Presentation is loading. Please wait.

Presentation is loading. Please wait.

Creating a Culture of Patient Safety

Similar presentations

Presentation on theme: "Creating a Culture of Patient Safety"— Presentation transcript:

1 Creating a Culture of Patient Safety
WVU Department of Family Medicine RCB HSC- Eastern Division Konrad C. Nau, MD

2 We work in a complex environment

3 We value quality medical care
UHA STATEMENT OF VALUES We will provide high-quality service and responsiveness to our patients and to each other that exceed expectations

4 We know that error happens

5 We know that patient safety is the bedrock of quality care
Institute of Medicine: Quality Care

6 IOM elements of “Quality”
Safe: avoiding injuries to patients from the care that is intended to help them Timely: reducing waits and sometimes harmful delays for both those who receive and those who give care Effective: providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit (avoiding underuse and overuse) Efficient: avoiding waste, in particular waste of equipment, supplies, ideas, and energy Equitable: providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status Patient-Centered: providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring that patient values guide all clinical decisions “STEEEP” Framework outlined by the Institute of Medicine (“IOM”)

7 We preach “quality” but can we say we have a true “culture of safety”
“The way we do things around here” Safety Avoiding injuries from care intended to help patients

8 Can everyone in our clinic name five ways to improve patient safety ?

9 AHRQ Five Steps to Safer Health Care
1. Ask questions if you have doubts or concerns. 2. Keep and bring a list of ALL the medicines you take. 3. Get the results of any test or procedure. 4. Talk to your doctor about which hospital is best for your health needs.. 5. Make sure you understand what will happen if you need surgery.

10 Delivering on our Promise of Quality Medical Care
Quality Care Patient Safety

11 Patient Safety & Quality Medical Care
Two fundamental questions guide us, as a world-class academic family medicine center, and in this order: 1.How can we help the patient? 2.In doing so, what can we learn?

12 Patient Safety Campaign WVU Dept Family Medicine-East Div
Patient Safety Kickoff System of Reporting and Analyzing Error Regular Patient Safety Grand Rounds Create a Culture of Safety

13 Patient Safety Kickoff
Entire office assembled off-site for lunch meeting January 2005 Present : Epidemiology of Medical Error Present : Creating a Culture of Patient Safety

14 System to Report and Analyze Error
Electronic Occurrence Reporting System Quantros/Dr Quality/ORM Web based We encourage ALL staff to file reports online Patient injury Adverse drug reactions Near-misses Non-putative, can be filed anonymously

15                Click here to report an occurrence (a.k.a. variance or incident) anonymously. You do not need a User ID or Password to do this. Please assist us in creating a safer healthcare environment for the customers we serve

16 Resident Physicians Reporting and Analyzing Error
All residents are REQUIRED to self report their own “medical errors”. Electronic format is confidential and Peer Review protected. Encourages reflection and honesty expected in physicians Non-putative focus on systems-based analysis Will formulate basis of Patient Safety Grand Rounds topics

17 Patient Safety Grand Rounds
Bimonthly – residents, faculty, students, invited clinic staff Based on resident’s self reported medical error or near miss Clinical case presented Systems-based analysis of the error Present patient safety literature that supports recommendations Case Report and analysis is written up and reviewed with Chair prior to required submission to AHRQ M&M

18 Create a Culture of Patient Safety
Enhance clinic library with Patient Safety materials Journal of Patient Safety Patient Safety & Quality Healthcare Journal Seminal textbooks Crossing the Quality Chasm To Err is Human Enhance clinic technology for Patient Safety Clinic wide Lexicomp/Drug Interaction software on all computers and handhelds Redesign Clinic Web Page Medication Charts Office Visit preparation/safety tips

19 Create a Culture of Patient Safety
AHRQ Patient Safety Culture Survey Outpatient format available in PDF or Word Results display template on PowerPoint Involve entire clinic in patient safety culture survey Patient focus groups to inform clinic about patient stakeholder perspectives Clinic leadership makes “Patient Safety Rounds”

20 Patient Safety Culture Survey

21 Overall Perceptions of Safety
Sample culture Survey result slide: Overall Perceptions of Safety Survey Items % Strongly Disagree/ % Neither % Strongly Agree/ Disagree Agree 1. Patient safety is never sacrificed to get more work done. (A15) 2. Our procedures and systems are good at preventing errors from happening. (A18) R3. It is just by chance that more serious mistakes don’t happen around here. (A10) R4. We have patient safety problems in this unit. (A17) R Indicates reversed-worded items. NOTE: The item letter and number in parentheses indicate the item’s survey location. Page

22 Quality Primary Care for the 21st Century
Safe Patient Care Consistent Best Practices Great Patient Service

23 Ambulatory Patient Safety Culture
Create a Culture of Safety Culture = the way we do things around here Culture of Safety Requirements Visualize a safe system Non-punitive environment Leadership support Quality Care Patient Safety

24 Ambulatory Patient Safety
Capture errors that occur Analyze errors Follow-up on analysis Safety projects will emerge Medication EMR Communications Team work Test results Pt education about safety Quality Care Patient Safety

25 First Class Patient Safety will require everyone’s best efforts

26 We need creativity

27 We need enthusiasm We need you.

Download ppt "Creating a Culture of Patient Safety"

Similar presentations

Ads by Google