Patient Safety Culture Bundle for CEOs & Senior Leaders. Presenters: Chris Power, Polly Stevens, Alex Munter, Linda Hughes
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1 Patient Safety Culture Bundle for CEOs & Senior Leaders Presenters: Chris Power, Polly Stevens, Alex Munter, Linda #NHLC2018
2 Patient Safety Culture Bundle for CEOs & Senior Leaders National Health Leadership Conference June 4 th, 2018 Chris Power CEO, CPSI
3 Disclosure The Canadian Patient Safety Institute would like to acknowledge funding support from Health Canada. The views expressed here do not necessarily represent the views of Health Canada.
4 Background National Patient Safety Consortium
5 Background (cont) Within the education thematic area there was a recognition of the critical role senior leadership plays in ensuring patient safety is an organizational priority. Working group of partners, co-led by Canadian College of Health Leaders and HealthCareCAN, brought together to advance work in this area
6 The Patient Safety Call to Action 1 death per 100 admissions (Canadian Adverse Events Study, 2004) In 2014, 1 in 18 hospital stays in Canada involved at least 1 harmful event - 138,000 out of 2.5 million hospital stays (CIHI, 2016) 15% of healthcare costs; $2.75 billion/year (Risk Analytica, 2017)
7 The Inspiration The importance of culture change needs to be brought to the forefront, rather than taking a backseat to other safety activities. Even though tools for developing a safety culture are available, a common set of best practices is needed. One can envision the development of a culture bundle, analogous to the bundle of interventions that drastically reduced ventilator associated pneumonia. - Free From Harm, 2015
8 The Challenge Patient safety culture is a complex phenomenon that is not clearly understood by hospital leaders, thus making it difficult to operationalize. - Sammer,
9 Shift to Safety Patients and their families shift to advocate for their healthcare safety. Healthcare providers shift to prioritize safety when caring for patients. Leaders in healthcare organizations shift to create a positive patient safety culture.
10 Patient Safety Culture Bundle for CEOs & Senior Leaders National Health Leadership Conference June 4 th, 2018 Polly Stevens VP, Healthcare Risk Management Healthcare Insurance Reciprocal of Canada (HIROC)
11 Disclosure HIROC is owned and governed by: Healthcare organizations Employees, volunteers, boards, MDs in leadership Midwives; regulatory colleges; national associations We are not-for-profit Surplus funds go back into healthcare We are passionate about patient safety We promote evidence-informed management 11 PARTNERING TO CREATE THE SAFEST HEALTHCARE SYSTEM
12 Definitions Patient Safety Culture An integrated pattern of individual and organizational behavior, based on shared beliefs and values that continuously seeks to minimize patient harm, which may result for the processes of care delivery. (Kizer, 1999) Bundle A set of evidence-based practices that must all be applied in order to reliably deliver good care. (IHI) PARTNERING TO CREATE THE SAFEST HEALTHCARE SYSTEM
13 Breakthrough Who is the leading authority on culture in healthcare? G. Ross Baker, PhD University of Toronto Sara Singer, PhD Harvard PARTNERING TO CREATE THE SAFEST HEALTHCARE SYSTEM
14 Breakthrough (cont) We have argued that piecemeal initiatives are inadequate and that strengthening safety culture necessitates interventions that simultaneously (1)enable, (2) enact and (3) elaborate (learn) it in a way that is attuned to the existing culture. This approach may hold the key to demonstrably reducing hospital (healthcare) errors and ultimately saving lives. Singer & Vogus, PARTNERING TO CREATE THE SAFEST HEALTHCARE SYSTEM
15 The inputs 42 key resources 1. What do senior leaders need to know to improve safety? 2. What do senior leaders need to do to improve safety? PARTNERING TO CREATE THE SAFEST HEALTHCARE SYSTEM
16 Key concepts Safety science Implementation science Just culture Psychological safety Staff safety/health Patient & family engagement Disruptive behaviour High reliability organizations /resilience Patient safety measurement (e.g. Vincent) Frontline / distributed leadership Physician leadership Staff engagement Teamwork / communication Industry-wide alignment PARTNERING TO CREATE THE SAFEST HEALTHCARE SYSTEM
17 The Safety Culture 13-part frame Enabling Enacting Learning Organizational Priority CEO/ Sr Leader Behaviours HR HIT System Alignment Care Setting / Managers Care Processes Patient and Family Coproduction Situational Awareness / Resilience Education / Capability Building Incident Reporting / Management Safety / Quality Measures Operational Improvements PARTNERING TO CREATE THE SAFEST HEALTHCARE SYSTEM
18 The Safety Culture Patient/Family focus Enabling Enacting Learning Organizational Priority CEO/ Sr Leader Behaviours HR HIT System Alignment Care Setting / Managers Care Processes Patient and Family Coproduction Situational Awareness / Resilience Education / Capability Building Incident Reporting / Management Safety / Quality Measures Operational Improvements PARTNERING TO CREATE THE SAFEST HEALTHCARE SYSTEM
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20 shift-to-safety/pages/default.aspx
21 National Health Leader s Conference, Building Winning Conditions, St-John s Newfoundland, June 2, President and CEO of CHEO
22 22
23 Safety First an Organizational Commitment and Value 23
24 Leadership Behaviors Walking the Walk 24
25 High Reliability Organization principles 1. Preoccupation with failure (track small failures) 2. Reluctance to simplify 3. Sensitivity to operations 4. Commitment to resilience 5. Deference to expertise 25
26 26
27 Safety First guides our work with partners: 27
28 We are changing the culture with Old Behaviors Do it all Hide problems Quickly work around issues Reactive Intuition Info flows with difficulty Top down control Ad hoc training Some staff/physicians Short-term thinking Get it done heroic New Behaviors Alignment and focus Expose problems Get to root truly improve Proactive with rigor Evidence-based decisions Info flows smoothly Local decision making Structured development Engaging all Long-term thinking Appreciation for standards and process 28
29 is the engine that drives Quality Improvement and Safety (it s HOW we identify and resolve issues and ultimately make care better) 29
30 Daily Brief The Daily Brief is a virtual (teleconference) huddle of organizational leaders held at the start of every day to establish situational awareness of recent, ongoing or anticipated events that impact the quality of our patient care and the safety of our patients, staff and organization. It also allows us to quickly establish leadership priority, alignment and accountability for resolving issues 30
31 We work together with children, youth and families Together we are making care, not just safer, but better! 31
32 Continuously reporting continuous improvements 32
33 Learning and building capacity for improvement 33
34 Questions? 34
35 Patients for Patient Safety Canada Perspective Patient Safety Culture Bundle Linda Hughes, Co-chair National Health Leadership Conference, 2018
36 PATIENTS FOR PATIENT SAFETY CANADA (PFPSC) Patient-led program of Canadian Patient Safety Institute since 2006 Canadian arm of the World Health Organization PFPS programme - since 2006 ~ 70 Patient/family volunteers from across Canada Every year ~ 100 requests for participation Increasing requests to be part of committees to develop products, policies, practices rather than speaking engagements Most at Canadian level
37 PFPSC CULTURE BUNDLE Three of our members supported and participated in the development of the patient safety culture bundle We are very pleased that Patient/Family Engagement is reflected in all three aspects of the bundle The bundle complements the Engaging Patients in Patient Safety a Canadian Guide
38 Why do we need tools like the Bundle and the document on Engaging Patients in Patient Safety THE BUNDLE MATTERS We need to be honest with ourselves Despite all the best efforts of all of us The 3 rd leading cause of death in Canada is unsafe care
39 IPSOS SURVEY RESULTS Recent Survey of public commissioned by CPSI regarding patient safety In response to question who is responsible for patient safety? 63% replied: leaders within health care organizations
40 TRUSTING PARTNERS So we still have a lot of work to do TOGETHER. This work can be uncomfortable It begins with building TRUST and agreeing that patients and families can assist in improving our safety Part of trust building is to ensure that everyone has the same expectations about what engagement means Theresa Sabo TEDxStanleyPark
41 ENGAGEMENT SPECTRUM
42 AT ORGANIZATIONAL LEVEL 2010 study by the Canadian Foundation for Healthcare Improvement investigated the benefits of engaging patients at all levels within the organization The study found that embedding patient in decision making structures within multiple levels of the organization will sustain real and ongoing patient engagement. This Leadership bundle provides some structure about how to achieve this level of engagement
43 ENABLING Establish a Patient Care Committee of the Board which includes Board members, Patient and Family members and which reports to the Board on a monthly basis Involve patients and families in the interviewing and hiring of senior positions within the organization A great example is the involvement of Patient surveyors through Accreditation Canada
44 ENACTING Review your visiting hours policies in hospitals families are partners in care, not visitors Provide a means whereby families have immediate access to someone who can address the concerns they may have example: posted phone number in every room of the hospital which can be called and will be answered 24/7.
45 LEARNING Involve patients and families in the design of processes to monitor and evaluate your safety and quality measurement. Another great example is the recent establishment of the HSO/CPSI Health Quality and Safety Advisory Committee which includes three patients from PFPSC and whose goal is to set priorities for required Quality and Safety standards
46 CPSI AS LEADER IN ENGAGEMENT CPSI is an example of a leader who engaged with PFPSC from the beginning of its formation Together we showed that it can be done even in the most difficult circumstances -when there has been harm Took courage on both parts our early members of PFPSC who were hurting and fearful and CPSI who worked with us through all the bumps and hard times
47 READY TO HELP Today, we are both stronger for our efforts PFPSC stands ready to provide assistance and support to those organizations who make a request from us to do so
48 PATIENTS - INNOVATORS Involvement and Engagement of Patients and Families in all aspects of Health care decision making structures is crucial to moving forward on the safety agenda Patients and Families are the disruptive innovation that accelerates system reform Together we can improve Patient Safety
49
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