Issue link: https://beckershealthcare.uberflip.com/i/1311160
16 PATIENT SAFETY The path to zero harm: How to create a culture of safety in the OR In collaboration with Stryker W hile errors are unavoidable, achieving zero harm in periopera- tive settings isn't. In a Oct. 20 webinar hosted by Becker's Hospital Review and spon- sored by Stryker, industry leaders discussed the leadership values and management tools necessary to transform ORs into high-reliability systems. e presenters were: • Jessica Perlo, director of joy in work at Boston-based Institute for Healthcare Improvement • Valerie Marsh, DNP, RN, clinical assistant professor at Ann Arbor-based University of Michigan School of Nursing • Colleen Clancy Harrington, change management consultant at Hingham, Mass.-based C2 Consulting • Frank Federico, vice president and senior patient safety expert at the Institute for Healthcare Improvement It's unavoidable — humans will make errors, Mr. Federico began. Of the top 10 sentinel events, 30 percent occur in surgical or invasive procedures, according to the July 2020 Joint Commission report. To develop a highly reliable organization, trust must be established as a foundation of both the learning system and culture. Considerations Workforce harm must be considered when embarking on the journey to becoming a zero-harm organization, according to Ms. Perlo. In- stitutional leadership needs to be held accountable for staff well-be- ing. Leaders should also empower the care team to speak up about unsafe, highly stressful or morally challenging conditions and ensure those concerns are addressed. High rates of burnout can stem from insufficient resources, unsustainable hours, documentation burden, racism and sexism. To address these deeper concerns, organizations must constantly ask for feedback, provide channels for anonymous concerns and articulate leader accountability, Ms. Perlo explained. Dr. Marsh agreed, adding that zero-harm organizations must first identify the cause of the errors. Problems are most oen rooted in human error, according to Dr. Marsh, and systems have to be "brave enough to look at human factors, and then develop a just culture, which is where you don't blame people but instead hold them accountable." Cultures of blame are not found in highly reliable organizations, Dr. Marsh concluded. Best Practices Culture eats strategy for lunch, as the adage goes. As healthcare leaders look to create and maintain cultures of high reliability in the OR, they must consider organizational culture as much as any other strategy deployed, including relationship-centered communication skills training (ex: Marshall Rosenberg's nonviolent communication training), structured communication rounds (ex: visual management boards) and Listen-Act-Develop models, according to Ms. Perlo. How staff treat each other drastically changes culture, Ms. Har- rington explained. One outpatient surgery center took the "Ritz Carl- ton approach," where patients and other departments were all con- sidered customers. "Before walking away from one another, we'd say 'Is there anything else I can do for you? I have time,'" Ms. Harrington said, adding that the approach made people feel comfortable opening up and asking for help. e new culture improved staff atmosphere and civility, which also positively affected patient care. Empowering staff To encourage staff to champion changes that support high reliabil- ity and safety, leadership must ensure staff have the resources to effectively further the cause. "Prioritize giving that person room to explore the task they're championing," Ms. Harrington explained, emphasizing the importance of mentorship. "Mentorship is a huge piece of the puzzle," Dr. Marsh agreed. Her institution developed a program to support champions, in which nurse executives come forward with patient safety ideas and partner with someone who can help with research, provide resources, and support the nurse execu- tives to implement and drive change. Using technology to support safety Change management processes oen include technology that sup- ports workforce and patient safety. Stryker focuses on developing simple solutions that support systemic changes to drive standard- ization and help mitigate common risks and hazards in the OR, including the Neptune Waste Management System, SurgiCount Safe- ty-Sponge System and comprehensive smoke evacuation portfolio. n Culture eats strategy for lunch, as the adage goes. As healthcare leaders look to create and maintain cultures of high reliability in the OR, they must consider organizational cul- ture as much as any other strategy deployed.