the elephant in the room: clear kick-off event
DESCRIPTION
This presentation was delivered by Marlies van Dijk, director of clinical improvement of the BC Patient Safety & Quality Council, at the kick-off event for CLeAR on October 9, 2013. The aim of CLeAR – our Call for Less Antipsychotics in Residential Care – is to achieve a reduction in the number of seniors in residential care on antipsychotic medications by 50% across BC by December 31, 2014 through a province-wide, voluntary initiative that supports participating sites. Learn more at www.CLeARBC.ca.TRANSCRIPT
THE ELEPHANT IN THE ROOM WORTH TALKING ABOUT…
MARLIES VAN DIJK
CultureAttitudes, behaviours, and what’s considered normal with regard
to safety, communication, and collaboration
“The way we do things around here”
So what?
• In a major study, communication breakdown was the most common factor implicated in adverse events1
• Silence Kills Study• Reviews of academic literature conclude
strong connection between culture & outcomes
1. Disease-Specific Care Certification – National Patient Safety Goals. Oak Brook Terrace (IL): The Joint Commission; 2008. Available from: www.jointcommision.org.
Long Term Care
• Adverse Events are hard to capture– Falls– Medication Errors
• Less positive perceptions of safety and staffing as it relates to safety compared to hospital benchmarks (Wagner 2009)
• Non-management roles significantly less positive safety culture (Wagner 2009)
• Health care aids provide the majority of care but found very little on this group
Bad CultureWork Environment· Being behind· Care planning w/o
information· “Heavy lifting”
Individual Staff· Dissatisfaction· Burnout & Stress· Exhaustion· Frustration· Not feeling valued
Resident Care· Poor quality outcomes· Poor Safety climate
Ruth Anderson, Duke University
Concrete examples?
Positive Safety CultureAnyone on the team can bring up a safety concern
It is easy to ask a question if there is something a person does not understand.
Nurses and Healthcare Aids work as a team; Healthcare Aid input is well-received.
Negative Safety CultureIt is difficult to bring up a safety concern, or to do so is discouraged
Questions are discouraged.
Formal job titles affect teamwork and communication.
Your Turn
• How is your safety culture?
• Do you think everyone feels this way?
• What are your challenges?
“Providing the best care for your residents…”Simple recipe
Complicated formulas and expert knowledge
Complex there is no recipe and context matters. Depending on many factors….
Good Culture
Exchange Information
Connect
Cognitive Diversity
• Listen• Give/receive
information• Explain• Confirm
• Pitch-in• Seek assistance• Coach/Mentor• Show
appreciation• Say thank you• Pay Attention
• Ask questions• Give/receive
feedback• Suggest
alternatives
Ruth Anderson 2013
Long Term Care Initiative
CONNECTT
Falls
Falls
Outcomes
CONNECTLearning Protocols
Interdisciplinary in-class learning sessions
All staff 2 x 45 min
In-house coach training Coaches 6 hrs
Relationship Map Protocols
Group-to-group maps Managers 2 x 1 hr
Individual maps All staff 2 x 45 min
Unit-Based Mentoring Protocols
Structured mentoring All staff 2 x 10 min
Chance encounter mentoring All staff 1.25 hr/d co-facilitator
Relationship Map
Approaches• Facilitate staff
discussions to map existing relationships and
• Identify and agree on goals for changes
Falls Rates: COM+VAGroup Comparison
Baseline Outcome1
2
3
4
2.59 2.632.34
1.66
FALLSCONNECT + FALLS
Recurrent Fallers: COM + VAGroup Comparison
Baseline Outcome30
35
40
45
50
55
60
45.744.2
47.6 47.9FALLSCONNECT + FALLS
Any room?
• To try some things at your site for this project?• What is your initial thought about these
concepts?
What can you do?• Nurses are in a position to facilitate a culture of safety • Empowering care aides• Less focus on rules and on rule enforcement• Informal leaders can mentor others – often poking fun
at themselves• Encourage staff not to wait for managers but to take
initiative to raise issues and take advantage of chance encounters with managers to problem solve.
• Changing the physical environment• Involving families as partners
Ruth Anderson; Canmer; Putting People First – Alzheimers Society of BC
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Preventing Falls in a Behavioral Health Unit
B On December 1, 2012, these staff members used the unit’s Learning Board to share their concern.
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Preventing Falls in a Behavioral Health Unit
S Two team members who work with patients on the Geriatric Behavioral Health Unit noticed patients with dementia would consistently try to step or jump over decorative green tiles on the floor. They often bent over to investigate the tiles or tried to pick them up. Sometimes patients lost their balance. Sometimes they fell.
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