|
Petra S. Berger, PhD, RN,
CPHRM
Petra S. Berger, PhD, RN,
CPHRM, is senior editor and manager of publications for
The Risk Management and Patient Safety Institute. |
Implementing
Our Patient Safety Vision
One
Facility's Roadmap
As
the movement of patient safety in health care is
gathering speed, regulatory standards focusing on high
priority aspects of care are increasingly issued for
hospital-wide risk prevention, as well as for medical
care quality improvement. For a health care facility
accredited by The Joint Commission, many directives are
available, such as the current array of National Patient
Safety Goals that include detailed practice
“requirements” and “implementation expectations” for
both staff and medical providers (1).
“Problems with
communication” is frequently mentioned as a barrier to
implementation by facility leaders who are pioneering
patient safety initiatives. Inadequate communication in
this instance appears to denote difficulty in imparting,
conveying, disseminating, or getting across to providers
(nurses, physicians, other staff and managers) a clear
understanding about new procedures and required patient
care action steps. Such new understanding ideally
results in sustained change in practice patterns and
work habits. In other words, the challenge seems to be
to make process changes “stick.”
That same challenge is being
proactively tackled at a 25-bed, Joint Commission
accredited, rural hospital located in the upper
peninsula of Michigan in the town of Newberry, according
to its Quality & Risk Manager, Donna Slezak, and Chief
Executive, Wayne Hellerstedt (2). The facility includes
a 48-bed long-term care facility and several satellite
outpatient clinics. The fact that nearly all of the
town’s physicians are hospital employees is also
noteworthy.
At the Helen Newberry Joy
Hospital & Healthcare Center, the current national
emphasis on patient safety initiatives has resulted in a
highly focused, continued evolution of an existing
facility-wide quality and safety program. It involves
all staff from the frontline to the executive level.
Patient safety practices such as medication
reconciliation, the SBAR model for hand off
communication, and an electronic health record system,
suggested by The Joint Commission and others, are being
implemented. Executive rounds are successfully conducted
in every department on a periodic schedule in order to
elicit open and frank dialogue, feedback and comments
from frontline staff and clinicians, thereby
facilitating a direct and unfiltered flow of information
to the hospital administrator.
Facility-wide transparency
and cross-departmental collaboration is an important
component of the local “culture of safety” that was
broadly initiated four years ago as the “service
excellence program.” Non-punitive reporting of adverse
outcomes or near miss events has resulted in a greatly
increased flow of patient safety information from staff
and physicians. Any staff complaints receive prompt
attention to ensure optimum resolution.
A major topic of new staff
orientation conducted by the quality & risk manager
includes the concepts inherent in “service excellence,”
such as customer orientation, with coworkers and
physicians included as mutual customers. Since the
program was introduced, internal conflicts have nearly
disappeared and have been replaced by intentional
helpfulness among health care providers.
One approach to closing the
loop between risk identification, prompt response and
corrective action is the consistent follow-up process
carried out by the quality & risk manager. When openly
supported by executive administration, reliable
follow-up is achieved in the spirit of mentoring and
shared accountability, and is not based on blame and
automatically applied sanctions. This collaborative
partnership culture has yielded much progress in staff
commitment to patient safety strategies and has
successfully included the local union leadership as
well.
In summary, the Helen
Newberry Joy Hospital & Healthcare Center takes pride in
achieving close adherence to the National Patient Safety
Goals, which truly pays off during surveys by The Joint
Commission. The quality & risk manager considers
expectations and directives by The Joint Commission as
welcome opportunities to stay on the continuous road to
high quality inpatient services. The “culture of
safety,” or “service excellence program,” has helped the
facility to squarely address the challenge of
effectively “imparting, conveying, disseminating and
getting across” to providers an understanding about
optimum quality and delivery of patient care services.
References
1. The Joint Commission,
2008 National Patient Safety Goals, Oakbrook Terrace,
IL, 2008.
Interview on December 17, 2008, with Wayne Hellerstedt,
CEO, of Helen Newberry Joy Hospital & Healthcare Center
in
2. Newberry, MI, and Donna
M. Slezak, RN, BSN, CNOR, Director of Quality
Improvement & Risk Management.
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