A Comprehensive Framework for Patient Safety
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- Beverly Atkinson
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1 A Comprehensive Framework for Patient Safety
2 A Framework for a System of Safety Objectives 1. Link safety to organizational strategy and resources 2. Define a culture of safety 3. Apply improvement methods through applied human factors and reliability science 4. Differentiate continuous learning systems (at organization and unit levels) 5. Describe patient safety governance 6. Link patient safety and patient centeredness
3 Exercise You are assigned responsibility to evaluate a unit in a healthcare organization. (Unit = Department, Division, Section a delineated group working together) The unit is new to you. You are to evaluate the unit for its ability to achieve safe, reliable, patient-centered operational excellence. What will you assess?
4 A Familiar Framework Personal Habits 1. Risk Factors 2. Exercise 3. Nutrition 4. Health Literacy 5. Etc Physical Exam 1. Cardiovascular 2. Pulmonary 3. Gastrointestinal 4. Musculoskeletal 5. Etc 2010 Pascal Metrics Inc.
5 Framework for Clinical Excellence Patient Safety A learning system collects and analyzes social, clinical and operation metrics based on a strategic plan; engages multidisciplinary teams to debrief and put into action processes (PDSA) Learning to improve System the outcomes and incorporate a continuous feedback loop to reassess if the new processes has generated better social, clinical and operational outcomes. Leadership Reliability Continuous Learning Improvement & Measurement Person Accountability Transparency Teamwork & Communication Negotiation Psychological Safety Culture the product of the individual and group values, attitudes, competencies and patterns of behavior that determine the commitment to, and the style and proficiency of, an organization s health and safety programs. IHI and Allan Frankel
6 Framework for Clinical Excellence Patient Safety Improving work processes and patient outcomes using standard improvement tools including measurements over time. Openly sharing data and other information concerning safe, respectful and reliable care with staff and partners and families. Facilitating and mentoring teamwork, improvement, respect and psychological safety. Leadership Improvement & Measurement Transparency Teamwork & Communication Developing a shared understanding, anticipation of needs and problems, agreed methods to manage these as well as conflict situations Applying best evidence and minimizing non-patient specific variation with the goal of failure free operation over time. Reliability Person Psychological Safety Creating an environment where people feel comfortable and have opportunities to raise concerns or ask questions. Continuous Learning Negotiation Regularly collecting and learning from defects and successes. Accountability Being held to act in a safe and respectful manner given the training and support to do so. Gaining genuine agreement on matters of importance to team members, patients and families. IHI and Allan Frankel
7 Patient and Family Centered Care An organizational goal Patient and family knowledge, value, beliefs and cultural backgrounds are incorporated into care planning and decision-making Patients, families, health care practitioners, and health care leaders collaborate in policy and program development, implementation and evaluation, facility design, professional education and care delivery Open discussion of adverse events is supported and expected
8 A Safety Framework 9 Components Patient and Family Centered Care Learning System Culture Leadership facilitate and mentor teamwork, improvement, respect and psychological safety Teams agree upon specific behaviors Communication transmission and reception of information is one and the same Accountability supports psychological safety because employees believe that they ll be treated fairly Psychological Safety speaking up is safe to do Continuous learning generate reliable care by applying best evidence and minimizing variation Reliable care continuous and owned by the frontline Improvement and measurement generate quality, mitigates and eliminates defects Transparency continuous learning is visible
9 Culture Components Patient and Family Centered Care Culture Leadership facilitate and mentor teamwork, improvement, respect and psychological safety Teams agree upon specific behaviors Communication transmission and reception of information is one and the same Accountability supports psychological safety because employees believe that they ll be treated fairly Psychological Safety speaking up is safe to do
10 Leadership Guardians of the Learning System Ensure psychological safety Approachable Competent
11 Psychological Safety Image Protection Stupid Don t ask questions Incompetent Don t request feedback Negative Don t criticize Disruptive Don t make suggestions Attribution: Amy Edmondson
12 Teamwork Plan forward Reflect back Resolve conflict Use of: Briefing Debriefing Critical language
13 Briefing Goal and game plan Psychological safety Norms of conduct Attitudes Behaviors Expectations of excellence
14 Debriefing What worked well? What didn t? What should we differently next time?
15 Communication Communicate clearly SBAR Closed loop communication
16 Just Culture You can t be malicious You can t have you sensorium impaired You can t be reckless Would 3 others with similar skills in the similar situation do the same? Do you have a history of unsafe acts? Attribution: James Reason and David Marx
17 Continuous Learning System Ensure Feedback Collect Information Assign Accountability Analyze it Identify Actions
18 An improvement method Driver Diagrams Set Aims Link Strategy to Tactics (Objectives to Action) PDSAs What are we trying to accomplish? What change are we making? How will we know the change is an improvement? Deployment plan Testing, Implementation, Spread
19 Framework for Clinical Excellence Patient Safety A learning system collects and analyzes social, clinical and operation metrics based on a strategic plan; engages multidisciplinary teams to debrief and put into action processes (PDSA) Learning to improve System the outcomes and incorporate a continuous feedback loop to reassess if the new processes has generated better social, clinical and operational outcomes. Leadership Reliability Continuous Learning Improvement & Measurement Person Accountability Transparency Teamwork & Communication Negotiation Psychological Safety Culture the product of the individual and group values, attitudes, competencies and patterns of behavior that determine the commitment to, and the style and proficiency of, an organization s health and safety programs. IHI and Allan Frankel
20 Framework for Clinical Excellence Patient Safety Improving work processes and patient outcomes using standard improvement tools including measurements over time. Openly sharing data and other information concerning safe, respectful and reliable care with staff and partners and families. Facilitating and mentoring teamwork, improvement, respect and psychological safety. Leadership Improvement & Measurement Transparency Teamwork & Communication Developing a shared understanding, anticipation of needs and problems, agreed methods to manage these as well as conflict situations Applying best evidence and minimizing non-patient specific variation with the goal of failure free operation over time. Reliability Person Psychological Safety Creating an environment where people feel comfortable and have opportunities to raise concerns or ask questions. Continuous Learning Negotiation Regularly collecting and learning from defects and successes. Accountability Being held to act in a safe and respectful manner given the training and support to do so. Gaining genuine agreement on matters of importance to team members, patients and families. IHI and Allan Frankel
21 TO ACHIEVE SAFE AND RELIABLE CARE: PATIENT SAFETY GOVERNANCE Board level measures of safety, risk and culture are included in dashboards. There is a process that incorporates Board members in Leadership WalkRounds. The Board and senior leaders message a simple set of organizational values. Leaders support an environment of appropriate accountability, transparency, and open disclosure. Leaders support and nurture a collaborative care culture based on effective teamwork.
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