By: Patti J. Magyar, RN, MSN, JD; Hospital Counsel Chelsea Community Hospital – Chelsea, MI (734) 475-3911 pjm@cch

1. Patient Safety Fellowship Opportunities & Beyond!Lessons Learned From AHA Health Forum Fellowship & Beyond!Techniques & Tools:Effectively Development and PromotingA Culture of Patient Safety By: Patti J. Magyar, RN, MSN, JD; Hospital Counsel Chelsea Community Hospital – Chelsea, MI (734) 475-3911 pjm@cch.org

2. A Culture of Patient Safety Shared ways of thinking and behaving that work to meet the primary objective of Patient safety. (Schein)

3. Be APatient Safety Champion! Be Realistic: • Some Colleagues are first on the bus•Some need help getting on the bus • Some Colleagues will board the bus late, possibly kicking and screaming (and “’pay’ a late fee!”) • Some Colleagues will be left at the bus stop and won’t even know it: “What ‘was’ that!” • Some don’t care that there is a bus & may need to be “invited” to leave.

4. Be a Patient Safety Champion Assess your current environment: Informally: Open dialogue at staff meetings Initial & On-Going Inquiry: How are we doing: NPSF:“The ABC’s of Patient Safety” - Linkage: PSLF & NPSF! - How can we make things safer for patients and staff?

5. Be a Patient Safety Champion Assess your current environment: Formally: Cultural Assessment e.g., “Strategies for Leadership-” VHA, Inc. (Supported by & available through AHA) (2000) Cultural Survey CCH A Survey of Hospital Clinical & Non-Clinical Staff

6. Be a Patient Safety Champion Integrate Patient Safety Into Your Hospital’s: • Strategic goal for Excellence • Climate as a “Learning Environment” • Formal & Informal Marketing! … Your Hospital aspiring to be “Great!” Flower, Joe. Good to Great. Health Forum Journal (July-August) 2002, 17-20 (related editorial pp 5-6). - PSLF Linkage –AHA Summit -

7. Be a Patient Safety Champion Invite & Facilitate Resolution to: “Wicked Questions” - PSLF Meeting #1- “How can we move patient safety forward given our barrier of skepticism? … barrier of financial challenge? … barrier of work overload? …overlap with QI/RM?

8. Be a Patient Safety Champion Be Patient Safety Vigilant for: Patient Safety Risk Opportunity Success Reward

9. Be a Patient Safety Champion Recognition (verbal/card/letter/sharing of patient success stories), financial (major based on risk minimization and cost savings; minor: meal tickets, gift shop certificate, dinner out with PSO/other, pizza party for department, AmEx certificate; balloons!)

10. Be a Patient Safety Champion Equipment & Systems Enhancements Braun Outlook IV Pumps Midas+ Integrated Systems “Chelsea Community Hospital Partnering in Patient Safety”

11. Be a Patient Safety Champion Be clear & committed to critical patient safety “values” ~ Error Tolerance ~ “…errors will occur in any system, no matter how well managed, and early identification and analysis of errors can provide an opportunity for the proactive correction of conditions that are unsafe.” (Merry p. 127)

12. Be a Patient Safety Champion Be clear & committed to critical patient safety “values” ~ Interdisciplinary Teaming ~ Patient safety problems cannot be successfully resolved through traditional management OR traditional healthcare! • Joint S/PS/RM “Wheelchair Availability to Guests memo • “FMEA: Medication Administration; Patient Identification” • Interdisciplinary education (e.g., UMMC Conference @ CCH) • HiQ Teams: Legibility in the Medical Record (PosterBoard)

13. Be a Patient Safety Champion Be clear & committed to critical patient safety “values” “A Just Culture” ~ PSLF~ • Accountability v. Blame! • Patient/Visitor Occurrence Reporting Process • Peer Review (“Real” PE! with input, ensuring competence +/or conduct issues are addressed early to “salvage,” develop and retain talented physicians!) • Performance Evaluation

14. Be APatient Safety Champion! Communicate: Evidence, Innovation & News! Create effective feedback loops regarding latent workplace conditions and latent organizational conditions (Merry, 127)

15. Be APatient Safety Champion! Communicate: Evidence, Innovation & News! Latent Workplace Conditions • Undue time pressure • Inadequate maintenance • Inadequate tools • Inadequate training • Understaffing • Unworkable procedures (Merry, 126)

16. Be APatient Safety Champion! Communicate: Evidence, Innovation & News! Latent Organizational Conditions • Budgeting • Communication • Norms and Informal Expectations • Planning • Resource Allocation • Senior Level Decisions • Strategic Decisions (Merry, 126)

17. Be APatient Safety Champion! Communicate: Transfer Your Expertise! “Scripting” “I am so sorry you received Valium 5 mg. by mouth for your hip pain instead of the Demerol 50 mg. IV that was ordered; (it was a misreading on my part). Your physician has been made aware, and per the physician’s order I am going to give you the Demerol now for your pain relief. (Have you taken Valium before? – e.g., hx of response?). You should have no ill effects from the Valium although you may feel … I will be back in 15 minutes to take your vital signs … >”

18. Be APatient Safety Champion! Communicate: Transfer Your Expertise! “Scripting” ”Your surgical procedure went well and you are doing very well (minimal blood loss, blood pressure is good …). As I explained during your office visit, the plastic piece for your knee replacement was fitted into your knee after careful evaluation during the operation. … Upon my review of your knee film after surgery, I see that a 3 mm larger plastic device would be better for your knee stability. It will be safe to walk and bear weight on your knee over the next two weeks. Then, if you agree, I would like to do a 15” procedure replacing the smaller with the larger device …”

19. Be APatient Safety Champion! Communicate: Transfer Your Expertise! “Scripting” INVITE SHARING OF CONCERNS “…Do you have any questions or concerns at this time?” “Please let us know at the earliest point possible if you have concerns or ideas about how we can improve the care you are receiving..”

20. Be APatient Safety Champion! Communicate: Evidence, Innovation & News! (e.g., P & T Newsletter or Quality/Safety Newsletter or Patient Safety/Risk Management Newsletter) • Automatic Stop Orders and Renewals Policy • Alternative Medication Policy Revisions • New Products Added to Formulary • The “Do Not Use!” Abbreviations • Patient Fall Assessment: Who & Why!

21. Be APatient Safety Champion! Communicate Evidence, Innovation & News! Dynamic In-person Updates: Self or Other PS Champions • Administrative Staff • BOT • Hospital Staff (Dept. Mtgs., Directors [Hospital “Forums”]) • Medical Staff (MEC v Services v Entire) • Volunteers (Annual Mtg)(Leadership)

22. Be APatient Safety Champion! • Written Communication with clinicians • e.g., Memo: “Morphine Sulphate Unit Dosage Nation-wide Backorder Shortage (January 23, 2003) • e.g., Reminders of f/u process when illegible entries are found & remind of commitment! • Judicious use of e-mails

23. Be APatient Safety Champion! Transfer your expertise: Scripting “I am sorry you received Valium 5 mgs. by mouth for your hip pain instead of the Demerol 50 mg. IV that was ordered. You are not allergic to Valium – correct? Your physician has been made aware and per the physician’s order I am going to give you the Demerol 50 mg for your pain relief. (Have you ever taken Valium before?) You should have no ill effects from the Valium although you may feel … I will be back in 15 minutes to check on you (+/or take your vital signs) …”

24. Be APatient Safety Champion! Transfer your expertise: Scripting: Hospital Orientation & Beyond • Patient/Visitor Occurrence Initial Apology • Guidelines for Explaining the Facts when Error occurs in a complex procedure • Any/all staff in effective listening to a patient/family member sharing a complaint

25. Attract & CultivatePatient Safety Co-Champions!Personally Exude “Service Excellence!”“How Can I Be of Help?”Acknowledge others’ capabilitiesCo-Present and Share Ideas & ResourcesInternally

26. Attract & CultivatePatient Safety Co-Champions! • Nurture relationships with prospective co-champions (e.g., orthopedic surgeon, internal medicine specialist, Directors, staff) • Put others in the spotlight as often as possible! (e.g., I want to thank and recognize Kim for … in PS) • Involve physician as (co)/speakers, nurses & other clinicians as FMEA leaders +/or team members) • Celebrate patient safety achievements! (Literally Celebrate: party … shared summary!)

27. Collaborate Internally & Externally! Collaborate • Join Forces ! • Team Up !! • Work in Partnership !!! • Pool Resources !!!!

28. Collaborate! Collaborate Internally • Department Directors • Directors of Nursing, Pharmacy, Quality, Recipient Rights, Risk Management and Safety • Chief of Staff and VPMA/Service Chiefs/Informal Medical Staff Leaders • Nurse Director Group & Informal Nurse Leaders • Patients & Families!!! (e.g., Pulse; Advisory Committee)

29. Collaborate Internally Executive Rounds (Great for Administrative Buy-In to Patient Safety, after buying into rounding!) • “Have you seen or experienced any patient safety concerns during your stay?” • “Have you seen your care providers wash their hands just before providing care to you?” • “Do your nurses introduce themselves to you?” • “Do nurses look at your patient identification band just before they give you medication?”

30. Collaborate Internally *Patient Safety Rounds via Patient Safety Interviews By Diverse Staff Committed to Patient Safety *See: Attachment

31. Collaborate Internally & Externally “Align legal counsel activity with the patient safety agenda, ensuring accountability, while concurrently protecting the organization.” (Wilson, 33)

32. Collaborate Externally Use the plethora of patient safety resources with wild abandon but share them very strategically! See Attached List: Patient Safety Resources

33. Collaborate Externally Brainstorm with others: Your organization’s Greatest patient safety knowledge or resource Challenge & Potential Solutions (e.g., Human Error Factors Analysis, “Internal Neutral,” Patient/Family Inclusion in PS …) Do a (Formal or Informal) Cost:Benefit Analysis!

34. A Culture of Patient Safety • Be a Patient Safety Champion • Attract & Cultivate Co-Champions • Collaborate Internally • Collaborate Externally

35. ~ In Summary ~ A Culture of Patient Safety (shared ways of thinking and behaving) will evolve based on our underlying organizational culture, via a Process of Evolution over time

36. A Culture of Patient Safety … Moving Hospitals and Healthcare to Greatness! Thank You AHA Health Forum PSLF!!!

37. Questions & DiscussionLeadership, Disclosure, Tools & Techniques +/or PSLF! AHA Health Forum Patient Safety Leadership Fellowship #1 2002-2003 http://www.hospitalconnect.com/healthforum/hfeducation/ Co-sponsored by: AHA-HRET, AONE, ASHRM, NPSF