1. Southlake Academic Family Health Team’s “Doing It Better” Rounds
A DFCM Learning Collaborative
Congress: February 09, 2018

2. Patient Safety Leadership Team
Dr. David Makary, Quality Improvement Director, Family Medicine Residency Program
Dr. Gurpreet Mand, FMTU Faculty
Dr. Monica Nijhawan, Site Director, Family Medicine Residency Program
J.C. Kirk, Executive Director, Southlake Academic Family Health Team
Identify that this team was “voluntold” as they were seen as important to achieving the leadership element from the IHI Framework
Highlight the original titles when the group was formed
Highlight, we hope this team will change and grow over time, however, goal was to have a team in place that was large enough to help facilitate success, but small enough to achieve deliverables in the first year of this initiative.

3. Our Beginning
SAFHT collected and reviewed patient safety incidents arising from our FHT employed administrative staff and IHP
Reviewed/actioned upon by SAFHT’s executive director and medical director
While efforts had been made to ensure this was conducted within a safe and just culture, we recognized that a team approach was missing if the goal of patient safety improvement was to truly be disseminated across the entire organization.

4. Initial Goals Learn from other Academic Sites. Of special thanks:
Sunnybrook Academic Family Health Team
Toronto Western Family Health Team
Build a sustainable project
Recognize capacity limitations of leadership team and our organization
Integrate patient safety into the culture of the organization, including our physicians and residents
Use our main site (academic site) as the initiator
Achieve an observable improvement in patient safety

5. Framework of our “Doing it Better” Rounds
Developed a communication strategy and rounds documentation (Excel Tracker and Power Point Template)
Goal: 1 hour rounds, 3 times per year
All sites invited, participation facilitated by webinar links
Guiding Principles:
Safe and Just Culture
Consistency and Fairness
Team Approach
Confidentiality
Identify, this allowed us to focus on the following IHI framework elements:
Psychological safety
Teamwork and Communication
Continuous Learning
Improvement and Measurement (to some degree)

6. First “Doing it Better” Rounds
September 2017
Case identified and presented by the leadership team
Case included administrative staff, IHP, residents and physicians
Rounds attended by academic site physicians, residents, IHP and administrative staff (employed by FHT)
Successfully introduced rounds concept and completed:
Case review
Root cause analysis in small groups
Identification of mitigation strategies

7. Results of First Rounds
Successes:
Participation from all teams (physicians, residents, IHP, admin)
Completed in one hour
Following the rounds, collaboratively developed a interim solution and a subsequent permanent solution to address the root causes identified
Lessons:
Barriers for webinar participation
Communication strategy had missed some individuals
Lack of participation from satellite sites
No feedback on rounds or tracking for statistical analysis
Success:
Collaboration included the patient safety leadership team, admin and nursing leaders and consultation with IHP, physicians and admin.
Highlight, that the case had been identified as a high likelihood of recurrence and severe impact if it reoccurred, so while not perfect, our interim solution mitigated the risks and we developed a more complex process to handle the issue if it were to arise again.
Lessons:
Webinar – include unable to hear discussion or see items written on white board
Communication Startegy

8. 2nd “Doing it Better” Rounds
Strategies implemented to improve:
Pre-rounds communication
Offsite participation
Feedback
Reviewed past case – 93% of participants reported being “Very Aware” or “Somewhat Aware” of the permanent solution implemented
Case put forward and presented by one of our residents
78% of participants indicated these rounds are “Very Important” to improving patient safety within SAFHT
Include picture from 2nd rounds
Highlight, that we struggled with what to include on the post Rounds survey (Improvement and Measurement element of IHI Framework).

10. Future Direction Continue Rounds Cases Identification Participation
Increase participation
Expand the Patient Safety Leadership Team
Expand the scope to include a review all patient safety incidents in the organization
Integration of “Doing it Better” Rounds with the Southlake Regional Health Centre
Ensuring cases continue to be put forward, especially by physicians indicates our difficulty with psychological safety, accountability and teamwork on the IHI framework.
If we ever wanted to pursue bullet 4, this would be a significant cultural shift, especially for non-FHT employees. Overcoming psychological safety and accountability on the IHI framework would be a challenge.