A Culture of “Surgical” Patient Safety · Medical Director of Patient Safety Medical Director...

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MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching. MetroHealth and Case Western Reserve University, affiliated since 1914, partners in advancing patient care through research and teaching. A Culture of “Surgical” Patient Safety Joseph F. Golob Jr. MD FACS CPHQ Medical Director of Patient Safety Medical Director of SICU and TICU Program Director – Surgical Critical Care Fellowship MetroHealth Medical Center

Transcript of A Culture of “Surgical” Patient Safety · Medical Director of Patient Safety Medical Director...

Page 1: A Culture of “Surgical” Patient Safety · Medical Director of Patient Safety Medical Director of SICU and TICU Program Director –Surgical Critical Care Fellowship MetroHealth

MetroHealth and Case Western Reserve University, affiliated since 1914,

partners in advancing patient care through research and teaching.

MetroHealth and Case Western Reserve University, affiliated since 1914,

partners in advancing patient care through research and teaching.

A Culture of “Surgical” Patient

Safety

Joseph F. Golob Jr. MD FACS CPHQ

Medical Director of Patient Safety

Medical Director of SICU and TICU

Program Director – Surgical Critical Care Fellowship

MetroHealth Medical Center

Page 2: A Culture of “Surgical” Patient Safety · Medical Director of Patient Safety Medical Director of SICU and TICU Program Director –Surgical Critical Care Fellowship MetroHealth

MetroHealth and Case Western Reserve University, affiliated since 1914,

partners in advancing patient care through research and teaching.

Objectives1. What is culture and specifically what is a

culture of safety?

2. Describe the key components to a patient

safety culture: leadership, psychological

safety, accountability, teamwork and

negotiation.

3. Google’s model of culture

4. What can you do to foster a culture of

safety?

Page 3: A Culture of “Surgical” Patient Safety · Medical Director of Patient Safety Medical Director of SICU and TICU Program Director –Surgical Critical Care Fellowship MetroHealth

MetroHealth and Case Western Reserve University, affiliated since 1914,

partners in advancing patient care through research and teaching.

1999 IOM report: 44,000 to 98,000 deaths per year from preventable medical mistakes

“The equivalent of a jumbo jet crashing everyday with no survivors”

Page 4: A Culture of “Surgical” Patient Safety · Medical Director of Patient Safety Medical Director of SICU and TICU Program Director –Surgical Critical Care Fellowship MetroHealth

MetroHealth and Case Western Reserve University, affiliated since 1914,

partners in advancing patient care through research and teaching.

© 2016 BMJ Publishing Group LTDMakary MA, Michael D. Medical error-the third leading cause of death in the US. BMJ 2016; 353:i2139

Page 5: A Culture of “Surgical” Patient Safety · Medical Director of Patient Safety Medical Director of SICU and TICU Program Director –Surgical Critical Care Fellowship MetroHealth

MetroHealth and Case Western Reserve University, affiliated since 1914,

partners in advancing patient care through research and teaching.

How do we improve?

© 2017 Institute for Healthcare Improvement and Safe & Reliable Healthcare

Page 6: A Culture of “Surgical” Patient Safety · Medical Director of Patient Safety Medical Director of SICU and TICU Program Director –Surgical Critical Care Fellowship MetroHealth

MetroHealth and Case Western Reserve University, affiliated since 1914,

partners in advancing patient care through research and teaching.

What is culture?

The way of life, especially thegeneral customs and beliefs, of

a particular group of peopleat a particular time

“Surgical Dogma”“Because we have done it that way for years”

Page 7: A Culture of “Surgical” Patient Safety · Medical Director of Patient Safety Medical Director of SICU and TICU Program Director –Surgical Critical Care Fellowship MetroHealth

MetroHealth and Case Western Reserve University, affiliated since 1914,

partners in advancing patient care through research and teaching.

What is a patient safety culture?

“A culture in which healthcare professionals are held accountable for unprofessional conduct, yet not

punished for human mistakes; errors are identified and mitigated before harm occurs; and systems are in

place to enable staff to learn from errors and near-misses and prevent recurrence”(AHRQ PSNet Safety Culture – 2014)

Page 8: A Culture of “Surgical” Patient Safety · Medical Director of Patient Safety Medical Director of SICU and TICU Program Director –Surgical Critical Care Fellowship MetroHealth

MetroHealth and Case Western Reserve University, affiliated since 1914,

partners in advancing patient care through research and teaching.

What is a patient safety culture?

Page 9: A Culture of “Surgical” Patient Safety · Medical Director of Patient Safety Medical Director of SICU and TICU Program Director –Surgical Critical Care Fellowship MetroHealth

MetroHealth and Case Western Reserve University, affiliated since 1914,

partners in advancing patient care through research and teaching.

Why is culture so important?

American management consultant, educator and author.“Founder of modern management”

Page 10: A Culture of “Surgical” Patient Safety · Medical Director of Patient Safety Medical Director of SICU and TICU Program Director –Surgical Critical Care Fellowship MetroHealth

MetroHealth and Case Western Reserve University, affiliated since 1914,

partners in advancing patient care through research and teaching.

Framework for Clinical

Excellence: Leadership

Page 11: A Culture of “Surgical” Patient Safety · Medical Director of Patient Safety Medical Director of SICU and TICU Program Director –Surgical Critical Care Fellowship MetroHealth

MetroHealth and Case Western Reserve University, affiliated since 1914,

partners in advancing patient care through research and teaching.

Leaders (Surgeons) and Culture

Leaders have 4 main responsibilities:1. Guard the learning system – transparency, applying

improvement and reliability science, and inspiring staff2. Creating psychological safety – making sure everyone

including patients/families can voice concerns3. Fostering trust – creating environment of non-

negotiable trust4. Ensuring value alignment – applying organization

values to every decision

Page 12: A Culture of “Surgical” Patient Safety · Medical Director of Patient Safety Medical Director of SICU and TICU Program Director –Surgical Critical Care Fellowship MetroHealth

MetroHealth and Case Western Reserve University, affiliated since 1914,

partners in advancing patient care through research and teaching.

Surgeons and Culture

Performance

Behaviors

Values

Page 13: A Culture of “Surgical” Patient Safety · Medical Director of Patient Safety Medical Director of SICU and TICU Program Director –Surgical Critical Care Fellowship MetroHealth

MetroHealth and Case Western Reserve University, affiliated since 1914,

partners in advancing patient care through research and teaching.

Framework for Clinical Excellence:

Psychological Safety

Page 14: A Culture of “Surgical” Patient Safety · Medical Director of Patient Safety Medical Director of SICU and TICU Program Director –Surgical Critical Care Fellowship MetroHealth

MetroHealth and Case Western Reserve University, affiliated since 1914,

partners in advancing patient care through research and teaching.

Psychological Safety

• Originated with James Reason’s book,

Managing the Risks of Organizational

Accidents.

• Popularized by Amy Edmondson’s book,

Teaming

It is more than “I can speak up

about concerns”

Page 15: A Culture of “Surgical” Patient Safety · Medical Director of Patient Safety Medical Director of SICU and TICU Program Director –Surgical Critical Care Fellowship MetroHealth

MetroHealth and Case Western Reserve University, affiliated since 1914,

partners in advancing patient care through research and teaching.

Psychological Safety

https://www.youtube.com/watch?v=3r4rS0yz

Q1M

Page 16: A Culture of “Surgical” Patient Safety · Medical Director of Patient Safety Medical Director of SICU and TICU Program Director –Surgical Critical Care Fellowship MetroHealth

MetroHealth and Case Western Reserve University, affiliated since 1914,

partners in advancing patient care through research and teaching.

Psychological Safety and

Retained Surgical Sponges

Steelman VM, et al. Retained Surgical Sponges: a descriptive study of occurrences and contributing factors from 2012 to 2017. Patient Surg. 12:20, 2018

Page 17: A Culture of “Surgical” Patient Safety · Medical Director of Patient Safety Medical Director of SICU and TICU Program Director –Surgical Critical Care Fellowship MetroHealth

MetroHealth and Case Western Reserve University, affiliated since 1914,

partners in advancing patient care through research and teaching.

Key Components of

Psychological Safety1. Anyone can ask questions without

looking stupid

2. Anyone can ask for feedback without

looking incompetent

3. Anyone can be respectfully critical

without appearing negative

4. Anyone can suggest innovative ideas

without being perceived as disruptiveAdopted from Amy Edmondson, Teaming

Page 18: A Culture of “Surgical” Patient Safety · Medical Director of Patient Safety Medical Director of SICU and TICU Program Director –Surgical Critical Care Fellowship MetroHealth

MetroHealth and Case Western Reserve University, affiliated since 1914,

partners in advancing patient care through research and teaching.

Framework for Clinical

Excellence: Accountability

Page 19: A Culture of “Surgical” Patient Safety · Medical Director of Patient Safety Medical Director of SICU and TICU Program Director –Surgical Critical Care Fellowship MetroHealth

MetroHealth and Case Western Reserve University, affiliated since 1914,

partners in advancing patient care through research and teaching.

Accountability

We are held accountable for our

actions, but we are not accountable

for system flaws!

• Comes together with psychological safety

– You can’t have true psychological safety

without accountability

Page 20: A Culture of “Surgical” Patient Safety · Medical Director of Patient Safety Medical Director of SICU and TICU Program Director –Surgical Critical Care Fellowship MetroHealth

MetroHealth and Case Western Reserve University, affiliated since 1914,

partners in advancing patient care through research and teaching.

Fair and Just Culture

• Requires a simple and precise algorithm

– Fosters an environment in which staff members

accept responsibility for their own actions…

– But know the organization will treat them fairly and

not blame them for things out of their control

• The literature presents a few different

accountability algorithms

– David Marx, Just Culture Algorithm

– James Reason, Incident Decision Tree

Page 21: A Culture of “Surgical” Patient Safety · Medical Director of Patient Safety Medical Director of SICU and TICU Program Director –Surgical Critical Care Fellowship MetroHealth

MetroHealth and Case Western Reserve University, affiliated since 1914,

partners in advancing patient care through research and teaching.

Framework for Clinical

Excellence: Teamwork

Page 22: A Culture of “Surgical” Patient Safety · Medical Director of Patient Safety Medical Director of SICU and TICU Program Director –Surgical Critical Care Fellowship MetroHealth

MetroHealth and Case Western Reserve University, affiliated since 1914,

partners in advancing patient care through research and teaching.

TeamSTEPPS

Page 23: A Culture of “Surgical” Patient Safety · Medical Director of Patient Safety Medical Director of SICU and TICU Program Director –Surgical Critical Care Fellowship MetroHealth

MetroHealth and Case Western Reserve University, affiliated since 1914,

partners in advancing patient care through research and teaching.

Teamwork

• Huddles, Briefs and Debriefs

– Plan forward

– Reflect back

– Communicate clearly

– Manage risk

• Backbone of culture

• Must permeate through the entire

organization

Page 24: A Culture of “Surgical” Patient Safety · Medical Director of Patient Safety Medical Director of SICU and TICU Program Director –Surgical Critical Care Fellowship MetroHealth

MetroHealth and Case Western Reserve University, affiliated since 1914,

partners in advancing patient care through research and teaching.

Teamwork and Communication

• Complete

– Communication all relevant information

• Clear

– Convey information that is plainly understood

• Brief

– Be concise

• Timely

– Offer / request information in the appropriate

time

Page 25: A Culture of “Surgical” Patient Safety · Medical Director of Patient Safety Medical Director of SICU and TICU Program Director –Surgical Critical Care Fellowship MetroHealth

MetroHealth and Case Western Reserve University, affiliated since 1914,

partners in advancing patient care through research and teaching.

Framework for Clinical

Excellence: Negotiation

Page 26: A Culture of “Surgical” Patient Safety · Medical Director of Patient Safety Medical Director of SICU and TICU Program Director –Surgical Critical Care Fellowship MetroHealth

MetroHealth and Case Western Reserve University, affiliated since 1914,

partners in advancing patient care through research and teaching.

Negotiating Styles

Page 27: A Culture of “Surgical” Patient Safety · Medical Director of Patient Safety Medical Director of SICU and TICU Program Director –Surgical Critical Care Fellowship MetroHealth

MetroHealth and Case Western Reserve University, affiliated since 1914,

partners in advancing patient care through research and teaching.

Page 28: A Culture of “Surgical” Patient Safety · Medical Director of Patient Safety Medical Director of SICU and TICU Program Director –Surgical Critical Care Fellowship MetroHealth

MetroHealth and Case Western Reserve University, affiliated since 1914,

partners in advancing patient care through research and teaching.

Learning from Google: Building

the Perfect Culture• Project Aristotle

– Multimillion-dollar project conducted from

2012-2014

– Data gathered and assessed from 180

different Google teams

– No patterns of types of team members

detected why some teams succeeded and

others failed

Page 29: A Culture of “Surgical” Patient Safety · Medical Director of Patient Safety Medical Director of SICU and TICU Program Director –Surgical Critical Care Fellowship MetroHealth

MetroHealth and Case Western Reserve University, affiliated since 1914,

partners in advancing patient care through research and teaching.

Learning from Google: Building

the Perfect Culture• “Group Norms” or unwritten and often

unspoken rules guiding behavior were

identified as the key to success

– Culture = Group Norms

• Who is on a team matters less than how

the team members interact, structure their

work, and view their contributions

Page 30: A Culture of “Surgical” Patient Safety · Medical Director of Patient Safety Medical Director of SICU and TICU Program Director –Surgical Critical Care Fellowship MetroHealth

MetroHealth and Case Western Reserve University, affiliated since 1914,

partners in advancing patient care through research and teaching.

Google’s 5 Keys to Success

Page 31: A Culture of “Surgical” Patient Safety · Medical Director of Patient Safety Medical Director of SICU and TICU Program Director –Surgical Critical Care Fellowship MetroHealth

MetroHealth and Case Western Reserve University, affiliated since 1914,

partners in advancing patient care through research and teaching.

What Can You Do to Get There?

• Know thy self

– Be aware of your patterns and how it affects the team

culture

– Make small adjustments that will increase the quality

and productivity of interactions

– Recognize your vulnerabilities and be open with them

in your team

• Be preoccupied with failure – never settle for

average care

• Support psychological safety in your teams and

throughout the hospital

Page 32: A Culture of “Surgical” Patient Safety · Medical Director of Patient Safety Medical Director of SICU and TICU Program Director –Surgical Critical Care Fellowship MetroHealth

MetroHealth and Case Western Reserve University, affiliated since 1914,

partners in advancing patient care through research and teaching.

Valuable Culture Lesson

Technical expertise alone is

inadequate to keep our patients

safe, non-technical skills are just as

important


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