Loretta Consiglio-Ward, MSN Robert Dressler, MD, MBA Neil Jasani, MD, MBA Lisa Maxwell, MD Carol Moore, MS, FNP-BC. AIAMC Annual Meeting - March 2015

Transcription

1 Loretta Consiglio-Ward, MSN Robert Dressler, MD, MBA Neil Jasani, MD, MBA Lisa Maxwell, MD Carol Moore, MS, FNP-BC AIAMC Annual Meeting - March 2015

2 Didactic Integration of a Resident Quality & Safety (Q&S) Council into organizational Q&S structure and GME Creating future physician leaders in quality and patient safety Small group discussion Small group report out Update on CCHS initiative Final thoughts and wrap up 2

3 To discuss use of tools to guide the implementation of a Resident Quality & Safety Council To discuss methods for measurement of safety and reporting climates in the GME enterprise To recognize barriers to implementing a Resident Quality & Safety Council through case-based learning To develop strategies for effectively addressing barriers to implementation To understand how to integrate Resident Quality & Safety Councils across clinical departments and within your organization 3

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5 Two hospital 1100 bed tertiary care regional referral center Hospital Admissions (16 th ) 52,884 Residents and Fellows 255 Outpatient ti t Visitsit 531,483 Residency programs 15 ED Visits (22 nd ) 166,945 Fellowship programs 6 Births (28 th ) 6,641 Employees 10,447 Surgical Procedures (19 th ) 40,220 Medical-Dental Staff 1,447 Clinical research studies 709 5

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7 5 Key Questions CLER Site Visit How is the hospital s infrastructure designed to address the 6 focus areas? How integrated is GME leadership and faculty in hospital efforts across the 6 focus areas? How engaged are the residents/fellows in hospital efforts across the 6 focus areas? How does the hospital determine the success of its efforts to integrate GME into the 6 focus areas? CCHS group within NI IV Patient Safety Duty Hours Fatigue Management Supervision Professionalism Transitions of Care Healthcare Quality Healthcare Disparities What are the opportunities the hospital has prioritized for improvement? 7

8 No deliberate or formal connection between GME Q&S efforts and system structure for Q&S

9 CMO GME Chief Safety Officer Q&S leadership Department Chairs Q&S education Senior Leadership NI-IV Steer Committee Program Directors Risk Management Patient Safety Leaders Operations Group Current State Data Analysis 9

10 Safety Climate Assessment-CLER Survey All residents, program directors, medical students, fellows and faculty 2-3/2014 Reporting Climate-# Reports Submitted Resident Participation in System Committees/ Councils New Interns Attitudes Assessment 10

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17 63 % (115) observed at least 1 event in past 3 months 35 % (62) reported event themselves Receive feedback from reporting - 51% agree, 49% disagree Reports impact system changes 49% agree, 37% not sure 17

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22 System Initiatives Achieve Alignment of GME and System efforts Resident Safety Council Create a collaborative, two-way interface to disseminate ideas and safety activities across departments Department / Program Initiatives

23 No deliberate or formal connection between GME Q&S efforts and system structure for Q&S N C il New Council reports out to Safety First Committee

24 2 nd Tuesday 4-5:30 Pre-work / Homework from previous session Review / Discuss assignments Introduce a specific tool that incorporates principles needed for next assignment Present next assignment 24

25 Invited members with: Expertise in quality and safety Leadership roles in the system Leads of system Safety/Quality initiatives Important collaborative partners to the Council Ex. Could be resident representatives from other safety initiatives other safety initiatives 25

26 What would be your barriers to implementing a program such as this? Flip through toolkit on your table Brainstorm and list identified barriers Report out 26

27 What are solutions to the top barriers identified? Each table brainstorm solution to assigned barrier Report out 27

28 There have been seven meetings Average individual attendance is 61% Overall attendance is 52% 28

29 1. Meet with Chair and safety designee Discuss the program or department s general structure around safety and safety events o event definition= something that happened that should not have happened OR something that didn t happen that should have What are the current top safety concerns of the program/department 1. Observe Go into your daily work and observe clinical activity using a lens of patient safety and record examples of safety issues you encounter o Good, bad or ugly o What makes your job harder or unsafe for patients? o What are solid examples of current processes that work well? 29

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33 Potential solutions Simulation for infrequent procedures Reduce variation in equipment across settings Needle safety box/block for delivery kits Standardize needles, etc Reduce unnecessary variation in processes Add sharps injury prevention training to intern orientation Call out needle location repeat back during procedure Attending oversight Refreshers on procedures during year Team training Assign pager to someone else while doing procedure Ensure adequate experience with procedure for trainers Follow time-out prior to procedure with sharps Double gloving 33

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35 Institutional support & buy-in Teamwork by interdisciplinary organizers Curriculum framework Meaningful use homework Agenda flexibility l to foster group engagement Ample safety material to work with 35

36 Bidirectional integration of residents into system processes and priorities, i i including safety awareness Capacity Needlesticks Reporting outpatient safety events challenges Monthly Q&S journal club and Medicine Safety conference 36

37 Being adaptive to the diversity of the dyad s preferred learning styles Resident Quality & Safety Council storming and norming Dyad s protected time, including covering nights for residents Hidden curriculum transferring the learnings of the dyads into the other faculty and residents 37

38 Balancing the council s work so that it remains meaningful to their perspective, while minimizing i i i the system s keen interest in this new group of doers Feedback to the council as to the system changes, along with the associated impact, that t result from their efforts 38

39 Resident Quality & Patient Safety council can be a powerful lever to be used in advancing the quality and safety culture in your organization It is work for both the organizers and the members This work needs to be supported 39 39

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