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1© 2019 TMIT

December 19, 2019Webinar Month 133

For resource downloads go to: www.safetyleaders.org

Violence in Healthcare and Keeping Everyone Safe

2© 2019 TMIT

Charles Denham, MDChairman, TMIT

TMIT High Performer WebinarDecember 19, 2019

Webinar Month 133

Welcome

3© 2019 TMIT

To optimize webinar sound volume, please check:• WebEx volume• Computer volume• External speaker volume

4© 2019 TMIT

If you are still having difficulty hearing the webinar:

Please click on Participants

Then the “Request Phone” button to receive a toll dial-in

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If you wish to follow us on Twitter, go to: http://twitter.com/TMIT1or use #safetyleaders hashtag

Also, go to: www.facebook.com/SafetyLeaders

and related sites

8© 2019 TMIT

TMIT Purpose Statement

Our Purpose: We will measure our success by how we protect and enrich the lives of families…patients AND caregivers.

Our Mission: To accelerate performance solutions that save lives, save money, and create value in the communities we serve and ventures we undertake.

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9© 2019 TMIT

Disclosure StatementThe following panelists certify that unless otherwise noted below, each presenter provided full disclosure information; does not intend to discuss an unapproved/investigative use of a commercial product/device; and has no significant financial relationship(s) to disclose. If unapproved uses of products are discussed, presenters are expected to disclose this to participants. None of the participants have any relationship medication or device companies discussed in their presentations.

Casey Clements, MD, PhD, describes himself as a ‘recovering researcher’ who now works on evidence-based practice change and implementation. As Associate Practice Chair of Emergency Medicine at Mayo Clinic, he focuses on multidisciplinary and interdepartmental improvement projects in Rochester and across the Midwest. His first love and academic focus remains sepsis, emergency infection, and critical care. As director of the Mayo Clinic ED Sepsis Program and primary investigator of the Mayo ED Sepsis Biobank, Dr. Clements has led and participated in the last five improvement projects surrounding sepsis at Mayo. Currently, he is working on diffusion and advocacy with national organizations to improve systems surrounding sepsis outcomes and metrics. He has nothing to disclose.

William H. Adcox serves as the Chief of Police and CSO at The University of Texas MD Anderson Cancer Center and The University of Texas Health Science Center. Chief Adcox holds an MBA degree from UTEP and is a graduate of the PERF’s Senior Management Institute for Police and the Wharton School ASIS Program for Security Executives. He is the recipient of the IACLEA’s 2013 Award for Administrative Excellence and was named by Security Magazine as one of the “Most Influential People in Security 2013.” The agency received the IHSS Foundation’s prestigious 2015 Lindberg Bell Distinguished Program Award. Nationally, Chief Adcox received the Campus Safety 2015 Director of the Year Award in Healthcare; and locally he received the Texas Police Chiefs Association’s 2015 Leadership Award. He has nothing to disclose.

Vicki King, MSCJ, is the Assistant Chief of Police with the University of Texas Police at Houston. During her 30-year career, Vicki served 27 years with the Houston Police Department, rising to the rank of Assistant Chief and earning a master’s degree in Criminal Justice. As Chief of Detectives, Tactical Support Commander, and Director of Forensic Services, she oversaw some of HPD’s highest-profile cases, including serial homicides, corruption, domestic violence, sexual assaults, and gangland slayings. After retiring from HPD, Inspector King served as an emissary to the Saudi Royal family; as an adjunct professor for the University of Houston system; and as Chief of Police for the City of La Marque. MD Anderson and UT-Health recruited Inspector King to head up their Threat Assessment Unit. In her new role, Inspector King works with multidisciplinary teams to identify and mitigate risks. She has nothing to disclose.

Gregory H. Botz, MD, FCCM, is a professor in the Department of Critical Care at the UT MD Anderson Cancer Center. He received his medical degree from George Washington University School of Medicine in Washington, DC. He completed an internship in internal medicine at Huntington Memorial Hospital and then completed a residency in anesthesiology and a fellowship in critical care medicine at Stanford University in California. He also completed a medical simulation fellowship at Stanford with Dr. David Gaba and the Laboratory for Human Performance in Healthcare. Dr. Botz is board-certified in anesthesiology and critical care medicine. He is a Fellow of the American College of Critical Care Medicine. He has nothing to disclose.

Dan Ford, MBA, LFACHE, developed a deep passion for patient safety as a result of medical errors experienced in Illinois by his first wife, Diane, and the treatment he experienced when he started asking logical and genuine questions. The mother of three children (11, 14, and 17 at the time) and age 47, Diane was pursuing her second master’s degree, and suffered a morphine-induced respiratory arrest following a hysterectomy. She has permanent brain damage/short-term memory loss and a poor quality of life, and resides in an independent living facility. He has nothing to disclose.

Charles Denham, MD, is the Chairman of TMIT; a former TMIT education grantee of CareFusion and AORN with co-production by Discovery Channel for Chasing Zero documentary and Toolbox including models; and an education grantee of GE with co-production by Discovery Channel for Surfing the Healthcare Tsunami documentary and Toolbox, including models. HCC is a former contractor for GE and CareFusion, and a former contractor with Siemens and Nanosonics, which produces a sterilization device, Trophon. HCC is a former contractor with Senior Care Centers. HCC is a former contractor for ByoPlanet, a producer of sanitation devices for multiple industries. He does not currently work with any pharmaceutical or device company. His current area of research is in threat management to institutions including conflict of interest, healthcare fraud, and continuing professional education and consumer education including bystander care. Dr. Denham is a collaborator with Professor Christensen at Harvard Business School.

10© 2019 TMIT

Speakers and Reactors Dr. Casey Clements

Dr. Charles Denham

William Adcox

Vicki King

Dan Ford

Gregory Botz

11© 2019 TMIT

Voice of Patient and Family

Dan Ford, MBA, LFACHE

Voluntary Patient Safety AdvocateSpectrum Health Hospital Group Board, Quality & Safety Committee Memberand Executive PFAC former member and ChairTMIT Patient Advocate Team MemberRetired Healthcare Executive Search ConsultantVeteran, Naval Aviation, Vietnam WarRockford, MI

TMIT High Performer WebinarDecember 19, 2019

12© 2019 TMIT

Charles Denham, MDChairman, TMIT

TMIT High Performer WebinarDecember 19, 2019

Webinar 133

In the News Update andNovember 2019 Webinar Recap

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In The News …

Recent Safety Scandals Suggest Healthcare Leaders Haven’t Learned Lessons

https://www.modernhealthcare.com/safety-quality/recent-safety-scandals-suggest-healthcare-leaders-havent-learned-lessons https://www.modernhealthcare.com/safety-quality/recent-safety-scandals-suggest-healthcare-leaders-havent-learned-lessons

November 09, 2019

© 2006 HCC, Inc. CD000000-0000XX 14© 2019 TMIT

In The News …

https://www.modernhealthcare.com/safety-quality/hospitals-fall-short-patient-safety-goals-20-years-after-err-human

November 09, 2019

Hospitals Fall Short of Patient Safety Goals 20 Years after 'To Err Is Human'

© 2006 HCC, Inc. CD000000-0000XX 15© 2019 TMIT

In The News …

https://www.modernhealthcare.com/safety-quality/hospitals-fall-short-patient-safety-goals-20-years-after-err-human

November 09, 2019

Hospitals Fall Short of Patient Safety Goals 20 Years after 'To Err Is Human'

© 2006 HCC, Inc. CD000000-0000XX 16© 2019 TMIT

In The News …

August 20, 2018

Unfortunately, threats to the integrity of U.S. biomedical research exist. NIH is aware that someforeign entities have mounted systematic programs to influence NIH researchers and peerreviewers and to take advantage of the long tradition of trust, fairness, and excellence of NIH supported research activities. This kind of inappropriate influence is not limited to biomedicalresearch; it has been a significant issue for defense and energy research for some time. Threeareas of concern have emerged:

1. Diversion of intellectual property (IP) in grant applications or produced by NIH supported biomedical research to other entities, including other countries;

2. Sharing of confidential information on grant applications by NIH peer reviewers with others, including foreign entities, or otherwise attempting to influence funding decisions; and

3. Failure by some researchers working at NIH-funded institutions in the U.S. to disclose substantial resources from other organizations, including foreign governments, which threatens to distort decisions about the appropriate use of NIH funds.

“We recently reminded the community that applicants and awardees must disclose all forms ofother support and financial interests, including support coming from foreign governments or-other foreign entities.”

“We also expect and encourage your institution to notify us immediately upon identifying new information that affects your institution's applications or awards. Lastly, we encourage you to reach out to an FBI field office to schedule a briefing on this matter.”

DEPARTMENT OF HEALTH & HUMAN SERVICESPublic Health ServiceNational Institutes of HealthBethesda, Maryland 20892

LETTER TO THOSE ORGANIZATIONS RECEIVING FEDERAL GRANTS

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In The News …

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Dec 9, 2019

Federally funded health researchers reported more than 8,000 “significant” financial conflicts of interest worth at least $188 million since 2012, according to filings in a government database obtained by ProPublica.

Source: PBS News Hour: https://www.pbs.org/newshour/health/health-researchers-disclose-188-million-in-conflicts-of-interest-nih-data-suggests

The total value of the conflicts is likely much higher than $188 million, in part because 44% of the disclosures did not place a dollar value on the investigator’s financial relationship.

© 2006 HCC, Inc. CD000000-0000XX 18© 2019 TMIT

In The News …

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Dec 6, 2019

A review of almost 90 University of California system health faculty members found that about two-thirds did not report all of their outside income.

Source: LA Times https://www.latimes.com/california/story/2019-12-06/conflicts-cost-university-of-california-as-professors-fail-to-share-outside-income

UC Professors Fail To Report Outside Income, Shortchanging the University System

The analysis was conducted by ProPublica, an independent, nonprofit newsroom for investigative reporting. The news organization compared UC-required “outside professional activity” disclosure forms with a federal database, Open Payments, which collects information from pharmaceutical and medical device companies on their payments to doctors.

© 2006 HCC, Inc. CD000000-0000XX 19© 2019 TMIT

In The News …

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Dec 18, 2019

The actions come amid a widening federal investigation of foreign attempts to take advantage of U.S.-backed medical research.

Source: Tampa Bay Times https://www.tampabay.com/news/health/2019/12/18/moffitt-cancer-center-shakeup-ceo-and-others-resign-over-china-ties/

Moffitt Cancer Center Shakeup: CEO and Others Resign Over China Ties

Dr. Alan List, the CEO and President of H. Lee Moffitt Cancer Center & Research Institute was joined by Thomas Sellers, a vice president and director at Moffitt, and four of the cancer center’s researchers, who also resigned abruptly.

© 2006 HCC, Inc. CD000000-0000XX 20© 2019 TMIT

In The News …

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Patient Safety and COI Stories Being Followed

Tampa Bay Times Reports:• Deaths of children in 1 in 10

undergoing CV Surgery at JH All Children's

• Mutilation of children in burn unit in Maryland

• Cover up of harm• Retaliation against

whistleblower MD• Patient Safety Issues in all

Johns Hopkins hospitals• Whistle blower law suit• Multiple malpractice suits.• Regulatory problems• Oversight letting team of

doctors make unannounced visits

NYT & Propublica Reports:• Conflicts and large payments

to Chief Med Officer – resigns• CEO with conflicts, vote of

non-confidence – resigns• Board Members own equity in

start up with special deals.• Revision of conflict of interest

policies.• Top executives barred from

serving on corporate boards or investing in start-ups

Propublica & Houston Chronicle Reports:

• Cardiac Complications• Undeclared financial conflicts

of interest• Allegations of exaggerated

quality program to lure patients.

• Transplant program shut down based on reporting.

• Leadership restructuring• State and federal officials

enforcing safety standards.• 08-08-19 Feds Cease Greater

Oversight Of Baylor St. Luke’s Medical Center Initiated After Patient Death

New York Times & Washington Post Reports:

• Falsification of research in cardiac stem care.

• Scientific misconduct• 31 Articles Retracted• Many patients treated• Unknown impact of product

used in patients treated.• Hospital paid to settle

allegations.• Hospital pays $10M to settle

Tennessean & Beckers Hospital Review Reports:

• Nurse medication error during imaging with patient death

• Electronic medication dispensing cabinet safeguards overridden.

• Nurse indicted for reckless homicide for fatal error.

• State Health Officials decided no reason to discipline or take action against nurses license.

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© 2006 HCC, Inc. CD000000-0000XX 21© 2019 TMIT

In The News …

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Patient Safety and COI Stories Being Followed

Medscape Reports:• Duke Settles Doctored Data

Lawsuit for $112.5 Million• Duke Whistleblower Gets

More Than $33 Million In Research Fraud Settlement

• William Foster, who ran the lab where the data were faked, studied the effects of pollutants on the lungs of mouse models.

• Thomas alleged that Duke had won some 50 grants from the NIH

The Washington Post Reports:• Baltimore Mayor Pugh involved in

self-dealing book scandal for hundreds of thousands of dollars.

• UMMS Board Chairman announced the board's unanimous decision March 21 to have CEO Robert Chrencik take a leave of absence.

• Resignations of three UMMS, including Baltimore Mayor Pugh.

• Hours before Mr. Burch notified the public of Mr. Chrencik's leave of absence, the Maryland House of Delegates unanimously fast-tracked bill to overhaul UMMS' 27-member board of directors.

• Kaiser Permanente paid Pugh more than $100,000 for 20,000 copies of her books during a period when the company was seeking a lucrative contract to provide health benefits to city employees.

Medscape Reports:• Between 2011 and 2019

William Roper, failed to disclose his seats on the boards of major corporations.

• At the same time, those corporations did business with the state, records show.

• Roper has served on the board of directors of DaVita, Inc.

• Roper also a member of the board of directors of three successor companies in the pharmacy benefits administration industry.

• None of his corporate board service was disclosed on state ethics forms.

Tampa Bay Times Reports:• Johns Hopkins All Children’s

faces record state fines.• The planned $800,000 penalty is

the latest fallout from problems in the hospital’s heart surgery department.

• State regulators intend to hit Johns Hopkins All Children’s Hospital with some of the largest fines levied against a Florida hospital in recent memory,.

• The Times found that surgeons in the hospital’s Heart Institute made serious mistakes and their procedures went wrong in unusual ways. It also found that the hospital continued to perform heart surgeries for years after frontline workers raised safety concerns to their supervisions.

New York Times Reports:• Director of M.I.T.’s Media Lab

Resigns After Taking Money From Jeffrey Epstein.

• M.I.T. official, Joichi Ito, left the boards the MacArthur Foundation, the John S. and James L. Knight Foundation, and The New York Times.

• He “stepped down after the disclosure of his efforts to conceal his financial connections to Mr. Epstein, the disgraced financier who killed himself in a Manhattan jail cell last month while facing federal sex trafficking charges”. acknowledged last week that he had received $1.7 million from Mr. Epstein, including $1.2 million for his own outside investment funds.

© 2006 HCC, Inc. CD000000-0000XX 22© 2019 TMIT

In The News …

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Dec 10, 2018

These were big stories with no small implications. If these scandals were the work of only a few selfish individuals, most HR departments could resolve them. Unfortunately, the problems are endemic and deeply embedded in medical culture. When it comes to the questionable ethics of accepting money and perks from drug and device companies, doctors and hospital administrators routinely look the other way.

Source: Forbes https://www.forbes.com/sites/robertpearl/2018/12/10/shame-scandal/#785cc45c6807

Shame, Scandal Plague Healthcare Providers In 2018

In 2005, Dr. Sharon Levine designed and orchestrated the industry’s strictest conflict-of-interest policy, a program that defied the doomsday predictions of many doctors. Only two of the 5,000 physicians working in the medical group at the time left as a result of the new policy. (Kaiser conflict of interest policy)

© 2006 HCC, Inc. CD000000-0000XX 23© 2019 TMIT

In The News …

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1. Prohibit doctors from accepting anything at all from drug or device companies.

Conflict of Interest Code of Conduct

Source: Kaiser Conflict‐of‐Interest Policy, Forbes

2. Form an ethics committee to address any concerns doctors may have.

3. Direct all research funding, regardless of the source, to the institution and not to individuals.

4. Require all providers to disclose any past payments, prior to the policy’s implementation.

© 2006 HCC, Inc. CD000000-0000XX 24© 2019 TMIT

A New Program

The Healthcare Innocence Project builds on the successful model of The Innocence Project. Where it used the new technology of DNA 25 years ago, we will use the new technology of electronic records and the digital DNA in the E.H.R. and administrative records to protect the medical identity of patients and the professional identity of caregivers. Both patients and caregivers may be unjustly treated through intentional or unintentional behaviors of insiders or outsiders of healthcare organizations. They include weaponization of HR, sham peer review, discrediting patients and families after healthcare accidents, or unjust harm through outsider cybersecurity issues.

The Healthcare Innocence Project

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www.HealthcareInnocenceProject.org

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© 2006 HCC, Inc. CD000000-0000XX 25© 2019 TMIT

Healthcare Innocence Project

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Doctors, Defamation, and Damages:Medical Practitioners Fighting Back.

© 2006 HCC, Inc. CD000000-0000XX 26© 2019 TMIT

Healthcare Innocence Project

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From Mobsters to Managers. RICO (Racketeer Influenced and Corrupt Organizations Act) 

Extends Beyond the Underworld

© 2006 HCC, Inc. CD000000-0000XX 27© 2019 TMIT

Cardiac Arrest

Meaningful Use is dead. Long live something better!High Impact Care Hazards to Patients, Students, and Employees

Opioid Overdose

Common Accidents

Bullying

A Medical-Tactical Approach undertaken by clinical and non-clinical people can have enormous impact on los of life and harm from very common hazards:

• High Impact Care Hazards are frequent, severe, preventable, and measurable.

• Lifeline Behaviors undertaken by anyone can save lives.

Choking & Drowning

Anaphylaxis

Major Trauma

Transportation Accidents

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Med Tac Story Article

Active Shooter Healthcare Article

AED & Bleeding Control Gear Article

Rapid Response Teams Article

Battling Failure to Rescue

Automated External Defibrillator

& Bleeding ControlGear Placement

© 2006 HCC, Inc. CD000000-0000XX 28© 2019 TMIT

Meaningful Use is dead. Long live something better!High Impact Care Hazards to Patients, Students, and Employees

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Published November 11, 2019https://www.campussafetymagazine.com/news/inadequate-

placement-of-aed-and-bleeding-control-gear-could-cost-you/

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29© 2017 TMIT

Meaningful Use is dead. Long live something better!YouTube Patient Safety Briefings

Active Shooter Events in Healthcarehttps://www.youtube.com/watch?v=qSsWAs5JJBw&feature=youtu.be

Med Tac Bystander Care Traininghttps://www.youtube.com/watch?v=2lM0jh4qCQU&feature=youtu.be

Opioid Overdose Crisis 2019 Updatehttps://www.youtube.com/watch?v=vyCxQWxaEqE

YouTube TMIT Patient Safety Briefings

Sudden Cardiac Arresthttps://www.youtube.com/watch?v=qdXW5WxDDY8&feature=youtu.be

Med Tac Lifeguard-Surf Programhttps://www.youtube.com/watch?v=G1V8s7LWL6M&feature=youtu.be

Rapid Response Teamshttps://www.youtube.com/channel/UCCcoR25LxSltmrdRqyCQ7fA/

30© 2019 TMIT

J. Michael Henderson, MB ChB. FRSC(Ed). FACS

Chief Medical Officer

Leadership Tools, Performance Improvement, and 100 Day Plans

Kevin S. Cook, MSBA

Chief Executive Officer

TMIT High Performer WebinarNovember 21, 2019

Dr. Shannon Pittman, MD

Chair of Family Medicine

Candice Whitfield

Administrator of CMO office

31© 2019 TMIT

100%

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96% Agreed and 81% Strongly or Very Strongly Agreed, and 55% Very Strongly Agreed

Anonymous Survey Questions

Source: TMIT High Performer Webinar Series; Leadership Tools, Performance Improvement, and 100 Day Plans – November 21, 2019

I would like another webinar on PERFORMANCE IMPROVEMENT PLANS & TOOLS

32© 2019 TMIT

• A detailed storyboard type presentation on the 100-day workout. I'm really interested in adopting that process at my facility.

• Accountability, spread and adoption and sustainability with improvement plans with RCAs

• Any topic that promotes high reliability

• Cause analysis, sustaining results

• Common sense plans vs. Formal use of PI tools (i.e. Fishbone)• Connecting improvements to the strategic plan in a way frontline employees understand.

• Culture, staff engagement

• Data analysis; planning tools

• Data validity

• EHR workload, EHR dashboards & reporting for PI

• Engaging staff, helping staff understand it is not "extra" work but the way of work.

• Engaging staff; mid level buy in

• FMEA, process mapping, RCA

• Focusing on the tools• Getting physicians on board with peer review process

• How to encourage employees to participate and to sustain the changes/improvement made.

• Human communication skills/tools

• Leading from the unit level up--"grass roots driven"

• Maintaining the change

• Managers understanding causes of variation in the data and how to identify contributing factors

• Medication safety - high alert medications

• Metrics used to measure success

• Open to any. Loved this

• Other process improvement and performance improvement tools that can be used.

• Overarching structures /processes to move entire organization (hospital/physicians, across continuum of care)

• Patient safety.

• Performance improvement tools; best way to show data• Physician engagement

• Piloting/innovating safely in healthcare

• Project management

• Reducing resistance to change

• Retention tools for senior leaders

• Sharing of new tools

• Simple PI tools that work for front-line clinicians

• Strategies for handling negativity - naysayers

• Sustainability• Sustaining gains

• Sustainment

• Teamwork

• Tips on how to engage physicians in change

• Training programs for middle mgmt., 5S implementation in healthcare, beating the cultural obstacle of "bring in the lean specialist" vs emphasizing cultural transformation within your own organization

• Utilization of performance improvement plans and tools to improve operations.

• What are the variety of tools available, and what scenario are they best used for?Source: TMIT High Performer Webinar Series; Leadership Tools, Performance Improvement, and 100 Day Plans – November 21, 2019

The topics I wish to have covered in a webinar onPERFORMANCE IMPROVEMENT PLANS & TOOLS

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33© 2019 TMITSource: C. Denham, TMIT

The #1 Concern to healthcare leaders is brand damage of the institution and the individual brands of those who serve.

Their brand is what they are known for by the public.

Our Emerging Threats Community of Practice is addressing the inside, outside, and inside-outside threats to patients, caregivers, and institutions.

© C Denham 2019

© C Denham 2019

34© 2019 TMIT

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90% Agreed and 68% Strongly or Very Strongly Agreed, and 47% Very Strongly Agreed

Anonymous Survey Questions

Source: TMIT High Performer Webinar Series; Leadership Tools, Performance Improvement, and 100 Day Plans – November 21, 2019

I would like another webinar on ENGAGING SENIOR LEADERS IN PATIENT SAFETY

35© 2019 TMIT

• Getting an understanding of why it is important to them and the impact for them.

• Helping them to recognize benefits of rounding (intentional rounding), not just saying hello to everyone.

• Helping them with time management to accomplish. My organization has very poor adoption of senior leader rounding.

• Collaboration• Communication• Dealing with potentially competing priorities coming from various senior

leader sources (health system vs local site-level executive leaders)• Empowering teams to make just in time decision. I.E. Giving away power

to the teams• Engaging physicians & overcoming their resistant• Essential training for leader - what should execs invest in for their

leaders?• Governance; systematized implementation; why budget-neutral

projects?• How does it fit into patient experience/how does one not transcend the

other• How to get senior leadership to improve staff interactions

• Leader rounding; recognizing improvements• Making patient experience (quality/safety/pt sat) the same priority as

financial. • Quality is not costly; the cost of motivation and engagement is minimal

compared to the payoff.• ROI• Roles and responsibilities• Roles of senior leaders in PI. How can they bring change in organization

by getting involved in PI• Staff engagement• Utilization of performance improvement plans and tools to improve

operations.• Value of long-range plan• What types of organization safety goals to other sites have aside from

HAIs, HACs, readmissions, etc. To avoid unintended consequences to culture

• Who & how

Source: TMIT High Performer Webinar Series; Leadership Tools, Performance Improvement, and 100 Day Plans – November 21, 2019

The topics I wish to have covered in a webinar onENGAGING SENIOR LEADERS IN PATIENT SAFETY

36© 2019 TMIT

Casey Clements, MD, PhD Emergency Medicine PhysicianMayo Clinic Rochester, MN

TMIT High Performer WebinarDecember 19, 2019

Violence in Healthcare and Keeping Everyone Safe

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©2017 MFMER

Violence in Healthcare &Keeping Everyone SafeCasey M Clements, MD PhDDept. of Emergency MedicineMayo Clinic

©2017 MFMER

Disclosures• No financial interest• Images used in this presentation are from Mayo Clinic held

resources for Mayo business (MAUD, Shutterstock), or are publicly available and cited.

Copyrighted content is only used in this presentation with permission or under fair use/fair dealing exceptions according to international copyright laws

©2017 MFMER

Objectives:• 1. Explain the problem of violence in healthcare, including

prevalence and key factors contributing to violent acts

• 2. Describe barriers to improvement for violence in healthcare both internal to healthcare organizations and within communities

• 3. Understand violence mitigation interventions at Mayo Clinic and the effect on staff and patients

©2017 MFMER

Workplace violence (WPV) annual data

•1.7 million nonfatal assaults

•900 homicides

•Cost: $4.2 billion each year

US Department of Labor, Occupational Safety and Health Administration. Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers. OSHA 3148-06R. 2016.

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©2017 MFMER

Workplace violence (WPV) – 2011-2013

74%

26%

Healthcare ViolenceAll other workplaces

US Department of Labor, Occupational Safety and Health Administration. Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers. OSHA 3148-06R. 2016.

©2017 MFMER

73%

27%

Non-ED Nurses

Victim of violence inthe last yearNo violence in the lastyear

97%

3%

ED Nurses

Workplace violence (WPV) – 2011-2013

J Emerg Nurs. 2014 May;40(3):218-28

©2017 MFMER ©2017 MFMER

Emergency Department Violence Surveillance Study 11/2011 (ENA)

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©2017 MFMER

Emergency Department Violence Surveillance Study 11/2011 (ENA)©2017 MFMER

Emergency Department Violence Surveillance Study 11/2011 (ENA)

©2017 MFMERJ Emerg Nurs. 2014 May;40(3):218-28

©2017 MFMERA World Without Words/Cristian V./Creative Commons

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©2017 MFMER

Only 19% of assaults are reported by staffAm J Ind Med. 2015 Nov;58(11):1194-204.

A World Without Words/Cristian V./Creative Commons©2017 MFMER

J Emerg Nurs. 2014 Jul;40(4):305-10.

©2017 MFMERJ Emerg Nurs. 2014 May;40(3):218-28 ©2017 MFMER

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©2017 MFMER

Minnesota law609.2231 ASSAULT IN THE FOURTH DEGREE.Subd. 2: Firefighters and emergency medical personnel.Whoever assaults any of the following persons and inflicts demonstrable bodily harm is guilty of a felony

• (2) a physician, nurse, or other person providing health care services in a hospital emergency department.

©2017 MFMER

Training disconnect

©2017 MFMER

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Acute, Undifferentiated, Psychomotor Agitation: Need for Treatment Algorithm

• Common presentation to ED

• Worrisome upsurge in violence in healthcare settings, nationally and locally.

• Our patient and staff safety depends on rapid and safe control of these patients.

• A standardized approach would help.

©2017 MFMER

Paradigm: Two Staged Approach in the ED

Step 2

Initial ControlSafety

Short acting

Definitive Management

Rx for suspected

etiology

Step 1

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©2017 MFMER

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©2017 MFMER ©2017 MFMER

Larson et. al, Jt Comm J Qual Patient Saf. 2019 Jan 9. pii: S1553-7250(18)30103-X

©2017 MFMER ©2017 MFMER

Handoff has info for safe transfer of care

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©2017 MFMER ©2017 MFMER

©2017 MFMER ©2017 MFMER

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©2017 MFMER

Violet for violence

©2017 MFMER

©2017 MFMER ©2017 MFMER

Complex Intervention Unit (CIU)

• Cooperative project between hospital medicine, emergency medicine, and psychiatry

• Hospital based unit with ‘closed’ staffing model & dedicated medical service

• Physical plant for behavioral and medical complexity

• Voluntary staff, trained and experienced with both medical and behavioral complexity

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CIU Performance MetricsWhat Performance measuredRestraints/Seclusions Safety by use of interventions

Admissions requested/pending/occupied Demand/capacity/utilization

Staff workdays lost due to patient inflicted injury Safety

HCAHPS Patient satisfaction

Additional calls for Mayo Security & RPD to CIU Safety

ED Registered Patient Days ED utilization

Staff sense of safety Perceived safetyNumber of BERT calls

Additional regular unit metrics (ADC, LOS, readmissions, etc.) to be monitored as well.

©2017 MFMER

©2017 MFMER ©2017 MFMER

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©2017 MFMER

The bottom line:• Violence is an epidemic and is one of the biggest challenges

facing healthcare in the US

• The culture in healthcare and in the public has to change• This requires administrative and public action

• There are steps we can take to prevent and mitigate the risk of violence

©2017 MFMER

It is not ‘part of the job’ to be assaulted

©2017 MFMER

Questions & Discussion

80© 2019 TMIT

National Survey QuestionsI would like another webinar on

WORKPLACE VIOLENCE

VeryStrongly

Agree

10Strongly

Agree

9Agree

8Agree

7Very

Strongly Disagree

1

Disagree

3Strongly Disagree

2Neutral

6Neutral

5Negative to Neutral

4

The topics I wish to have covered in a webinar onWORKPLACE VIOLENCE

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81© 2019 TMIT

National Survey QuestionsI would like a webinar on HOSPITAL ACQUIRED CONDTIONS

Known as the HACs

VeryStrongly

Agree

10Strongly

Agree

9Agree

8Agree

7Very

Strongly Disagree

1

Disagree

3Strongly Disagree

2Neutral

6Neutral

5Negative to Neutral

4

The topics I wish to have covered in a webinar onHOSPITAL ACQUIRED CONDTIONS (HACs) include:

81 82© 2019 TMIT

National Survey QuestionsI would like a webinar on ADVERSE DRUG EVENTS

VeryStrongly

Agree

10Strongly

Agree

9Agree

8Agree

7Very

Strongly Disagree

1

Disagree

3Strongly Disagree

2Neutral

6Neutral

5Negative to Neutral

4

The topics I wish to have covered in a webinar onADVERSE DRUG EVENTS INCLUDING ANTI-COAGULATION

82

83© 2019 TMIT

Speakers and Reactors Dr. Casey Clements

Dr. Charles Denham

William Adcox

Vicki King

Dan Ford

Gregory Botz

84© 2019 TMIT

Voice of Patient and Family

Dan Ford, MBA, LFACHE

Voluntary Patient Safety AdvocateSpectrum Health Hospital Group Board, Quality & Safety Committee Memberand Executive PFAC former member and ChairTMIT Patient Advocate Team MemberRetired Healthcare Executive Search ConsultantVeteran, Naval Aviation, Vietnam WarRockford, MI

TMIT High Performer WebinarDecember 19, 2019

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85© 2019 TMIT

ADDITIONAL RESOURCES

© 2006 HCC, Inc. CD000000-0000XX 86© 2019 TMIT

In The News …

86

More and deadlier: Mass shooting trends in America

© 2006 HCC, Inc. CD000000-0000XX 87© 2019 TMIT

In The News …

87

More and deadlier: Mass shooting trends in America

88© 2019 TMIT

Meaningful Use is dead. Long live something better!In the News: Med Tac Updates

Source: Campus Safety Nov/Dec Issue - https://www.campussafetymagazine.com/public/med-tac-training-bystanders/

Nov/Dec 2018 Issue

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Meaningful Use is dead. Long live something better!Med Tac Slides and Articles in RESOURCES SECTION

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Med Tac Articles: Campus Safety Magazine