1. Treating Harm to Dignity as Preventable Harm Team Elizabeth Crowell, Patient-Family Advisor, Erica Dente, Patient-Family Advisor, Patricia Folcarelli, HCQ, Jane Foley, Nursing and Patient Care Services, Lachlan Forrow, Palliative Care and Ethics Support Services, Harvey Freishtat, PCAC Member, Shari Gold-Gomez, Interpreter Services, Jennie Greene, Communications, Stephanie Harriston-Diggs, Volunteer Services, Nancy Kasen, Community Benefits, Barbara Sarnoff Lee, Social Work, Lynn Mackinson, Critical Care Nursing, Kathleen Murray, Performance Assessment and Regulatory Compliance, Stephen O’Neill, Social Work and Ethics Support Services, Kenneth Sands, HCQ, Lauge Sokol Hessner, Medicine and HCQ, Melinda Van Niel, HCQ Treating Harm to Dignity as Preventable Harm Team Elizabeth Crowell, Patient-Family Advisor, Erica Dente, Patient-Family Advisor, Patricia Folcarelli, HCQ, Jane Foley, Nursing and Patient Care Services, Lachlan Forrow, Palliative Care and Ethics Support Services, Harvey Freishtat, PCAC Member, Shari Gold-Gomez, Interpreter Services, Jennie Greene, Communications, Stephanie Harriston-Diggs, Volunteer Services, Nancy Kasen, Community Benefits, Barbara Sarnoff Lee, Social Work, Lynn Mackinson, Critical Care Nursing, Kathleen Murray, Performance Assessment and Regulatory Compliance, Stephen O’Neill, Social Work and Ethics Support Services, Kenneth Sands, HCQ, Lauge Sokol Hessner, Medicine and HCQ, Melinda Van Niel, HCQ The Problem Aim/Goal The Interventions The Results/Progress to Date Lessons Learned Next Steps At BIDMC we have a process and strategy for identifying physical harm to patients, assessing whether that harm was preventable, and creating systemic solutions to stop the preventable harm from recurring. However, we recognized that sometimes our patients also experience harm to their dignity and disrespect at BIDMC, and we want to prevent this harm from occurring as well. At the same time, the Moore Foundation challenged us to incorporate respect and dignity into our preventable harm work in the ICUs, and we saw an opportunity to develop an institution-wide strategy to address disrespect and harm to our patients’ dignity, and improve the Patient Centeredness of our culture. To identify the major categories of harm to dignity, assess their frequency through tracking and trending, add these categories to the BID Preventable Harm Dashboard to increase visibility, and begin to address the problem of harm to dignity by replicating the thorough, tiered review process already in place for physical harm. Define the terms “respect” and “dignity” Determine the categories of harm events that occur at the medical center regarding respect and dignity, and add these to the preventable harm dashboard Conduct interviews to better understand under-served populations’ perceptions of respect and dignity to ensure our definitions are complete Complete a retrospective look at the patient safety databases that track concerns to obtain a baseline figure Present the concept to leadership teams to get their feedback and buy in Integrate harm to dignity into the existing preventable harm framework, including high level case review We have created new categories for the preventable harm dashboard. We have also educated staff on our efforts around harm to dignity and have created a way for them to report such incidences in the RL6 reporting system to make it easy for staff to identify and report these occurrences. We need to recognize the contributions of system factors, focus on learning rather than judging, and support providers so they can improve in a just culture. The severity of these events is difficult to determine, because there is no existing scale and there are so many perspectives involved including the patient, the provider, the health care quality staff. We continue to revise our own scale to create the most accurate measure possible. It is important to account for the perspective of those patients who are not speaking up about the harms they have suffered. We will continue to engage with community health centers and marginalized populations to make sure their voices are heard. Implement a review process for adverse events and put several cases through the existing QI Structure for review and corrective action generation (i.e. QI Directors, Chiefs, Patient Care Assessment Committee) Report the Respect and Dignity harm outcomes on the dashboard to a variety of leadership groups. Continue to engage staff and patients, around this work and encourage them to report events and support the review process.

2. R&D Section - PREVENTABLE HARM AT BIDMC FY15 AIM FY15 Targe t Q1 15 Q2 15Q3 15Q4 15 Disrespectful Communication (Severe) ▼0 Language Related ▼0 Etiquette Related [Total Reviewed: 6] ▼0 Failure to be Patient-Centered [Total Reviewed: 38] ▼0 5 Prejudice or Discrimination that Affects Care [Total: 1] ▼0 Minimization of Patient Concerns (incl. Pain Management) [Total Reviewed: 8] ▼0 2 Failure to Conduct or Incorporate Advance Care Planning [Total Reviewed: 1] ▼0 Adverse Event Related [Total Reviewed: 1] ▼0 1 Failure to Maintain an Environment that Preserves Dignity (Severe) ▼0 Privacy Violation – Auditory/Information [Total Reviewed: 4 ] ▼0 1 Privacy Violation – Physical ▼0 Visitor Mismanagement ▼0 Prolonged unclean conditions – Environment. [Total Reviewed: 3] ▼0 1 Prolonged unclean conditions – Personal ▼0 Failure to Provide Appropriate Care after Death (Severe) ▼0 Body Mismanagement ▼0 Bereavement Related ▼0 Failure to Care for Personal Possessions (Severe) [Total: 6] ▼0 Other Disrespect Causing Harm to Dignity (Severe) ▼0 TOTAL [68 Q1 Events Reviewed] ▼0 10000

3. Sign in to Portal; Click on Report an Incident

4. Click the link to the reporting system

5. Login with your BIDMC username and password

6. Wait for the screen to come up; find “Respect and Dignity” Icon, and click.