WELLNESS WORKGROUP November 13, 2018
2 Today s Agenda Welcome & Introductions Spotlight: Second Victim Programs and How They Support Employee Health and Wellness Northwell Health s Team Lavender Program Agnes Barden, DNP, RN, CPXP, Vice President, Patient & Customer Experience NYC Health + Hospitals Helping Healers Heal Program Jeremy Segall, MA, RDT, LCAT, Senior Director, System Performance Improvement, Office of Quality & Safety Using Culture of Safety Surveys to Assess Second Victim-related Issues Jared Bosk, Vice President, Survey and Outcomes Research, GNYHA Updates & Sharing
3 Spotlight: Second Victim Programs and How They Support Employee Health and Wellness
Northwell Health s Team Lavender Program Agnes Barden, DNP, RN, CPXP, Vice President, Patient & Customer Experience
5 Second Victim Phenomenon & Prevalence Second victims are healthcare providers who are involved in an unanticipated adverse patient event, medical error and/or a patient related injury and become victimized in the sense that the provider is traumatized by the event. It is estimated that approximately half of all healthcare providers will experience its impact at least once during the professional career. Can result in psychological harm and long-term impacts if not addressed
6 Connection to Culture of Safety 2000: Publication of Institute of Medicine To Err is Human: Building a Safer Health System report. 2004: AHRQ releases Hospital Survey on Patient Safety Culture 2007: Joint Commission begins requiring hospitals to conduct staff surveys to specific to patient safety in order to assess and advance organizational safety cultures. Patient safety protocols and practices, such as root cause analyses, can have the unintended consequence of causing further distress to second victims if unconnected to support programs.
7 Citations Center for Patient Safety, Second Victim Experience. Website accessed October 30, 2018: https://www.centerforpatientsafety.org/second-victims/ Joint Commission. Quick Safety: Supporting Second Victims, Issue 30, January 2018: https://www.jointcommission.org/assets/1/23/quick_safety_issue_39_2017_ Second_victim_FINAL2.pdf Scott, S. Second Victim Support: Implications for Patient Safety Attitudes and Perceptions. Patient Safety and Quality Healthcare, September/October 2015: 26-31.
8 NYC Health + Hospitals Helping Healers Heal Program Jeremy Segall, MA, RDT, LCAT, Senior Director, System Performance Improvement, Office of Quality & Safety
Using Culture of Safety Surveys to Assess Second Victim-related Issues Jared Bosk, Vice President, Survey and Outcomes Research, GNYHA
AHRQ Hospital Survey on Patient Safety Culture - Survey Dimensions Seven unit level safety dimensions Three hospital level safety dimensions Four outcome dimensions Supervisor/Manager Expectations & Actions Promoting Safety (4 items) Organizational Learning Continuous Improvement (3 items) Teamwork Within Units (4 items) Hospital Management Support for Patient Safety (3 items) Teamwork Across Hospital Units (4 items) Hospital Handoffs and Transitions (4 items) Overall Perceptions of Safety (4 items) Frequency of Event Reporting (3 items) Patient Safety Grade (of the Hospital Unit) (1 item) Communication Openness (3 items) Number of Events Reported (1 item) Feedback and Communication About Error (3 items) Nonpunitive Response to Error (3 items) Staffing (4 items)
Example Items Frequency of Events Reported When a mistake is made that could harm the patient, but does not, how often is this reported? Overall Perceptions of Safety Our procedures and systems are good at preventing errors from happening. Supervisor/manager expectations & actions promoting safety Whenever pressure builds up, my supervisor/manager wants us to work faster, even if it means taking shortcuts. Feedback and Communication About Error We are informed about errors that happen in this unit.
Survey Administration How often should the survey be administered? No specific guidance Best practice is every 18-24 months Who should take the survey? Staff with direct patient contact Staff without direct patient contact but whose work affects patient care Physicians who spend significant time in the hospital Administration/Management What kinds of questions? 5 point scales Strongly Disagree to Strongly Agree Never to Always Positively and negatively worded items How are respondents identified? Survey is anonymous Respondents include information on staff type, work area, and specific unit
13 Incorporating Second Victim Questions into Surveys Research Question Over time is there a difference in clinician perceptions related to patient safety among three groups of survey respondents (non-victims, second victims with support, and second victims without support)? Prevalence In the last 12 months, were there any patient safety events that caused you personal problems such as anxiety, depression, or concerns about your ability to do your job? Support If yes: Did you receive support from anyone within the [HOSPITAL/HEALTH SYSTEM]?
14 Findings Prevalence Approximately one-fourth (25%) of respondents self-identified as second victims Safety Culture Results Scores among supported second victims are similar to non-victims Unsupported second victims consistently score lower than supported second victims Conclusion Supported second victims help raise the overall patient safety grade within units and facilities that have higher levels of perceived support. Conversely, unsupported second victims can significantly lower the overall patient safety score.
15 How to Use Data Incorporate second victim questions into safety culture survey Measure Prevalence of Second Victims and Feelings of Support Stratify results to see what types of staff/areas of the hospital are most affected Measure again after second victim programs have been incorporated to see if feelings of support have changed
16 Updates
17 Biometric Screening and Wellness Portal (with HRA) Shared Services RFP Vendor selected via rigorous RFP process Total of 26 proposals received; 9 invited to make presentations After a rigorous process, selected a vendor and were in the midst of final negotiations New senior leadership made decision that they did not want to enter into a Group Purchasing Agreement We have now restarted conversations with our secondchoice vendor. Please stay tuned.
1 Clinician Wellness - National Updates National Academy of Medicine (NAM) October Meeting of Committee on Systems Approaches to Improve Patient Care by Supporting Clinician Well- Being Major themes Clinician burnout a serious and pervasive problem with important implications for patient care (as well as workforce capacity) and national associations involved in physician education, training, and practice are engaging in the problem There is an urgent need for innovation and evidence for system interventions that address burnout - the Committee will be putting that evidence together for a report due next year (Fall 2019) NAM Conceptual Model Statement of Commitment signed by 150 organizations nationally (NY/NJ institutions included)
2 Clinician Wellness - National Updates (con t) Regulatory Updates Related to Burnout Office of National Coordinator : Reducing administrative burdens as part of the 21 st Century Cures Act ( Patients Over Paperwork ) MedPAC metrics: Medicare Payment Advisory Committee has a major proposal to reduce burden and complexity of quality/safety measurement reporting and incentives for hospitals (proposals directed at physicians as well) from dozens of measures to four (action need by Congress) Federation of State Medical Board Policy Recommendations: State licensing boards should focus on current impairment on medical licensing applications Accreditation Council for Graduate Medical Education: Clinical Learning Environment Review Findings 2019 Executive Summary sponsoring institutions lack of focus on wellness
3 Clinician Wellness GNYHA Initiatives Wellness Training Models SMART-R, MAP-IT outreach and focus groups Schwartz Center Collaborations Helping Healers Heal (NYC H+H initiative) Wellness and the Health Workforce Survey of Chief Nursing Officers (CNOs) to understand wellness issues facing nursing staff results pending, CNO call planned for 11/19 Medical scribe utilization to alleviate physician documentation requirements Wellness Video Learning Series Planning to launch in 2019 to showcase best practices around wellness initiatives
21 Clinical Wellness Resources NAM Resources: https://nam.edu/initiatives/clinician-resilienceand-well-being/ Letter from CMS Administrator Seema Verma: https://protectus.mimecast.com/s/bf2jc9r316tmzja5fq5ezg FSMB Policy: http://www.fsmb.org/siteassets/advocacy/policies/policy-onwellness-and-burnout.pdf ACGME CLER Findings: https://www.acgme.org/portals/0/pdfs/cler/cler_2018_execut ive_summary_digital_081418.pdf
22 2019 Wellness-related Programming Workplace Violence Prevention Learning Series Kickoff Program, January 24 th Onsite fitness facilities further discussion & development of best practice document Comprehensively supporting injured and will workers Disseminating innovative practices Extending burnout/resiliency work to nurses and allied health professionals Other areas of focus/interest?
23 2019 Wellness Workgroup Meetings o Tuesday, January 29 th o Tuesday, March 19 th o Thursday, May 30 th o Tuesday, July 30 th o Tuesday, September 24 th o Thursday, November 14 th All meetings are 9:30am -11:30am