Presentation on theme: "Gren Kershaw Chief Executive – Conwy and Denbighshire Trust Gerry Marr"— Presentation transcript:
1 E1 Leading and creating safer health care environments: The CEO & patient safety walkabouts Gren KershawChief Executive – Conwy and Denbighshire TrustGerry MarrChief Operating Officer – NHS TaysidePat O’ConnorHead of Safety Governance and Risk – NHS Tayside
2 Overview Understand the role of Executives in Patient safety Identifying strengths and create leaders for patient safetyDesign a patient safety walkround program for your healthcare system to promote cultural changeShare examples of safety walkround processes and outcomes
4 Why the Health Foundation chose to work on improving patient safety To Improve health, and the quality of healthcare for the people of the UKThere is an identified need for patient safety to improveThere is a strong evidence base for what worksA focus on patient safety involves clinicians, managers, and patientsThe Health Foundation is an independent charity that aims to improve health and the quality of healthcare for the people of the UKi) There is an identified need for patient safety to improveMany reports worldwide including ‘An organisation with a memory’ (Department of Health, 2000) have observed that many breakdowns in patient safety have a familiar ring, displaying strong similarities to incidents that have happened before.ii) There is a strong evidence base for what worksThe evidence base for preventing similar incidents and creating safer care practices is strong, but there is an implementation gap, with evidence still not informing many commonplace procedures and practices in hospitals.We want you to achieve measurable improvements in the care that you offer, then you can start to develop your role as an exemplar rolling out models for improvement, providing opportunities and access for others to learn from your experiences.iii) A focus on patient safety involves clinicians, managers and patients.Safer organisations exhibit a culture that puts patient safety at the centre of everything they do. We hope that a focus on patient safety will help transform organisational culture, improving patient safety by galvanising support from clinicians, managers and patients. Also, by improving safety, organisations can learn how to improve the quality and performance of services overall.
5 The Health Foundation’s Safer Patient’s Initiative UK Program4 Healthcare Systems involved in 1st wave1 In each UK Country, Scotland England, Ireland and WalesWhole system change packageTeam driven from the board to the front line20 new hospitals joined Dec 2006
6 What were the aims and goals? Create a culture that demonstrates Patient Safety as our highest priorityReduce adverse events by 50%Build local capacity and capability for improvementDevelop highly reliable processes of careTransform the organisational approach to Patient Safety & Quality Improvement
7 Our GoalPlan for system-level (not just project-level) patient safety improvementsWeave patient improvement activity into the fabric of everyday life for the entire organisation
8 Work Streams 5 key Areas of patient safety work Leadership Medicines ManagementOperating theatresIntensive CareGeneral WardDetailed plan for spread throughout theorganisation
9 How did we make things happen? Implementing evidenced based practiceLearning from the expertsUsing small tests of change (PDSA cycles)Using data and measuring changeManaging clinical resistanceDemonstrating active leadership
10 As leaders it was essential to… Promote patient safety at every opportunityPut Patient Safety first item on every agendaManage the safety initiative as a project –making sure things get done!Manage the spread of good practiceIntroduce “Safety Walkrounds”
11 Leadership Patient Safety as a Strategic Imperative Clear Goals and MeasurementReduce variability, waste and harmSkill building
12 The Key Elements of Breakthrough Improvement Will to do what it takes to change to a new systemIdeas on which to base the design of the new systemExecution of the ideas
13 Patient safety program Provide a focusCelebrate successAccelerate ImprovementsSmall test of change to build confidence and competence in improvement techniques
14 Patient Safety Walkround AIMHighly structured process to bring lead executives and front line staff together to have patient safety conversation with a purpose to prevent, detect and mitigate patient harm.
15 What are WalkRounds?A carefully planned discussion between Frontline Staff andA hospital leader (or two)A Patient Safety Manager/Director/SpecialistA scribe.Other (Managers, Pharmacists, Students, patients )lasting about one hour and regularly repeatedAs frequently as weekly, but at a minimum monthly,located wherever frontline staff do their work,fully supported by back office quality analysis,fully integrated into organisational committees,requiring rigorous application to detail in every step.
16 History of Walkrounds 2004 Safer Patient’s Initiative 1997 IHI Collaboratives - Hospital teams work on rapid cycle improvement Leadership support tool1999WalkRounds concept is born in IHI Idealised Design meetingMany hospitals in IHI Collaboratives begin to implement2000-3Piloted in several US Hospitals2003JCAHO Journal publishes first article on WalkRounds WalkRounds in controlled trial2004 Safer Patient’s Initiative
17 How can patient safety walkrounds help? The Patient Safety Walkround process seeks to:Increase the awareness of safety issues by cliniciansMake safety a priority for senior executivesEducate staff about patient safety concepts such as non-punitive reporting andObtain and act on information elicited from staff about safety problems and issuesClose the gap between those who make or prevent error and those who make decisions to change the systems
18 ActivityDiscuss with a partner the ways in which you have a similar process in your organisation and how it works or how it could be set up
19 What it is for ?Safety quality, efficiency, effectiveness, timeliness, and equityare equal parts of the conversation.A comprehensive management tool designed to:Help Leaders lead better,Ensure ever safer and more reliable systems,Help align frontline and leadership perspectives
20 What its not about Parading senior leadership around the hospital. A relaxed conversation with frontline employees.Specifically about employee or patient satisfaction.Designed to solely address safety issues.Risky conversations.A soapbox for voicing opinions..However, these may periodically be attributes of WalkRounds
21 Who will participate?Senior Executives (President, Chief Nurse, Board Members,Chief Medical Officer, Clinical Chairs)Patient. Safety, Quality, Risk ManagerManagers/Administrators/Physician leadersFrontline StaffDoctors,Nurses,PharmacistsStudents, unit administrators, cleaners, portersWhoever is available and involved in clinical care
22 When and where? Weekly Everywhere Varying times Nighttime shifts Patient care floorsLabsRadiologyPharmacyNon-Clinical areas
23 The Process Schedule one year in advance. Base dates and times on staff availability and executive availability. Take into consideration shifts, lulls in activity and doctor/ team rounds.Schedule WalkRounds weekly.Frequency of WalkRounds will vary based on the size of the organisation, but one round per week is a good “rule of thumb.”Rounds should occur at any site where employees and clinicians are involved in patient care but you may include non-clinicial services.
24 Detailed Process Develop an introduction Highlight ConfidentialityWhat happens with the informationDevelop closing remarks Thank all for participatingSummarise key issuesAsk that all staff talk to their colleagues about the WalkRoundsRemind all staff that this is not the only forum for discussing safety issues; offer contact information
25 Example Questions How will the next patient be harmed in your area? How does the environment fail you?How was the last patient harmed in this area – what happened ?What prevents you from keeping your patients safe?What can senior leaders do to help?
27 Getting Started Developing an outline Get buy-in from senior executives; align expectationsTime commitmentExpected level of participation on roundsLevel of responsibility with follow upResources requiredBe clear about the processPeer review protectedExpectations for those who participatePromote the value of WalkRounds to nursing and medical staffReassure middle management that WalkRounds will support them, and will not be an avenue to bypass them.
29 Getting Started Planning Discuss optimum time for rounds with nurse managers and executivesAvoid shift changeOffer off-shift visitsDevelop a hospital map to keep track of visitsCreate a 3-6 month schedule and distributeDevelop questions to askPrepare senior executives
30 Collect and Analyse Data Track all individuals who participate: date, time, and location, comments heard.Classify each hazard/event by its contributing factors.Record frequency of each hazard/eventRecord severity of potential or actual impact on patients and prioritise.Priority informs actions for senior leadership
31 Assign Action ItemsProduce reports WalkRounds comments, and distribute the reports to senior executives, patient safety committees, and the Hospital Board.Determine actionOn a monthly basis review monthly reports of both open and closed action items.
32 ActivityDiscuss in your healthcare system how you could use or improve a patient safety walkround system
33 Give Feedback to Board, Leadership, Management, and Staff Develop a plan for feeding information back to rounds participants, senior leaders, committees, and the Board within your organisation.Share good practice in addition to the issues that are identified and addressed newsletters, roadshows,presentationsBe rigorous!
35 Example of WalkRounds™ Report to Executives Update:Challenges with the process –cancelations/attendeesList of prioritised concerns raised during patient safety WalkRound for senior management attentionWhole systems concernsUnit concernsEnvironmental concernsIndividual service issues
36 Outline Feedback to Frontline Point of contactThank youDateParticipant role or identification.Recognition that this process is helping the whole organisation to improveKey priorities discussed /Actions agreedE.g.Large number of new on staff .Difficult to get enough experienced RNs on nights and weekends.Not enough equipmentAny further information contact
38 Measure Your ProgressRefer to actions taken as the result of WalkRounds during later visits to each unit.Measure safety climate changes periodically, using the Safety Attitudes Questionnaire.Continually track follow-up comments, time to complete action items, frequency scores, and other indicators recorded in the WalkRounds database.
39 Key LearningsSurprisingly, it is not difficult to elicit comments from staffImportant to have multi-disciplinary representationImportant for leadership participants to be well-versed in on-going quality/safety initiativesCan provide feedback at time of WalkRound
40 Key LearningsManaging the large amount of information is the challengePrioritisationLevels of actionReporting and sharingIn a large institution, coordinated quality and safety groups are essentialTo assign accountabilityTo receive updates on follow-up
41 Examples of successLead Nurse spending too much time on AdministrationActionsLocal review of unit activityIntroduced new hospital processes for bed management systemWhole hospital reviewNational review of Senior Charge Nurse Role
43 Summary Make a plan Tell staff what its for Listen to the discussion Agree key prioritiesAssign action andFollow upRevisit and make sure its happened
44 Further Information email@example.com NHS Tayside Kingscross Clepington RoadDundeeScotland ,UKDD3 8EA
45 Refs and other helpful resources Frankel A, Graydon-Baker E, Neppl C, Simmonds T, GustafsonM, GandhiTK:Patient Safety Leadership Walk Rounds. Jt Comm J QualSaf 2003, 29:16-26.Thomas E.J The effect of executive walk rounds on nursesafety climate attitudes: A randomized trial of clinicalunits.BMC Health ServicesResearch 2005, 5:28 doi: /