Perinatal Patient Safety
An interdisciplinary approach to improve performance
J. Chris Carey MDDirector, Obstetrics and Gynecology, Denver Health
Professor, Obstetrics and Gynecology
**High reliability organizations are those that operate highly complex and hazardous
technological systems essentially without mistakes over long periods of time.
High reliability patient care units are built on a solid foundation of timely communication and collegial teamwork to maintain patient
safety as a top priority.** “Managing the Unexpected: Assuring High Performance in an Age of Complexity”
K. Sutcliff, MSN, PhDSan Francisco: Jossey-Bass; 2001
In these units…………• Concise, real-time and constant communication is
valued• Teamwork and collegiality characterize the
professional relationships• Hierarchy is minimized• Safety is the hallmark of the organizational culture• Their operations are viewed as potentially
dangerous• Emergencies are rehearsed and the unexpected
practiced
Partnering Relationships Are………………..
• Collaboration and teamwork that is an authentic partnership in which power on both sides is valued
• Each recognizes and accepts spheres of activity and responsibility
• Each mutually safeguards the interests of each other
• Each recognizes a commonality of goals• Based more on respect and contribution than
power and dependency
Partnership is evidenced by ……
• Communicating with patient’s family and healthcare providers regarding patient care and all providers’ role in the provision of that care
• Collaborating in creating a documented plan, focused on outcomes and communication with families and others
• Partners with others to effect change and generate positive outcomes through knowledge of the patient or situation
Strategies to achieve a strong partnership ethic include:
• Thinking expansively
• Being flexible
• Challenging assumptions
• Abandon the comfort zone
• Redefine boundaries
• Realize the vision
Think Expansively, become a “Totalist”
• Always learning and supporting the changes that benefit the patient
• Thinks beyond the confines of own experiences or knowledge
• Sees the whole picture
• Sees how people and processes work together
Be Flexible
• Adapt to change
• When situations are not controllable, your reaction to it is
• Work together to manage the surprises, ambiguity, conflict or disorientation that are part of every change
Challenge Assumptions
• Never blindly trust assumptions• Build on knowledge and understanding• Mistakes, errors, wrong turns and confusion are
often built on assumptions• Knowing your partners is essential• Believing assumptions to be true encourages a
lose-lose situation that fosters resentment, confusion, delays and waste.
• Stop Making Stuff Up – check it out!
Abandon the Niche
• Step outside of your personal comfort zone• Understand your team• Cannot continue to do things in the old way• Be willing to trust others• Be willing to stretch and share our expertise• Be willing to work on projects that involve others
in the organization• Be willing to take risks
Redefine Boundaries
• Let go of traditional roles
• Eliminate “turf protection”
• Remove barriers to cross-functional interactions
• Think big and out of the box
• Focus on patient needs
Key Elements for success
• Partnership• Equity• Outcomes• Benefits• Barriers• Accountability• Ownership
Why Effective Communication and Teamwork ?
• The overwhelming majority of untoward events involve communication failure
• Somebody knows there’s a problem but can’t get everyone in the same movie
• The clinical environment has evolved beyond the limitations of individual human performance
MD –RN: DifferentCommunication Styles
• Nurses are trained to be narrative and descriptive
• Physicians are trained to be problem solvers - “what do you want me to do” – “ just give me the headlines”
• Complicating factors: gender, national culture, the pecking order, prior relationship
• Perceptions of teamwork depend on your point of view
Effective Communication Requires:
* Structured communication – SBAR* Assertion/ Critical Language – key words,
the ability to speak up and stop the show* Psychological safety – an environment of
respect
SBAR in OB
* S – Impending uterine rupture* B – VBAC, dense epidural, persistent
breakthrough pain, complete* A – I’m concerned, something’s
wrong* R – I think she needs a C-S. I need
you now
SBAR
* Situation – the punch line 5-10 seconds* Background – the context, objective
data, how did we get here * Assessment – what is the problem ?* Recommendation – what do we
need to do ?
Assertion
• Model to guide andimprove assertion inthe interest of patient safety
GET PERSON’SATTENTION
EXPRESSCONCERN
REACHDECISION
STATEPROBLEM
PROPOSEACTION
*
The Difficult Conversation
* Focus on the common goal – high quality, safe care
* 3rd person – depersonalize the conversation – it’s not about you and me
* Avoid judgment; who’s right, who’s wrong is a loser
* What needs to happen for us to do the right thing here?
“Difficult Conversations”: Stone, Patton, Heen; Viking (1999)