Samaritan Pacific Communities Hospital Stephen Hale M.D., Verda Hale R.N.,M.S.N.

Size: px

Start display at page:

Download "Samaritan Pacific Communities Hospital Stephen Hale M.D., Verda Hale R.N.,M.S.N."

Madison Knight
5 years ago
Views:

1 Samaritan Pacific Communities Hospital Stephen Hale M.D., Verda Hale R.N.,M.S.N. June 25, 2013

About Us Samaritan Pacific Communities Hospital provides health care for residents and tourists throughout a 27-square-mile area in Lincoln County.

2 About Us Samaritan Pacific Communities Hospital provides health care for residents and tourists throughout a 27-square-mile area in Lincoln County. This area includes the communities of Newport, Waldport, Toledo, Depoe Bay and Yachats. The hospital was built in 1952 as a 17 bed acute care facility. Since then, it has been remodeled and expanded to meet the growing needs of the community. Currently, the hospital is a 25 bed critical access hospital, with 380 employees, 110 of whom are nurses, and 120 volunteers. 2

3 How We Got Started Why did your hospital want to do this? We acknowledged an organizational problem. Committed to take an active approach to disruptive behavior knowing the growing concerns about workforce shortages, staff satisfaction and retention, hospital reputation, liability and patient safety. How did you engage staff and get ownership? Spreading the word through staff, manager and medical staff meetings Expert education/training- Dr. Alan Rosenstein Developed a reporting tool with a closed-loop feedback mechanism Zero-tolerance and persistence Top management commitment To what extent was your hospital s administration involved? Senior management/ceo highly committed 3

4 Timeline of Events Dates Event Description Spring 2009 Fall 2010 Fall 2010 Spring & Summer 2011 First Team STEPPS Master Trainers 5 more trainers and a physician leader is born Employee training begins Master Team STEPPS instructors spend time walking the talk on unit rounds, team debriefings, case reviews, RCAs. Winter 2012 First multidisciplinary RCA using Team STEPPS as the framework. October 2012 December 2012 Present Disruptive Behavior survey distributed to all employees through survey monkey. Formal disruptive behavior training is embedded in Team STEPPS training. Disruptive Behavior Task Form is born and a reporting system implemented. Spread and sustain Team STEPPS and Disruptive Behavior initiatives. 4

5 Definition: Disruptive behavior is defined as any inappropriate behavior, confrontation or conflict ranging from verbal abuse to physical or sexual harassment that can potentially negatively impact patient care. Yelling/ Raising voice Disrespecful interaction Abusive language Berating in front of peers Condescension Insults Abusive anger Berating in front of patients Berating in private Physical abuse Other

6 Have You Ever Witnessed Disruptive Behavior? Joint Commission Journal on Quality & Patient Safety August

7 Stress Frustration Loss of Concentration Reduced RN/MD Collaboration Reduced Information Transfer Reduced Communication Percent Linkage Between Disruptive Behavior and Undesirable Behavioral Factors Occurring Sometimes, Frequent and Constant % 95 90% 85 83% % 89 82% 88%

8 Linkage of Disruptive Behavior to Undesirable Clinical Outcomes Occurring Sometimes, Frequent, and Constant 68% 74% 67% 57% 78% 8

9 Are You Aware of Any Specific Adverse Event That Occurred as a Result of Disruptive Behavior 18% 9

10 Could These Specific Adverse Events Have Been Prevented? 75% 10

11 Intervention Process Organizational Culture Assessment Recruitment behavior & personality/leadership commitment/structure and process Types of physicians; environment Clinical Champions Peer mentoring; trust; collaboration Recognition and Awareness Early identification by incident reporting, following rules Education: responsibility and accountability Structured Education/Training Diversity, sensitivity, conflict management, assertiveness Collaboration/Communication Tools Intent, barriers, exchange, outcomes Policies and Procedures Reporting Mechanism Intervention Prevention, real-time, post-event, long-term Reinforcement of Patient Safety Initiatives Prevention 11

12 Intervention Strategies Prevention Raise awareness Education/training/accountability Pre-event early intervention Empathy and assistance/support services Coaching and counseling (HR/Wellness Committees) Real-time intervention Assertiveness/assistance/support Discussion cup of coffee Cause/effect analysis; probe for other issues Organization based intervention Gather data with follow-up. Options (bad day) Pattern Vanderbilt (algorithm) Develop action plan (1,3 and 6 mos-hr, EAP) Other resources (dyad model) 12

13 DISRUPTIVE BEHAVIOR REPORTING ALGORITHM Last revised: August 20, 2012 Disruptive Behavior witnessed Attempt Resolution and/or Team STEPPS Tools Utilized Resolution Successful? Yes No Inform Supervisor and Manager Complete Disruptive Behavior Report Form DBTF will report Performance Improvement measures quarterly to the Administrative Team The Disruptive Behavior Task Force (DBTF) will evaluate reported incidences to determine if the incident should be referred on (either in addition to or instead of) as an Incident Security Report or an Unusual occurrence Report. A response letter ( opportunities for improvement) and the attached copy of the reporting form will be sent to the reporting individual/manager for review if appropriate. If further attention is necessary, information will be passed to appropriate department administrator for follow-up

14 Barriers and Solutions Barriers Solutions Culture Lack of institutional integrity Lack of definition Fear of reporting No process for reporting Poor adherence to practice guidelines Resistance to physician ownership/ witch hunt Civility Zero Tolerance Educate Breakdown hierarchy Reporting tool Low Emotional Intelligence Patient safety/reputation/external/ part of design 14

15 Advice for Others & Lessons Learned Awareness (covert vs overt) Committed senior management (CEO, CNO, Physician champion) Consistent reporting (timely feedback) Zero-tolerance (Rationalization/Justification) How to: Effective intervention (engagement vs enforcement), Action plan-carrot/stick 15

16 Plan for Spread/Sustainment Conflict management training EAP Periodic Employee Wellness Assessment (MBI, ProQual) Staff Retreats 16

17 Next Steps Post survey Annual competency Employee wellness- a missing quality indicator Patient/staff satisfaction Recognize and reward 17

18 Contact Info Stephen Hale M.D. Director Hospitalist Program Office: Pager: Verda Hale M.S.N. Director Quality Management Office:

TeamSTEPPS TM National Implementation

TeamSTEPPS TM National Implementation Implementing TeamSTEPPS in Critical Access Hospitals Katherine Jones, PT, PhD University of Nebraska Medical Center Implementing TeamSTEPPS in Critical Access Hospitals