1. The Application of Patient Safety Principles MORE OB and MORE EX Guy-Paul Gagné MD, FRCSC, FSOGC Director MORE OB Québec gpgagne@salusgc.com

2. The situation in Health Care “What has eluded us thus far…is maintaining a consistently high levels of safety and quality over time and across all health care services and settings. … Along with some progress, we are experiencing an epidemic of serious and preventable adverse events” The concept that I believe can and should change this is: “High Reliability.” 2 Dr Mark R. Chassin, president, JACHO, Health Affairs, April 2011

3. Patient safety “ The magnitude of medical error is enormous. The fault lies with poorly conceived systems rather than irresponsible people.” – Dr. Lucian Leape 3 Dr. L. Leape, Adjunct Professor of Health Policy at Harvard University at the National Patient Safety Foundation Meeting, Boston, Mass. 2004.

4. Patient Safety © 2011 Salus Global Corporation. MORE OB is a registered trademark of Salus Global Corporation. All Rights Reserved Dedicated, well-intentioned professionals work in complex, error-prone systems that are unsafe for patients and unhealthy for caregivers. 4

5. A new culture of safety @ 2011 Salus Global Corporation. MORE OB is a registered trademark of Salus Global Corporation. All rights reserved The IOM report - Health care organizations must develop a “culture of safety” such that their workforce and processes are focused on improving the reliability and safety of care for patients. 5

6. Culture : a definition @ 2011 Salus Global Corporation. MORE OB is a registered trademark of Salus Global Corporation. All rights reserved A culture is made of share values and beliefs that interact within an organization in order to produce behavioral norms or: “How we do things around here” It is determined by how individuals and teams learn together and work together 6

7. A culture of safety © 2011 Salus Global Corporation. MORE OB is a registered trademark of Salus Global Corporation. All Rights Reserved One way to achieve this: C-U-S-P or Comprehensive unit base safety program 7 http://www.hopkinsmedicine.org/quality_safety_research_group/our_projects/stop_bsi/toolkits_resources/cusp_toolkit.html

8. @ 2011 Salus Global Corporation. MORE OB is a registered trademark of Salus Global Corporation. All rights reserved E fficiently R isk O bstetrical M anaging From MORE OB

9. @ 2011 Salus Global Corporation. MORE OB is a registered trademark of Salus Global Corporation. All rights reserved E fficiently R isk O ur M anaging To MORE EX

10. High Reliability Organization  Air traffic control  Aircraft carriers  Nuclear power plants  Technical side of banking KH Roberts. Some characteristics of high reliability organizations,1990

11. HRO Principles 1. Safety is the priority and is everyone’s responsibility 2. Communication is highly valued 3. Operations are a team effort 4. Emergencies are rehearsed 5. Hierarchy disappears in an emergency. Decisions on safety issues can be made at any level of the organization 6. There is multidisciplinary review of events & routines American Society for Healthcare Risk Management (ASHRM). Reprinted with permission.

12. Relational Coordination © 2011 Salus Global Corporation. MORE OB is a registered trademark of Salus Global Corporation. All Rights Reserved High Quality Relationships High Quality Communication  Shared goals  Shared Knowledge  Mutual respect  Frequent  Timely  Accurate  Problem-solving Gittell JH. High performance healthcare. New York: McGraw-Hill; 2009.

13. Relational Coordination and Airline Performance Relational coordination index, is measured on a five-point scale, based on an employee survey. Airline performance is an index of quality: customer complaints, mishandled bags and late arrivals, as well as efficiency: gate time per departure and staff time per passenger. Gittell JH. High performance healthcare. New York: McGraw-Hill; 2009

14. Relational Coordination and Surgical Performance Relational coordination, is measured on a five-point scale, based on an employee survey. Surgical performance is an index of quality: patient satisfaction, post-operative freedom from pain and post- operative functioning, as well as efficiency: length of stay. Gittell JH. High performance healthcare. New York: McGraw-Hill; 2009

15. The MORE OB Program builds and sustains a culture of safety through the development of knowledge, skills, attitudes, behaviors, and practices that make safety the #1 priority for everyone, all of the time. Module 1 Learning Together Use the MORE OB Program elements to:  Embed safety practices in the infrastructure  Identify and solve patient safety issues Module 2 Working Together Module 3 Changing the Culture MORE OB Plus Building on Success  Communities of Practice  Failure Mode and Effect Analysis  Root Cause Analysis  Event Review  Disclosure  Audit  Teamwork Tools  Communication Tools  Emergency Drills  Workshops/ACEs  Skills Drills  Personal Learning Projects  Content Chapters The MORE OB Program Step by Step © 2011 Salus Global Corporation. MORE OB is a registered trademark of Salus Global Corporation. All Rights Reserved Workshops/ACEs Skills Drills Clinical content Chapters Personal Learning Projects Audit Teamwork Tools Communication Tools Emergency Drills Root Cause Analysis FMEA Even Review Disclosure Embed safety practices Identify and solve patient safety issues

16. Successful changes in knowledge, skills, and attitudes. 72% indicated that they gained confidence and were more competent in managing day to day situations 75% indicated that they gained confidence and were more competent in managing high risk situations As a nurse, it solidified what I had learned. I feel more confident and that everyone has the same level of knowledge Increased knowledge – people feel in control of bad situations when they arise - builds confidence and empowerment @ 2011 Salus Global Corporation. MORE OB is a registered trademark of Salus Global Corporation. All rights reserved Confidence and Competence

17. 77% agreed that the Program positively impacted caregiver satisfaction on the job 62% agreed that as a result of MORE OB work related stress among caregivers decreased Caregiver Satisfaction @ 2011 Salus Global Corporation. MORE OB is a registered trademark of Salus Global Corporation. All rights reserved

18. Culture Assessment Survey– Participant Averages 07/31/2010 @ 2011 Salus Global Corporation. MORE OB is a registered trademark of Salus Global Corporation. All rights reserved Average answers 1 - Never 2 - Rarely 3 - Sometimes 4 - Often 5 - Always

19. MORE OB in Alberta J Obstet Gynaecol Can 2010;32(8):74 9–755 Conclusion: The MORE OB program was associated with improvement in selected maternal and fetal health outcome indicators. When a patient safety program is introduced as an intensive, long-term continuing education and quality improvement initiative, health outcomes can be significantly impacted.

20. Alberta Study Results Frick C and all J Obstet Gynaecol Can 2010;32(8):749–755 Length of stay ≤ 48hr*: increased by 12% (first two years of the Program*) Infants on ventilator*: reduced up to 31% by Module 3 Severe infant morbidity*: reduced up to 24% Severe morbidity is an index of multiple conditions (respiratory distress; bacterial sepsis; omphalitis; cerebral, intraventricular or subarachnoid hemorrhage due to birth injury; intracranial non-traumatic hemorrhage 3 rd and 4 th degree tears*: reduced by up to 22% Infant mortality: reduced by up to 18% Hypoxic ischemic encephalopathy: reduced by up to 33% Admissions to NICU: reduced up to 11% (centres with + 1,000 births)

22. Total Incurred Costs Trend lines HIROC Data taken from 39 participating MORE OB hospitals 07/31/2010 @ 2011 Salus Global Corporation. MORE OB is a registered trademark of Salus Global Corporation. All rights reserved

23. What can I do on Monday? © 2011 Salus Global Corporation. MORE OB is a registered trademark of Salus Global Corporation. All Rights Reserved  Assemble an interdisciplinary Safety Team  Get support from administration  All activities should be multidisciplinary  Organize basic skill drills or workshop  Use simulation and emergency drills for communication and team training  Train all staff in the science of safety  Measure and celebrate the results  Be patient, this is a culture change 23

24. Thank you! Questions?