In each of our anesthesia practices at MEDNAX, we are committed to the implementation of comprehensive patient safety initiatives that embrace the principles of High Reliability Organizations (HRO).
By developing HeROs – HRO leaders – we can shape a reliability culture that creates safety.
Background
HROs have taught us important lessons in organizational cultures of safety. Whether a commercial airline, aircraft carrier or nuclear power plant, these organizations prioritize
safety; every individual understands and acts on their obligation to recognize and report unsafe conditions or errors, correct problems and communicate improvements.
To transform culture within anesthesia practices, we must challenge the traditional hierarchical authority and decision making structure of most team environments. We must also overcome individual practice complexities and priorities to improve communication.
Project aim
Using the foundational elements of Crew Resource Management, we developed a patient safety training program with an emphasis on the development and empowerment of HRO leaders – HeROs
Actions taken
We rely on our HeROs to inspire the cultural change needed to achieve high reliability. Our training program helps them facilitate mindful engagement and adoption of HRO guiding principles among their peers. In addition to high reliability and change implementation theory, we also provide education about fundamental principles, which are key to creating HROs, including:
• Precise communication tools
• Creation and promotion of a just culture
• Development of tools to facilitate a "reporting" culture
• Creation, implementation and proper use of checklists
• Implementation of debriefing and proper "time out" sessions
By promoting accountability, communication and engagement, we increase the likelihood of success.
Proven results
Safety climate surveys evaluating 12 critical areas conducted at six months, one year and two years post-training help us evaluate the success of our HRO programs. To date, 19 practices have implemented programs and 10 have surpassed the 6-month mark. Preliminary data shows that our comprehensive patient safety initiative creates change. By providing the appropriate tools to share concerns, improving communication and feedback to engage the care team, and developing leaders who encourage their peers to speak up and question authority, we will continue to achieve high reliability and, ultimately, deliver safe and consistent care to our patients.
% of participating practices with improvements 6 months post-implementation
• Feedback & Communication About Error: 91%
• Frequency of Events Reported: 82%
• Communication Openness: 82%
• Overall Perception of Safety: 73%
• Organizational Learning: 82%
• Non-Punitive Response to Error: 82%
• Teamwork within Units: 64%
Tools for Success
Strong safety climates prioritize safety and integrate it into the daily routine. To empower our providers and cultivate an environment that enables them to prevent, solve and learn collectively from problems that occur at the front-line of care, we have developed a variety of safety tools, such as:
• Transfer of care checklists
• Time out expectations for procedures and blocks
• Escalation policies to protect individuals from retaliation for reporting safety concerns
• Best safety practices
• Downloadable mobile safety checklists
• Mobile safety concerns application
Tapping in to technology
Empowering providers with a clinical safety app
One of the newest and most valuable tools in our arsenal is a mobile safety concern application. It gives clinicians the ability to use their smartphones or tablets to report a potential safety concern in seconds. A push notification allows for real-time closed loop communication and improved reporting capabilities.
Safety tools help us:
• Keep safety concerns top of mind
• Ensure skills are performed in a repeatable and reliable manner, no matter who is on the team
• Overcome human limitations and prevent, trap and mitigate error
• Focus on patient care rather than mundane or repeatable tasks
Our History
In 2012, American Anesthesiology of Georgia – Piedmont, a MEDNAX affiliate set a course to become a High Reliability Organization (HRO). Because of the pilot program success, MEDNAX is committed to implementing an HRO patient safety initiative across all affiliated practices.
Anesthesiology practices operate in highly complex and risky environments, much like the nuclear power and aeronautics industries, which have deep-rooted organizational cultures of safety. They understand and act on their obligation to recognize and report unsafe conditions and errors, and create an atmosphere that empowers individuals to prevent, solve and learn collectively from problems that occur.
Strong safety climates prioritize safety and integrate it into their daily routines. Our journey is to develop more than a culture of safety; it is to develop a culture of reliability that creates patient safety.
To make this cultural transformation, we adopted Crew Resource Management Training (CRM) strategies – proven to optimize safety in the aviation and aeronautics industries – so our anesthesia providers can deliver the safest care while communicating efficiently and effectively.
CRM training encompasses communication, teamwork, leadership and decision-making skills to develop the cognitive and interpersonal abilities to safely manage team-based, high-risk patient care. Developing our situational awareness, assertiveness training and permission to challenge authority is key to creating the culture change necessary to become an HRO.
Dr. Jeffrey Shapiro, Director of the HRO Patient Safety Initiative, is an anesthesia care leader and a passionate advocate for Patient Safety. He works for MEDNAX, Inc., a national health solutions partner comprised of the nation's leading providers of physician services. Physicians and advanced practitioners practicing as part of MEDNAX are reshaping the delivery of care within their specialties and subspecialties, using evidence-based tools, continuous quality initiatives, clinical research and telemedicine to enhance patient outcomes and provide high-quality, cost-effective care.
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