C&A is holding a series of dialogues, published in our newsletter, with leaders in the field around the topic of patent safety. These dialogues are shared with the hope of creating synergy among the work of quality improvement, regulatory compliance and patient safety initiatives. This month we provide an interview featuring Robert Imhoff, CEO of Maryland Patient Safety Center, and C&A CEO, Jill Ryan.
The Maryland Patient Safety Center, in collaboration with C&A, has created an organization-wide patient safety certification program which is currently being piloted in healthcare organizations in the state of Maryland.
Q: Robert, please share with our readers why an organization-wide patient safety certification approach works.
RI: An organization-wide patient safety certification program is all about collaboration, participation and partnership. Typically, in healthcare we have seen organizations work in silos, where staff is directed to work in their respective roles and units. There may be one person responsible to lead all patient safety efforts and perhaps even a patient safety committee, but a team-oriented, top down and bottom up approach to safety is often lacking. We know from research that there is so much to do in the realm of patient safety. Our program is designed to push the envelope, to help organizations get out of the bubble and require people to work together as one unit. In fact, one of our criteria for certification is that 80% of the organization has to work together in a unified approach. We know that patient safety requires all staff at all levels to participate. All aspects of the organization are involved.
Q: Jill, when you hear Robert talk about the tenets of the certification program, how does that tie into your own perspectives on patient safety?
JR: The first thing I tune into is the notion that patient safety is everyone’s responsibility. We can look back as far as Hippocrates and the oath to “do no harm” to see this has been our directive in healthcare for centuries. Yet, we still see wrong site surgeries, suicides in hospitals and patient falls despite the intensive regulatory and accreditation focus on patient safety.
Organizations have not yet gotten to a place of full transparency. Patient safety concepts need to be embraced and championed by Leadership teams. Organizations need to strive for high reliability, to be forward thinking, to not just think about the defect. There needs to be a focus on continual, robust process improvement, efforts to increase patient and family engagement and to enact fair systems of accountability.
Q: Robert, when thinking about the needs that remain in patient safety, what kinds of results have you seen in your pilots?
RI: Anne Arundel Medical Center (AAMC) was the first organization to enter the pilot and the first to receive organization wide patient safety certification. This organization demonstrated marked results in patient safety measures, but I’ll pick up on one thing Jill mentioned and that is transparency. We know this is a huge need and as it turns out one of AAMC’s biggest successes. AAMC experienced significant increases in their reporting. We saw a 73% increase in near miss reporting from the pre-pilot period to the twelve months post pilot. Unsafe conditioning reporting went up 16%. AAMC has adopted an appreciative inquiry methodology, looking at how strengths can be used to affect areas of need and this, combined with their just culture approach, has contributed greatly to the evolution of their culture of safety. The reporting has increased because staff from all levels of the organization have gotten involved.
Q: Appreciative inquiry allows organizations to learn what the opportunities are in their organization. What are the opportunities to improve patient safety? To improve culture? To address areas of need?
JR: Opportunity is the key word. Often opportunity has been placed in the hands of a select few. With this approach, everyone participates in the identification and mobilization of driving opportunities to measurable actions. Creating culture that is just and transparent – that drives improvement – is paramount. Leadership needs to provide more resources, to create a culture of shared responsibility.
RI: It is a developmental process, not an edict. People have to understand they are part of the process. AAMC deeds matched their words. They were successful in achieving buy-in at all levels.
JR: Processes have to be built and embedded in the organization. Competing priorities cannot knock patient safety out of first place.
RI: It is so important to remember that staff are pre-disposed to helping people. They went into healthcare because they want to help patients, to do the right things, to not contribute to harm. A culture of safety is self-perpetuating, helps put things on the right path. Management has to support and focus on this.
JR: It really must be a leadership priority. Leadership needs to make patient safety an organization priority, a planning priority, a budget priority. It starts and ends with leadership.
RI: If I could impart one thing I derive form the certification program is for organizations to be introspective. To look closely at what they are doing. To recognize that there is always room for improvement. What can we truly do? Not just to improve our dashboard, but to improve our culture, to make patient safety the priority it should be.
JR: We will all benefit if we can look beneath the surface and drive our efforts to benefit our patients and families while setting our employees up for success.
Special thanks to Robert Imhoff for sharing his perspectives with us.
For more information about Maryland Patient Safety Center click here