. The following is a potential/actual patient safety problem in my department and should be

addressed (use other side if necessary):


R.U.S.H. Initiative

A position was created in Human Resource Department to assume responsibilities for sustaining the initiative – also coordinates hospital volunteer efforts, AHA Programs and performs other HR duties

Begins with mandatory 1.5 hour introductory session for all employees

Employee Entrance being renovated to include R.U.S.H. elements


SBAR Communication

S – Situation B – Background A – Assessment R – Recommendation Q – Questions?

All patient care departments are included in the communication expectations – not just nursing departments


Patient Safety Committee

Membership now includes Patient Safety Officer (Chief Nursing Officer) Corporate Compliance Officer (Risk

Management) Health Information Director Admissions Manager Pharmacy Director Medical/Surgical Manager Chief Executive Officer


Leadership Development

Includes communication skills review of administrative policies incorporation of shared governance elements implementation of peer review processes in

the patient units


Additional Changes

Ancillary staff members speak directly to patient’s nurse – no messages

Staffing adjustments in the Medical/Surgical department

Goal development Developing consistency in all direct and

indirect patient care processes from person-to-person and shift-to-shift

New shift report system in both Respiratory Therapy and Medical/Surgical Departments

Monthly Patient Care Roundtable


Where do we go from here?


Questions?


We wish you success with your patient safety and culture initiatives

Thank you!

Documents

Culture Change: The Patient as the Priority Rush Memorial Hospitals Patient Safety Journey Linda Noble, CPUR, CRM and Deborah Hummel, RN, CNA, BC