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Quality and Safety: Are you creating an environment for safe, high quality care? Carolyn OBrien, MSN, RN.

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Presentation on theme: "Quality and Safety: Are you creating an environment for safe, high quality care? Carolyn OBrien, MSN, RN."— Presentation transcript:

1 Quality and Safety: Are you creating an environment for safe, high quality care? Carolyn OBrien, MSN, RN

2 Mayo Clinic International reputation for excellent patient care Long tradition of focus on quality care, putting the patient first Primary Value: The needs of the patient come first

3 Mission and Vision To inspire hope and contribute to health and well-being by providing the best care to every patient through integrated clinical practice, education and research Mayo will provide an unparalleled experience as the most trusted partner for healthcare In order to be trusted, we must be safe

4 How does Mayo define Quality? Service Outcomes Safety

5 Service Patient Satisfaction Awarded #1 hospital in patient satisfaction in 2010 and 2011 by Professional Research Consultants, Inc. (PRC) –patient satisfaction vendor Strong organizational focus and leadership involvement

6 Outcomes Quality Improvement (QI) Strongly woven into the fabric of our organization Improve outcomes by improving systems and processes Positive, healthy culture is determining factor in success or failure of performance improvement interventions

7 Safety Foundation of Quality Care Mayos Commitment to Safety Healthy culture, where staff speak up about safety concerns and work in an environment where we learn from and respond fairly to errors Safe behaviors Safe systems and processes

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9 Culture and Patient Safety Required elements for a healthy culture Psychological safety Organizational fairness Transparency

10 Psychological Safety Definition: peoples perception of the consequences associated with taking personal risks. (TEM Field Manual, 2012) Present when people feel free to speak up and questions are welcomed Mutual respect is key Professional tone of communication Flattened hierarchy between disciplines Management of disruptive behavior

11 How do we know if we have psychological safety? Staff are not hesitant to speak about patient safety concerns Staff are treated with respect when concerns are expressed Concerns are acted on

12 How do we promote psychological safety? Unit and organizational leaders encourage staff to raise concerns and welcome it Encourage feedback and act on it Celebrate and praise new ideas

13 Organizational Fairness Historically- healthcare has been a culture of blame and punishment, a punitive culture A punitive culture discourages staff from speaking up Safety depends on people speaking up Reporting errors Reporting and identifying near misses

14 Just Culture Leaders, managers and staff all value safety and create an environment where mistakes can be shared and learning occurs through identification of faulty processes and at-risk behaviors (J of Nurs Qual Vol 22, No.3 pp ) Encourages staff to use their unique position on the frontline to identify safety issues and speak up

15 Fair and Just Culture Moving from culture of blame, to fair and just Responding to errors in a fair and consistent manner System of accountability Systems and behaviors are examined Not individuals and outcomes (Mayo Clinic and Pascal Metrics, Inc. 2012)

16 Individual Behavioral Choice Human error Inadvertent action Lapse, slip, mistake Often involve underlying system issues Increases with complexity of task

17 Individual Behavioral Choice Risky (Drift) Behavioral Choice that increases risk where risk is unrecognized or mistakenly believed to be justified Drift- individual drifts away from what has been taught through the human desire to accomplish more or through a fading perception of risk as the individual becomes increasingly comfortable or competent in their work (Outcomes Engineering, LLC, 2007)

18 Individual Behavioral Choices Reckless Behavioral choice to consciously disregard a substantial and unjustifiable risk Putting self-interest above that of the patient or organization

19 Management Response Thoughtful deliberation related to staff choices Human error Console and Learn Risky Coach/Learn Reckless Corrective Action

20 Transparency Leaders conduct rounds to seek out and discuss current processes and opportunities for improvement Outcomes, adverse event, near misses are openly discussed on regular basis and data is shared with all caregivers Learning is visible - Boards on units that show active work on process improvement

21 This is Mayo Clinics Commitment to Safety System Competency Behavioral Competency Clearly Defined Behaviors Pay attention to detail Communicate clearly Have a questioning and receptive attitude Hand-off effectively Support each other Accountability for Behavior Preventable Harm Commitment to Safety in a fair & just culture Standardization & Diffusion of Best Practices Safe Care & Value Handoffs and transitions Medication errors Rapid response team and deteriorating patient Approved by BOG/Management Team 1/24/2011

22 Pay Attention to Detail Intentional focus on specific task to avoid errors Mindful of task and ramifications Eliminate distractions-noise, interruptions, other thoughts (Mayo Clinic and Pascal Metrics, Inc.)

23 Communicate Clearly Accurate exchange of information that ensures comprehension Communication is intentional, respectful Be aware of body language and tone Verify accuracy and understanding (Mayo Clinic and Pascal Metrics, Inc.)

24 Have a Questioning and Receptive Attitude Empowerment to speak up without fear in order to prevent harm Open and respectful to those asking questions Responsive and appreciative for concerns raised Mutual respect (Mayo Clinic and Pascal Metrics, Inc.)

25 Hand off Effectively Interactive process of passing on specific information from one person to another, transferring responsibility Watch body language, tone, respectful, non- intimidating (Mayo Clinic and Pascal Metrics, Inc.)

26 Support Each Other A spirit of teamwork, collaboration and cooperation across professions and at all staff levels Mutually supportive and respectful behavior- keeping a common goal first- the patient (Mayo Clinic and Pascal Metrics, Inc.)

27 Safe Behaviors = How we communicate Effective communication is integral part of a healthy, safe culture Communicate clearly- speak up Handoff effectively Questioning and receptive attitude Support each other

28 How do nurse leaders at every level contribute to safe, high quality care? Create environment and culture where staff feel empowered to: Speak up Question the way we do things Support one another Are accountable for choices/actions Learn from errors, dont blame others

29 Leadership Unit and organizational culture is shaped by leaders attitudes and behaviors Effective leaders Set a positive tone on unit Share the plan, think out loud and elicit staff input related to their expertise, ideas and concerns Are approachable, encourage open communication

30 Teamwork and Communication The next steps in keeping our patients safe and preventing harm focuses on teamwork High performing, effective teams have Team Behaviors Structured communication Hard-wire performance improvement into everyday work Team Attitudes Ensure psychological safety Set expectation of excellence

31 31 A Team is a Group with: Common goals and a game plan Agreed upon behaviors Agreed upon attitudes MAYOS 5 SAFE BEHAVIORS ARE NORMS

32 32 A Team: Plans Forward Reflects Back Briefings (huddle, pause, timeout, check-in) Debriefings Communicates Clearly Using Structured Critical Language The associated behaviors:

33 33 Briefings Also known as: Huddle Pause Timeout Check-in COMPONENTS Everyone knows the game plan Psychological Safety is ensured Expectation of excellence is set

34 34 Debriefings Debriefings can be the best tool for learning Three Questions What did we do well? What could we do better? What do we want to do differently tomorrow or next time?

35 35 Critical Language: Positive Assertion A PHRASE THAT STOPS THE WORK I just need a little clarity. I am concerned, unclear, this is unsafe. SBAR Situation, Background, Assessment, Recommendation Structured, predictable method of communication Repeat Back Critical labs, medication dosages

36 Mayos Model of Teamwork Team Training ID unit, collect data, share results, team training Ensure psychological safety Embed team behaviors Briefings, debriefings, critical language Improve processes Make work visible- transparent Learning boards Set goals PDSA Display knowledge gained Sustainable process to effect needed improvement

37 Team-Based Engagement Collect Data Team Training Identify Unit Implement Team Behaviors 1 Improve Systems (based on debriefings) 2 Display the Data (learning boards) 3 Eliminate Preventable Harm Culture & Teamwork Systems

38 ©2011 MFMER | slide-38 Learning Board 3 North

39 Ongoing Work: Further shifting our culture Model of teamwork How we…. do our work communicate identify safety concerns improve safety improve outcomes improve quality It is a journey……

40 Questions?

41 References Mayo Clinic and Pascal Metrics, Commitment to Safety Team-based Engagement Model (TEM) PowerPoint, July 31, Mayo Clinic. (2012). Mayo Clinic Commitment to Safety. Retrieved July 28, 2012 from Mayo Clinic Web site: Mayo Clinic and Pascal Metrics, Inc., Team-based Engagement Model (TEM) Field Manual, Outcomes Engineering, LLC. (2007). Just Culture Training for Healthcare Managers. Plano, TX: Outcome Engineering, LLC. Volgesmeier, A., Scott-Cawiezell, J. (2007). A Just Culture The Role of Nursing Leadership. Journal of Nursing Quality, Vol 22, No.3 pp


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