8th Annual Maryland Patient Safety Conference - April 3, 2012 · 2013-01-15 · Acute Care/Long...

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APRIL 3, 2012Baltimore Convention Center

8th AnnualMaryland Patient Safety Conference

LAYERSOF SAFETYAPRIL 3, 2012Baltimore Convention Center


Keeping Patients Safe

Platinum SponsorGold Sponsor

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The Day-At-A-Glance 8:00 – 8:15 Welcome & Introductions

8:15 – 9:15 Opening Keynote Address: Connecting Health and Health Care Jeffrey Selberg, MHA, Executive Vice President and Chief Operating Officer, Institute for Healthcare Improvement (IHI)

9:15 – 9:30 Presentation of the Minogue Award for Patient Safety Innovation by William Minogue, MD Culture & Continuity Leadership Value & Measurement Patient & Family Voices Hot Topics

Safety Culture is the Only Right AnswerMartha Hayward, Lead for Public and Patient Engagement, Institute for Healthcare Improvement (IHI); Executive Director, The Partnership for Healthcare Excellence

TeamSTEPPS™: Do or do not… there is no tryHolly Greever RN, TeamSTEPPS™ Program Coordinator, Magnet Program Coordinator, and Labor & Delivery RN, Anne Arundel Medical Center, Sherry Perkins, PhD, RN,Senior Vice President, Patient Care Services/Chief Nursing Officer, Anne Arundel Medical Center

TeamSTEPPS™: Success Through Culture ChangeJennifer Ustianov, Director, Vermont Perinatal Outreach Education and Perinatal Quality Improvement Initiatives, University of Vermont’s Child Health Improvement Program

Changing Organizational Beliefs: A Case StudyJeffrey Selberg, MHA, Executive Vice President and Chief Operating Officer, Institute for Healthcare Improvement (IHI)

Lean Done Right Thomas G. Zidel, President, Lean Hospitals, LLC

Using Positive Psychology to Create a High-Performing Organizational CultureDebbie Dang, PhD, RN, Director of Nursing for Practice, Education, and Research, The Johns Hopkins Hospital Joan Diamond, MSN, RN, NEA-BC, C-EFM, Perinatal Nurse Manager, The Johns Hopkins Hospital Tom Muha, PhD PROPEL Coach, PROPELperformanceLinda Burton, BS, PROPEL Coach, PROPELperformance

Patient Safety from a Daughter’s Perspective Mary Brennan-Taylor, Consumer Reports Patient Safety Advocate; Adjunct Research Instructor of Family Medicine at the University of Buffalo School of Medicine and Biomedical Sciences

Iron Hearts: A Family’s Experience in the Health Care SystemBrian Boyle and parents JoAnne and Garth Boyle

Partnering with Patients: A Bed’s Eye View of Safety Tiffany Christensen, CEO, Sick Girl Speaks, Inc.

Annual OHCQ UpdateRenee B. Webster, R.S., Assistant Director, Hospitals, Laboratories and Patient Safety Unit, Maryland Office of Health Care Quality Anne Jones, RN, BSN, MA, Nurse Surveyor, Maryland Office of Health Care Quality

Presentation by the 2012 Minogue Award for Patient Safety Innovation Winner

Presentation by the 2012 Distinguished Achievement in Patient Safety Innovation Award Winner

Assessment and Management of Suicidality in Acute Care/Long Term Care SettingsMonica Cooke, RNC, MA, CPHQ, CPHRM, Founder of Quality Plus Solutions, LLC

ECRI Institute’s Top Ten Health Technology Hazards for 2012James P. Keller, Jr., Vice President, Health Technology Evaluation and Safety, ECRI Institute

9:45 – 10:45

11:00 – 12:00

12:00 – 1:00

1:00 – 2:00

2:15 – 3:15 Closing Keynote Address: The Relationship Between Culture and Continuous Learning Allan Frankel, MD, co-Chief Medical Officer, Pascal Metrics, Inc.

3:15 – 3:30 Closing Remarks: Mary Barron, Consultant for the Maryland Patient Safety Center

Story Board Presentations, Lunch




Opening Keynote Address

Connecting Health and Health Care

C O N C U R R E N T S E S S I O N S

CULTURE AND CONTINUITY TRACK

Jeffrey Selberg, MHA, Executive Vice President and Chief Operating Officer, Institute for Healthcare Improvement (IHI)

Health care leaders are evaluating how to position their organizations as they respond to the demand for greater value and the rapid introduction of new technology. This presentation will depict one of the challenges leaders face as new clinical and business models are developed. The information is based on the concept of a model life cycle or an “S” curve illustrated by Ian Morrison in The Second Curve (1996) and Clayton Christensen in The Innovator’s Dilemma (1997).

The presentation will illustrate the dilemma leaders face when they realize that optimizing the current model may not meet the emerging demand of their market (community). When do they jump to the next model? And, how do they execute the transition successfully? Too early, and they run the risk of allocating significant resources to a new model that never materializes. Too late, and they are overtaken by competitors who have already built the capacity to execute successfully on the new model.

Safety Culture is the Only Right Answer

Martha Hayward, Lead for Public and Patient Engagement, Institute for Healthcare Improvement (IHI); Executive Director, The Partnership for Healthcare Excellence

Join in a case discussion that highlights patient safety from an organizational culture perspective. Learn specific strategies and tactics for changing culture and moving your organization to a culture where safety is the focus.

TeamSTEPPS™: Do or do not… there is no try

Holly Greever, RN – TeamSTEPPS™ Program Coordinator, Magnet Program Coordinator, and Labor & Delivery RN, Anne Arundel Medical Center

Sherry Perkins, PhD, RN – Senior Vice President, Patient Care Services/Chief Nursing Officer, Anne Arundel Medical Center

TeamSTEPPS™ training, which began at Anne Arundel Medical Center in Labor and Delivery (L&D) in 2008, has yielded improved outcomes, successes, and lessons learned. Due to the successes of the initial program, it has since been implemented in the NICU, Emergency Department, and Heart/Vascular Institute (to include CV OR). The strategy, implementation, and support of the program has evolved to include creative funding, a TeamSTEPPS™ program coordinator, and additional departments seeking out implementation. The critical success factor has been support from multiple levels to include front line staff, departmental management, and administrative leadership.

TeamSTEPPS™: Success Through Culture Change

Jennifer Ustianov, Director, Vermont Perinatal Outreach Education and Perinatal Quality Improvement Initiatives, University of Vermont’s Child Health Improvement Program

Learn how to identify your current culture, foresee and meet the challenges while planning for the changes needed to implement TeamSTEPPS™. During this interACTIVE hour you can relate to a successful hospital team who will openly share the steps to success, the challenges to overcome, the timeline and the vision for a sustained change in culture brought on by the implementation of TeamSTEPPS™. Hear how it worked and how the success has changed the workplace and the culture of patient safety.

LAYERSOF SAFETY





LEADERSHIP TRACK

Changing Organizational Beliefs: A Case Study

Jeffrey Selberg, MHA, Executive Vice President and Chief Operating Officer, Institute for Healthcare Improvement (IHI)

In this session, Jeffrey Selberg will present a case study about a 39-year-old male with abdominal pain. With the attendees, he will address the nature of beliefs and the ability to change an organization’s culture. Through conversation, the attendees will discuss how organizations can transition from a fear-based culture to a culture of learning centered on the best interests of the patient and clinical staff.

Lean Done Right

Thomas G. Zidel, President, Lean Hospitals, LLC

In this session, Thomas G. Zidel will provide a roadmap for launching a transformative and sustainable Lean initiative, focused on strategically-directed action, development of a Lean organizational culture, and enhancing the care delivery system.

Using Positive Psychology to Create a High-Performing Organizational Culture

Debbie Dang, PhD, RN, Director of Nursing for Practice, Education, and Research, The Johns Hopkins Hospital

Joan Diamond, MSN, RN, NEA-BC, C-EFM, Perinatal Nurse Manager, The Johns Hopkins Hospital

Tom Muha, PhD, PROPEL Coach, PROPELperformance

Linda Burton, BS, PROPEL Coach, PROPELperformance

Financial conditions, health care reform, changing needs of staff and increasing patient demands are spurring significant and massive changes in hospitals. These stressors often lead to a negative culture characterized by poor performance, safety problems, increased conflict, and low satisfaction levels. This presentation will tell the story of how one department at a major academic medical center was struggling to cope with lateral violence, insubordination, and a hostile work environment. By learning to use six Positive Psychology principles year after year they were able to totally transform the culture on their units and become a top ranked staff in the institution.


VALUE AND MEASUREMENT TRACK

Annual OHCQ Update

Renee B. Webster, R.S., Assistant Director, Hospitals, Laboratories and Patient Safety Unit, Maryland Office of Health Care Quality

Anne Jones, RN, BSN, MA, Nurse Surveyor, Maryland Office of Health Care Quality

In this session, the Maryland Office of Health Care Quality’s (OHCQ) role in mandatory reporting of adverse events will be briefly explained, an update on current data related to mandatory reporting of adverse events will be provided, and a focused report on individual events that have widespread implications as well as innovative interventions and best practices will be presented.

Presentation by the 2012 Minogue Award for Patient Safety Innovation Winner Presentation by the 2012 Distinguished Achievement in Patient Safety Innovation Award Winner





PATIENT AND FAMILY VOICES TRACK

Patient Safety from a Daughter’s Perspective

Mary Brennan-Taylor, Consumer Reports Patient Safety Advocate and Adjunct Research Instructor of Family Medicine at the University of Buffalo School of Medicine and Biomedical Sciences

When Mary Brennan-Taylor lost her mother to a series of preventable medical errors, she wasn’t interested in suing the hospital where the mistakes had been made. Instead, she was interested in culture change. By turning grief into action, Brennan-Taylor is bringing that culture change directly to medical and nursing students at the University at Buffalo in a unique program that educates future doctors and nurses about the human impact of medical harm and the actions they can take to prevent such harm. Embracing patients and their families as members of the interdisciplinary health care team is a message that Mary hopes to bring to medical professionals nationwide.

Iron Hearts: A Family’s Experience in the Health Care System

Brian Boyle and parents JoAnne and Garth Boyle

Brian Boyle’s story about catastrophe, survival, and transcending all odds has been well documented and continues to be an inspiration to others—as well as serving as a learning experience for health care providers. Come join Brian and his parents, JoAnne and Garth, as we explore the nuances of their hospital experience and answer the questions that will have us reflecting upon our own practice and policies.

Partnering with Patients: A Bed’s Eye View of Safety

Tiffany Christensen, CEO,Sick Girl Speaks, Inc.

As a person who has experienced severe to minor medical errors in her lifetime, Tiffany Christensen can speak from “A Bed’s Eye View” of how such incidents, and a health care provider’s reaction to them, can affect a patient’s sense of safety. This presentation also contains a more technical aspect in which new partnership strategies for safety are explored. As a TeamSTEPPS™ Master Trainer, Christensen believes in empowering patients/families with specific TeamSTEPPS™ tools as a way to “use everyone on the team” to decrease medical error. No matter the health care setting, participants will leave this presentation inspired to find new ways to understand and partner with their patients and families.


HOT TOPICS TRACK

Assessment and Management of Suicidality in Acute Care/Long Term Care Settings

Monica Cooke, RNC, MA, CPHQ, CPHRM, Founder, Quality Plus Solutions, LLC

This session will focus on the screening/assessment of patients for suicidality and how to safely manage them in the acute care and long term care settings. Increasingly, non-psychiatric settings have to manage behavioral health patients that present as a risk for self-harm. Staff often has little or no psychiatric experience, skills or competencies, which creates a daunting challenge for the organization. Monica Cooke will lead a discussion of the following: statistics related to suicide/suicidality; implementation of The Joint Commission’s Goal 15; maintaining a safe treatment environment; and required competencies of the staff managing the suicidal patient day to day.

ECRI Institute’s Top Ten Health Technology Hazards for 2012

James P. Keller, Jr., Vice President, Health Technology Evaluation and Safety, ECRI Institute

Health technology offers countless benefits, but also some real risks. What are the most serious device-related risks, and how can hospitals address them? For the fifth year, ECRI Institute has published its widely distributed list of Top Ten Health Technology Hazards that identifies these risks and provides guidance for how to avoid them. This presentation will provide an overview of ECRI Institute’s Top Ten list along with recommendations for how hospitals can most effectively prioritize their technology-related safety efforts.

LAYERSOF SAFETY




Closing Keynote Address

The Relationship Between Culture and Continuous LearningAllan Frankel, MD, co-Chief Medical Officer, Pascal Metrics, Inc.

The likelihood of a department achieving outstanding operational excellence is determined by the strength of its continuous learning. Organizations that don’t support—and managers who don’t know how to create—learning environments are destined to mediocrity. The threads in the tapestry of excellence are simple, but each must be strong and they must be carefully woven. The threads are, by name, leadership, teamwork, organizational fairness, a desire to achieve reliable process, transparency, measurement, and improvement methods. This talk defines these in simple terms and relates them to each other.

Weather Policy:In the event of adverse weather conditions, the decision to cancel or delay the Conference will be made by 5:00 a.m. the morning of the Conference. To find out if the Conference is delayed or cancelled, please call 410-540-9210 after 5:00 a.m. on April 3.

Special Note: The Maryland Patient Safety Center wishes to ensure that no individual with a disability is excluded, denied services, segregated or otherwise treated differently from other individuals because of the absence of auxiliary aids and services identified in the Americans With Disabilities Act, please call Jena Lindenbaum at 410.796.6239.

MPSC 8th Annual Conference:

Tuesday, April 3, 2012Baltimore

Convention Center

Registration and Continental Breakfast

7:00 a.m.Program

8:00 a.m. – 3:30 p.m.

M P S C 8 T H A N N U A L C O N F E R E N C E R E G I S T R AT I O N

PLEASE NOTE: Registration will only be online.

REGISTRATION CLOSES Tuesday, March 27, 2012

To Register:n Click on this line to link directly to the Registration Form.

n Complete all registrant’s information (You may include a secondary email address for others to receive correspondence regarding registration and program information).

n If you will be submitting a check request through your organization, please choose the “Register and Pay by Check” option.

n You will receive correspondence directly from the Program Coordinator immediately following your submission of the registration online.

n If you do not receive a confirmation email or have any questions regarding our new system, please contact Jena Lindenbaum at 410.796.6239 or [email protected].

FEEMaryland Health Care Professionals and employees of Beebe Medical Center:Early Registration and payment received by Thursday, March 1, 2012: $50Late Registration and payment received by March 27, 2012: $75Registration closes Tuesday, March 27, 2012On-site Registration and payment (including those not yet paid): $150

Non-Maryland Health Care Professionals and all other participants:Registered and Paid by March 27, 2012: $150Registration closes March 27, 2012On-site Registration and payment (including those not yet paid): $300




MembersStanton G. AdesSenior Vice President, Professional Pharmacies, Omnicare, Inc.

Senator John AstleMaryland State Senate

Mike AvotinsSenior Vice President, Large Group Operations, CareFirst, BlueCross, BlueShield

Carmela CoylePresident & CEO, Maryland Hospital Association

Raymond Cox, MDSenior Vice President, Medical Affairs, Providence Hospital

Joseph DeMattos, Jr., MAPresident, Health Facilities Association of Maryland

ChairSusan Glover Senior Vice President, Chief Quality Officer, Adventist HealthCare

Eugene FriedmanCorporate Counsel, 1st Mariner Bank

Chris Goeschel, ScD, MPA, MPS, RN The Armstrong Institute for Patient Safety & Quality

Nancy Beth GrimmDirector, DHMH Office of Health Care Quality

William HolmanPresident & CEO, Charles County Nursing & Rehabilitation Center

David HorrocksPresident, CRISP

Thomas JacksonCEO, Delmarva Foundation for Medical Care

The Honorable Heather R. MizeurDelegate, Maryland House of Delegates

Sherry Perkins, PhD, RNSenior Vice President for Patient Care Services, CNO, Anne Arundel Medical Center

BOARD OF DIRECTORS

Friends of Maryland Patient Safety Center

Gold Sponsor

HFAMHealth Facilities Association of Maryland

Partners in Quality Care

LAYERSOF SAFETY

THANK YOU TO OUR SPONSORS

Platinum Sponsor

Steve PortsPrincipal Deputy Director, Maryland Health Services Cost Review Commission

Sam Ross, MDCEO, Bon Secours Baltimore Health System

James R. Rost, MDMedical Director, NICU and Medical Director of Patient Safety, Shady Grove Adventist Hospital

Steve Schenkel, MDChair, Department of Emergency Medicine, Mercy Medical Center, and Assistant Professor, Emergency Medicine, University of Maryland School of Medicine

William L. Thomas, MDExecutive Vice President of Medical Affairs, MedStar Health

Fredia S. Wadley, MDPresident & CEO, Quality Health Strategies

Kathleen White, PhD, RN, CNAA, BC

NON PROFITU.S. POSTAGE

PAIDPERMIT NO 667BALTIMORE, MD

21233

Maryland Patient Safety Center6820 Deerpath RoadElkridge, MD 21075-6234

www.marylandpatientsafety.org

Presented in cooperation with:

C 100M 68Y 0K 12

C 70M 0Y 100K 9

C 69M 100Y 0K 2

culture. leadership. measurement. patient and family voices. culture. leadership. measurement. patient and family voices. culture. leadership. measurement. patient and family voices. culture.












measurement. patient and family voices. culture. leadership. measurement. patient and family voices. culture. leadership. measurement. patient and family voices. culture. leadership. measurement.

APRIL 3, 2012Baltimore Convention Center


LAYERSOF SAFETYAPRIL 3, 2012Baltimore Convention Center


8th Annual Maryland Patient Safety Conference - April 3, 2012 · 2013-01-15 · Acute Care/Long...

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Transcript of 8th Annual Maryland Patient Safety Conference - April 3, 2012 · 2013-01-15 · Acute Care/Long...