Cultivating Cultures for Safe Patients AND a Safe Workforce. Culture of Safety Drivers

Transcription

1 Cultivating Cultures for Safe Patients AND a Safe Workforce Tennessee Hospital Association Regional Meetings September 2017 Betsy Lee, MSPH, RN 1 Culture of Safety Drivers 1

2 Through the Eyes of the Workforce Dialogue Who has had success with addressing these workforce safety challenges? Fatigue Management Safe Patient Handling/Movement Workplace violence, including aggressive patients Disruptive behavior/bullying Pair up at your table. Debrief 2

3 Fatigue Management and Mitigation Track unit-based turnover Enforce work hour limits Eliminating mandatory overtime and consecutive shift work Mitigate fatigue promptly Cross-Monitoring Self and Others (TeamSTEPPS TM ) I = Illness M = Medication S = Stress A = Alcohol and Drugs F = Fatigue E = Eating and Elimination Musculoskeletal Injuries Overexertion injuries - Bureau of Labor Statistics (BLS) All industries 33/10,000 FTEs Hospital workers 68/10,000 FTEs Greatest risk factor: manual lifting, moving, repositioning patients Back injuries impact up to 38% of all nurses 3

4 Workforce Safety Measures Patient Handling (HIIN-WS-1b) Numerator: Number of harm events related to patient handling Includes: Musculoskeletal disorders associated with direct patient care or patient movement Denominator: Number of fulltime employees (may use number of clinical FTEs) Workplace Violence (HIIN-WS-1c) Numerator: Number of associated harm events related to workplace violence Includes: Workplace violence is any act or threat of physical violence, harassment, intimidation or other threatening disruptive behavior that occurs at the work site. OSHA does not dictate the severity level for reporting. Denominator: Number of FTEs Background: Safe Patient Handling and Mobility (SPHM) National Institute for Occupational Safety and Health (NIOSH) Limited Guidance for eliminating patient lifting over 35 lbs. without assistive equipment/devices Safe Patient Handling and Movement (SPHM) legislation in some states Assistive devices include: Mechanical patient lifting equipment Ceiling lifts Patient lateral transfer devices Lift teams Engage as leaders/coaches Not practical for all lifting can be used successfully to augment in urgent situations Pair with proper equipment Involve PT/Rehab Therapy 4

5 Myth Busters Exercise Use your flip chart paper to list MYTHS and FACTS about Safe Patient Handling MYTHS: FACTS: Moving Patients Myths: We can train workers to use proper body mechanics and avoid injury. Patients are not as comfortable or safe with mechanical lifting. It takes less time to manually move patients than to use lift equipment. Facts: Research shows that relying on body mechanics alone is insufficient to prevent injuries. Patient handling equipment can reduce falls and skin injury. Patients more secure with mechanical transfer devices. Takes longer to round up team for manual lifting. 5

6 Mechanical Equipment Myths: Lifting equipment is not affordable or cost-effective. One size fits all when it comes to lift equipment. Having mechanical lifts alone ensures SPH. If we invest in equipment, workers will not use it. Facts: Studies show that investment in policies and equipment can be recovered in 2-5 years. Engage staff in selecting equipment. Training is key to success. Proper maintenance, convenient storage and easy access are essential to use. Culture Change Myths: Having a safe patient handling policy ensures worker safety. Facts: Safe patient handling policies should be designed as a public pledge leaders make to staff. Proper training on equipment is essential, as are accountability and commitment to high reliability. 6

7 Link to the UP Campaign Gait Belts in every room Safe mobilization and patient handling training for nursing staff See CAPTURE Falls Project Website for guidance: Gait belts are used to help control the patient s center of balance. Gait belts are not intended to hold a patient up 13 OSHA Self-Assessment - SPH Magnitude of impact Recorded injuries Lost time Total WC claims Turnover rates Who is getting hurt? Where? How? Impact on patient care: HAPU/I Falls with injury Patient injuries due to manual lift, repositioning or transfer Strengths and opportunities 7

8 Dialogue for Action Reflect and discuss: What do you know from the selfassessment tool? Do you have a written safe patient handling protocol? Does the program minimize manual lifting? Do all clinical staff have ready access to equipment to assist with patient handling? If so, are they using it? If not, why not? What did you learn? What are some bright spots at your table? Gather on flip charts. Psychological Safety and Reliability 8

9 Habitual Excellence Paul O Neill Alcoa 1. Am I treated with dignity and respect by everyone? 2. Do I have what I need so I can make a contribution that gives meaning to my life? 3. Am I recognized and thanked for what I do? Psychological Safety Discussion Do all staff, patients, and families feel safe enough to speak up when they have patient safety or workforce safety concerns? 9

10 Psychological Safety 9/29/2017 High Performing Cultures Comfort Zone Learning Zone Apathy Zone Anxiety Zone Motivation and Accountability Edmondson, A. Cultures of Disrespect Overt Covert Institutionalized Physical disrespect putting people in a position to hurt themselves or others Psychological disrespect when it is not safe to talk about errors Knowingly putting a person in a position where they are more likely to hurt someone is the height of disrespect. - Lucian Leape, MD, September 30, 2013 Indiana Hospital Association Annual Meeting 10

11 Extinguish Unprofessional Behaviors PEER TO PEER ACCOUNTABILITY DRIVE OUT FEAR! INTOLERANCE FOR DISRESPECT JUST CULTURE CRUCIAL CONVERSATIONS Drive Out Fear 11

12 Peer-to-Peer Accountability Team accountability for speaking up to identify unsafe conditions Intolerance for disruptive and disrespectful behaviors Use cup of coffee conversations (G. Hickson) Show positive support for respectful communications Training with scripts and strategies Having the Conversation You are Avoiding. Principles: Have timely discussion Frame problem in terms of your own experience Use I statements to minimize defensiveness Avoid blaming statements Critique is not criticism Focus on what is right, not who is right 24 12

13 Vital Behaviors are Key Leadership behaviors to promote workplace and patient safety Individual/team behaviors Six Sources of Influence PERSONAL SOCIAL MOTIVATION 1 Link to Individual Mission and Values (Create new experiences) 3 Harness Peer Pressure 2 4 ABILITY Overinvest in Skill Building (Training/Education) Create Social Network (Strength in Numbers) STRUCTURAL 5 Align Rewards and Expect Accountability 6 Change the Environment Patterson K, Grenny J, Maxfield D, McMillan R, Switzler A. Influencer: The Power to Change Anything. (New York: McGraw Hill, 2008), p

14 Well-Being and Resilience Mutual support Joy and meaning in work Stories and connections Collaborate and engage Three Good Things Within 2 hours of sleep Think about : Three things that went well today and what was my role in bringing them about Significantly associated with better mood and better sleep quality Do every night for 2 weeks Exercise: Brian Sexton, Duke University 14

15 IHI Framework for Improving Joy in Work What matters to you? Identify pebbles in their shoes Commit to systems approach Culture of Safety Change Package Culture of Safety Change Package Link 30 15

16 Questions? Betsy Lee, RN, MSPH Improvement Advisor Cynosure Health 32 16