Becker's Hospital Review

51 Executive Briefing: Patient Safety Sponsored by W ith more than 400,000 Americans dying each year from preventable medical harm and errors, the ques- tion remains whether patient safety is really a priority in healthcare. While some hospitals are making great strides, there has been little overall improvement (6.3 percent) in hospital performance since 2012, according to the Leapfrog Group's spring 2014 Hos- pital Safety Scores. Many industries, such as mining and manu- facturing, involve inherently dangerous lines of work, but the best companies attack safety with a vengeance and nearly eliminate preventable errors and accidents. Organizations in these indus- tries put employee safety first at all times, and the same focus should be put on patient safety in healthcare. 1. Patient safety must be part of hospital culture. Putting pa- tient safety first requires healthcare organizations to commit time, resources and energy. Hospitals should not have to put their dai- ly operations on hold while they address patient safety issues. Rather, this focus should be part of their daily operations and an inherent part of their culture. The rate at which patients are put at risk would be unacceptable in other industries. The best companies create a culture where every meeting starts off with a safety topic. Leaders and front-line staff hold each other accountable for even simple safety behaviors and everyone is focused on reaching the goal of zero incidents. They do this even though providing their products and services, and thereby making a profit, is the real organizational purpose. In healthcare, patient outcomes and safety are the organization's purpose. The goal of keeping patients safe needs to be built into every interaction, thought and process at our hospitals. Every physician, administrator, nurse and front-line staff member should make patient safety their number one priority. 2. Allow clinicians to speak freely about medical errors. Par- ticularly in manufacturing, facilities that embrace Lean and Toyota Production, errors are seen as opportunities to improve process- es and performance. Many times, clinicians will not identify or discuss medical errors because they fear retribution. Allowing clinicians to report medical errors without fear is essential to patient safety, and hospital lead- ership is responsible for establishing a solution-oriented culture that values open communication. To implement an effective system for change concerning patient safety, hospital leadership must engage clinicians and all staff and encourage them to speak honestly. Through discussion, clini- cians can learn from mistakes and the conversations can inspire change in staff. By reducing individuals' inhibitions to speak up, hospital leaders can also learn of safety issues or near misses that result from systemic problems and demand organization- wide solutions. 3. Mandating protocols is not enough. When healthcare adopts Lean and other manufacturing solutions, they often focus on pro- cess at the expense of the role of people. Toyota will tell you that Lean is about two pillars — "process" and "people." The process won't work without engaging people. The Joint Commission Universal Surgical Protocol is a checklist endorsed by 50 national groups that was mandated for use in every hospital in 2004. The goal was for hospital staff and cli- nicians to use the checklist to standardize processes and elimi- nate errors in the operating room. Checklists are widely used with great success in other industries, but many hospitals originally had little success with OR checklists. In fact, some actually saw an increase in reportable events. The OR checklist did not work, and here's why: Merely mandat- ing that surgical teams implement the protocol was not enough. After their initial failure, some hospitals "re-implemented" surgical checklists, engaging staff in a larger OR approach focused on patient safety. The takeaway for any patient safety program? It's not about the checklist. The checklist is only one tool in a larger, staff-driven patient safety initiative. Checklists don't change cultures. 4. Collaboration is key. By taking a step back, many hospitals realized success with an OR checklist requires a high degree of teamwork and collaboration — and that these qualities and be- haviors cannot be assumed. The whole team, including techni- cians, anesthesiologist, surgeons, support personnel, surgical assistants, nurses and nurse anesthetists, had to work together to make the checklist effective. Collaboration is a relatively new concept in healthcare, an indus- try that has traditionally valued professional autonomy. Certainly there are areas where collaboration is the norm — think of a well coordinated trauma team. But when it comes to broader challeng- Are Hospitals Really Serious About Patient Safety? 6 Things We Can Learn from Other Industries By Bryan Warren, Manager, Healthcare Solutions, Select International

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