Why This Matters

Patients can both improve their own safety and encourage providers to adopt advanced safety practices by asking the following questions of their healthcare providers:

Do you use Patient Safety Checklists?

By ensuring that providers do not forget steps and allowing them to reflect on each completed step before moving on to the next, Patient Safety Checklists have proven extremely effective in reducing the risks of medical procedures, such as surgery, childbirth, infectious disease/pandemic management, and trauma treatment.

Sources

(1) www.hospitalsafetyscore.org/

(2) leapfroggroup.org/policy_leadership/

(3) atulgawande.com/books/

(4) ahrq.gov/professionals/quality-patient-safety/

(5) hospitalsafetyscore.org/

(6) Gawande, A. The Checklist Manifesto: How to Get Things Right. New York: Picador; 2010. p. 24.

Checklists are a vital tool in improving healthcare safety and accountability.

At the same time, even the best system of self-regulation depends on the participation of the individuals using it. In order to aggregate and prioritize the data gathered by the system, administrators must know that the front-line workers entering the data are doing so accurately. (1)

Readiness Rounds recognizes the importance of vigilance in scrutinizing real-time data, both in achieving optimal outcomes for our clients and for our ability to determine and maintain our own best practices.

The following three keys to making the best use of hospital checklists come from direct, extensive experience in the field.

Within a healthcare organization, three key factors must be in place if a self-regulatory system is to function efficiently. The first two elements help ensure that the people submitting data to the system will do so accurately. The third concerns the way in which administrators handle the data once it has been collected. (2)

The 3 Keys to Effective Hospital Checklists

Key #1. It’s Not About Getting a High Score

A culture of safety must guard against the very natural human desire to “get a good grade.” Although it is important to recognize those individuals and departments that are consistently high-performing, administrators must resist creating a culture that encourages people to “spin” or alter data to present their own performance as being better than it really is. Administrators must also be willing to apply special scrutiny to departments that report at or near 100% accuracy.

Such numbers could be a red flag, suggesting that the data is idealized, not realized. The goal of a culture of safety is, of course, to score 100% on every checklist. Pragmatic administrators, however, recognize that this goal is unlikely to be reached even on a single checklist, except on very rare occasions. (3)

Key #2. Approach every observation as if it has failed

Those who interpret the data generated by checklists cannot assume that all data in the system is reliable. Such an assumption can be dangerously misleading. Even in the most highly developed culture of safety and teamwork, administrators must be willing to look carefully at the input they receive. Ideally, all aspects of data collection and aggregation should be reviewed independently by several safety team members on an ongoing basis.

Key #3. Celebrate Failures

The flip side of the first key, is that within a safety culture, it is critical that failures and shortcomings be treated sources of valuable feedback for improvement. Employees must feel safe from reprisal in reporting problems and adverse events and must know that their concerns will be taken seriously. Administrators must create an atmosphere in which failures generate cooperative problem-solving rather than punitive measures. Only in such an environment will individual workers be motivated to report data accurately, especially when the data illuminates a failure to meet expectations.

By creating a culture in which failures are seen as opportunities to improve, and the goal of 100% accuracy is seen as a process, not a requirement, organizations can minimize the motivation for individuals to idealize the data they submit. In addition, persistent scrutiny of all aspects of the data gathering process further ensures accuracy in reporting and planning and thus promotes continuous process improvement.

1. Service Recovery in Real Time

A key building block to effective Patient Satisfaction and Experience is ensuring the design incorporates the ability to move your organizational culture away from the idea that this is a data collection exercise to be reviewed in a meeting at some later date.

While data collection is part of the exercise, the design must focus on uncovering service failures and executing service recovery in real time.

Done effectively this rounding will uncover patients’ issues. 

When you find a patient’s issue, it is critical to resolve it immediately.

Failure to act on issues or complaints adds fuel to the fire. 

With this volume of observations and potential failure points, the ability to respond effectively in real time is crucial.

An organizational question not asked often enough is, "Are we prepared to invest five minutes a day with each one of our patients to ensure they are satisfied with our service?"

• Don’t send a notification on a pain issue; get the nurse and have it attended to immediately. That is service and will be recognized.
  
  

Always look back at your discussion from yesterday and be sure that any issue identified stays fixed.

Spend time with these departments, ensuring they understand the response expectations and the hospital goal of improving patient satisfaction.

“Kind words can be short and easy to speak, but their echoes are truly endless”  —  Mother Teresa

Incorporate automatic paging or texting to ensure a prompt response.

Housekeeping often has, or should have, a house pager that is transferred from shift to shift to prevent this type of failure.

Do not rely on phone messages, or “remembering.” Build the functionality into your process.

This requires fairly sophisticated software and internal process development and is a crucial foundation for effective service recovery. This is discussed further under #9. Seamless Technology, below.

Accountability for all individuals is a key component for improving service recovery consistently.

Senior management must walk the talk. If there is not anxiety and pressure to get items resolved quickly, the process will not be sustainable.

• Don’t buy the “cheap” version. Look at the low end versions and capability so you are aware of the limitations. It almost certainly will not support your process. Find a supplier who has the software, a thorough understanding of hospitals (ideally specializes in hospitals), and who can demonstrate operational knowledge of patient care rounding.
• Stay out of the technology. Patient experience will improve if your focus is on:
• Ensuring patient rounds are completed daily.
• Ensuring that the staff conducting patient rounds make a thorough, honest assessment.
• Ensuring that service failures are corrected immediately.
• Initiating Performance Improvement against items with a high-fail rate.

This is a major task and typically involves a significant cultural shift. Don’t take this all on and assume responsibility for technology as well.

• Weekly / Monthly Summary: This is a consolidated view of all activity showing completion rates, highest failing items, etc.
• Department Dashboards: Incorporating these results into individual department dashboards to allow nursing unit managers to track their progress and results is critical. We often hear front line nurse managers say, “We conduct all sorts of checklist and patient rounds, but no one ever gets us the results consistently.”
• Performance Improvement: Take advantage of all of the hard work that has been done. Find the issues that are failing at a high rate and use the data to drive the performance improvement team’s focus. The key PI concept is that if you have one item failing at a high rate, it will be a “systematic” issue requiring correction.

Summary

• If it’s not Real Time, stop and redesign the approach
• Every patient, every day!
• Get the resource committed
• Hardwire service recovery for same day
• Ensure rounds are conducted thoroughly each day

Beginning January 1, 2017, Joint Commission-accredited nursing care centers are required to “implement evidence-based practices to prevent indwelling CAUTIs.”

According to the Joint Commission, the new National Patient Safety Goal will improve patient safety and mortality and reduce the costs and lengths of stay associated with CAUTIs. New elements of performance (EPs) include:

• Educating staff and licensed independent practitioners involved in the use of indwelling urinary catheters about CAUTI and the importance of infection prevention.
• Developing written criteria, using established evidence-based guidelines, for placement of an indwelling urinary catheter.
• Following written procedures based on established evidence-based guidelines for inserting and maintaining an indwelling urinary catheter.
• Measuring and monitoring CAUTI prevention processes and outcomes in high-volume areas.

Source: The Joint Commission

Read more about the new TJC SAFER Matrix here.

How Hospital Room Design Can Prevent Falls

As professionals in healthcare, we are taught and trained to heal, not harm. But when poor patient outcomes occur, who is to blame? The short answer is “everyone.” Whether you’re a front-line nurse, a department manager, the Director of Quality, or the CEO, YOU are to blame when your hospital fails the patient.

At this point, you may be asking “How am I to blame? I wasn’t the caregiver on the floor who made the error or mistake!” The truth is that it doesn’t matter – blame takes many forms and equally touches everyone in the hospital setting, no matter what their role may be.

Many of the professional articles that we have time to read (or at least skim through) give us the facts and the figures of healthcare associated infections (HAIs), then provide suggestions for implementing a “perfect world process” within our facilities. Everyone working in healthcare knows that their time is strictly limited and that implementation and maintenance of a multidisciplinary, large scale project is difficult to accomplish, at best.

Could the solution be as simple as a checklist? Of course! Checklists help staff ensure that they remember to take all necessary steps and precautions when performing rote tasks, such as indwelling catheter insertion and they also make clear the required and expected steps in complex processes such as inserting central and peripheral intravenous lines, thereby reinforcing adherence to established protocols. They also provide a sense of confidence to the staff that know that they are providing not only appropriate, but safe care to their patients.

Checklists are simple and proactive tools that can be used by anyone within the organization that will provide real-time data that pinpoints straight to the area/s where performance improvement is needed the most. In addition, routine use of the checklists will help show if implemented initiatives are successful or require redesign. Used wisely, they can help an organization transition from the endless “blame game” resulting from poor outcomes towards a culture of accountability and overall improvement in patient safety and the quality of care provided.