Organizational HuddlesAligning for Reliability

HQI Conference November 1, 2017Monterey, CA

Audience ParticipationDo you participate in a daily organizational huddle?Has it been in place• Less than a year?• More than a year?• More than two years?What was the effect on your organization?

Transformational

Cottage HealthSanta Barbara Cottage Hospital• 483 bed acute care teaching hospital and trauma center• 700 physicians• Most comprehensive hospital between LA and San FranciscoGoleta Valley Cottage Hospital• 52 bed community hospital• Outpatient surgery, ED and Wound Care CenterSanta Ynez Valley Cottage Hospital• 20 bed critical access hospital

Our Journey• Chasing Zero for a Decade

• Fighting poor community perception of infection rates

• Suffering from inconsistent results

• Preparing for Epic go-live 10/1/17

Lessons Learned• Never give up!

• Bring in an outside perspective: Cynosure, Joint Commission ORO assessment, HQI

• Implement one best practice– Safety Huddles

• Epic go live October 2016 – massive use of huddles post go-live

Culture Matters

• 15 years of shared governance

• All departments, units, service areas

• Gather 3 times a year to Communicate, Celebrate and Coordinate

• Voice Forms – employee suggestions

Voice Forms

• IV Cap Protectors to Reduce CLABSI's

• Request for Keyboard Cleaning

• Request for New Hand Sanitizer Dispensers

• Isolation Status Bar in CPOE

• Infection control concerns with reusable specimen bags

• Grab Bars for Toileting

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Culture of Safety Bright Stars

• Met the participation goal of 90%• Percentile ranking of 75 or more for Key questions• More than 50% answer that they had direct patient care• More than 10 employees

Key Culture of Safety Questions1. Our procedures and systems are good at preventing

errors from happening2. Patient safety is never sacrificed to get more work

done3. We have patient safety problems in this unit4. When an event is reported, it feels like the person is

being written up, not the problem5. Staff feel like their mistakes are held against them

Common Themes• Employee empowerment and recognition

• Approachable management

• Problem solving and initiative

• Family-like atmosphere

• Clear cultural standards

• Proactive thinking and planning

• Effective communication

• Strategic hiring

(C3 Video clip of SYVCH ED 4:40 – 6:30)

Sharing Best Practices

Joint Commission ORO Assessment

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Organization Safety Huddle

Look Back – Safety, quality and service events that occurred over the past 24 hours

Look Forward - Potential safety events that may occur over the next 24 hours

Lessons Learned - Good catches/near misses that prevented an event

Follow up - Efforts taken or still need to be taken to follow up on those events

Senior Leadership Leads

CEO or designee

All Senior Executives attend as they are able

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Director LevelNursing SupervisorEDCritical careMed/SurgWomen's servicesBehavioral healthSurgeryGIPharmacyLab/blood bankRadiology/Cath labRespiratory

Case ManagementPT/OTNutritionInfection preventionITEmployee healthSafety/securityFacilitiesConstruction/project managementMaterialsRisk managementEVS

Ground Rules

• 8:45 - 9:00

• M-F

• Mandatory with grace

• All meetings suspended for 15 minutes

• If onsite then attend in person

• If offsite dial in if possible or send a representative

Huddle Examples

• Patients with Same Name Alerts

• Friction Strips Installed in Stairwells During Rainy Season

• Construction Noise Alerts

• Pharmacy and Material Shortages

• Rare Blood Transfusion Needing Protocol

• Faulty Exam Gloves Pulled From Stock

• High Census/Holding in Ed Needing Physician Attention

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The Huddles after the HuddleImmediate problem solving

Discuss any challenging patients

• Behaviorally Challenged

• “Stuck”/Difficult discharge

• Stressful for employees

• Workplace violence issues

• Needing a clinical team ‘Huddle”

Immediate access to additional resources, medical staff leadership, employee assistance

We did not expect…

How much we would learn about day to day operational challenges.

How many falls, supply shortages, IT issues, workplace violence events, and the occasional creepy crawly creature our staff handle.

How much we would come to value this practice.

What is Next?

• Good Catch Sharing/Recognition Program

• Physician Just Culture Advisory Board

• Engaging Leadership and Frontline in Case Study Discussion Groups

• Unit based Performance Boards

• Root Cause Analysis Leading to Resilient Actions (not Vigilance)

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Questions?

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