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The Physician Role in Safety & ReliabilitySafety Culture Transformation2013

Karin Markey MSN RNQuality Improvement Specialist

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Safety Story

A story was shared in Interventional Cardiology where a tech handed the cardiologist the wrong sized balloon. It was too large and when inflated, ruptured the carotid artery. The situation was able to be corrected. However as the case was discussed, it was noted that other providers have experienced similar issues. It has been recognized that a new system process needs to be considered. A “time out” to verify product size with the cardiologist is being considered.

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Physicians?

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Vive la Difference

Sharp End Provider Know and comply with behavior expectations for error

prevention – make them personal work habits Encourage the practice of behavior expectations for

error prevention in others

Blunt End Leader Demonstrate in word and actions safety as a core

value that cannot be compromised at any time Find and fix causes of system and process problems

that challenge safe, high quality care Reinforce and build accountability for behavior

expectations for error prevention

© 2008 Healthcare Performance Improvement, LLC. ALL RIGHTS RESERVED.

Critical Impact of Physicians on Safety Culture Transformation

• Significant contribution to errors associated with patient injury (30-35% of medical errors in hospital patients)

• Unequaled impact on hospital morale through their considerable influence on hospital staff and leaders

• Profound impact on long-term hospital culture – sustained improvements require physician support

• Capable of blocking initiatives they do not support

Managing Your Strengths

© 2006 Healthcare Performance Improvement, LLC. ALL RIGHTS RESERVED.

The common thread for people who derail is that they exhibit superior skill in a particular area to the exclusion of developing complementary ones.

Lois Frankel, Ph.D.

PERSONALATTRIBUTES

ASSETS

LIABILITIES

RELIABILITY

UNRELIABILITY

Managing Your Strengths…

© 2006 Healthcare Performance Improvement, LLC. ALL RIGHTS RESERVED.

The Disruptive Path

Attributes

Intelligence

Independence

Objectivity

Analytic Capability

Sense of Urgency

Influence

Liabilities

Elitest

Team averse

Impersonal

Critical

Impatient

Aggressive

Unreliability

Condescending

Abrasive

Belligerent

Blaming

Insensitivity

Sabotage

Derived from Overcoming Your Strengths, by Lois P. Frankel, PhD

The Success Path

Attributes

Intelligence

Independence

Objectivity

Analytic Capability

Sense of Urgency

Influence

Strengths

Competence

Confidence

Thinking Critically

Problem Solving

Safety First

Team Building

Reliability

Preoccupation with failure

Sensitivity to operations

Reluctance to simplify

Commitment to resilience

Deference to expertise

© 2006 Healthcare Performance Improvement, LLC. ALL RIGHTS RESERVED.

Power Distance in Health Care

Large Distance• Relations are autocratic and

paternalistic• Power acknowledged based

on formal, hierarchical positions

Safety Culture Goal:Use organizational culture to reduce the power distance between groups

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Small Distance• Relations are consultative

and democratic• Relate as equals

regardless of formal positions

The perceived distance – not necessarily the real difference – as seen by the subordinate

Adapted from G. Hofstede’s Culture’s Consequences (2001)

Attention is the Currency of Leadership

Staff listen to your words and watch to see how well your actions match

If you pay no attention they pay no attention

You have the ability to influence both positive and negative behaviors

Physicians are Leaders

EVERY Physician is a Leader – whether you realize it or not

High Reliability Leadership: Your Role

Live Safety!

• Actions speak louder than words

• Identify barriers to safe, effective, compassionate care in your area and work to fix them swiftly

• Continually share lessons learned

• Hold people accountable when they are not doing the right thing: “What you permit you promote”

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Leading at the Sharp End

 Share a Safety Moment at the beginning of a meeting

Distribute the Safety Rounds or Stories newsletters at a meeting or in your work area

Submit a Safety Success story at Safetycentral@spectrumhealth.org or with a Safety Success Story form

Encourage staff to use SBAR (Situation, Background, Assessment, Recommendation) when you receive calls regarding patient status.

Support the team by giving a colleague 5:1 feedback

Encourage the use of the Safety Behaviors in the day to day work of those around you

Give a colleague a Safety Behavior Expectations card

Talk about work you are doing with the Top 11 Physician Safety List as part of a Safety Moment

Encourage or Submit an ISIS – RL6 report

Say “thank you” when someone approaches you about a potential error or concern

Our Patient Safety Toolkit

1. Support the Team• Peer Checking and Peer Coaching• Speak Up Using ARCC

2. Pay Attention to Detail• Self-Checking Using STAR

3. Use a Questioning Attitude• Validate & Verify• Know & Comply with Red Rules

4. Communicate Clearly• 3-Way Repeat Back and Read Back• Clarifying Questions• Phonetic & Numeric Clarifications• SBAR

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Additional Q&S Activities in Radiology

Enrolled in ACR’s CT-DIR

• Automated data upload w/benchmarking

• Will drive future ALARA activities in adults

• Physician Lead: Dr. Jim Larson

CT Coronary Collaborative

• Radiology/cardiology/ED joint effort

• Metrics include: TAT, image quality, radiation dose

• Physician Lead: Dr. Leena Mammen & Dr. Dave Langholz

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Additional Q&S Activities in Radiology

CT Coronary Technical Peer Review Panel

• CTCA readers convene to review images and interpretations. All information is blinded for confidentiality.

• Reports to HVI DEC.

• Physician Lead: Dr. Mike Vredenburg

Radiology DEC

• Peer review of radiology cases

• Physician Lead: Dr. Joe Junewick

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Additional Q&S Activities in Radiology

Contrast Induced Nephropathy in Outpatient CT

•Metrics include: pre and post contrast creatinine and eGFR, POC utilization, long-term follow-up of positive patients

•Working with cardiology, nephrology and ED to develop a system-wide policy

MRI Safety

•Outreach to system with education

•Intra-operative MRI in HDVCH go-live in January

Physician lead for above teams: Dr. Brad Betz

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Additional Q&S Activities in Radiology

Radiology Dashboard Development

• Mostly complete

• Will be submitting data to GRID for benchmarking

• GRID data will be used to drive improvement activities

Physician Lead: Dr. Jim Larson