Transcript Perinatal Patient Safety

Perinatal Patient Safety
An interdisciplinary approach to
improve performance
J. Chris Carey MD
Director, Obstetrics and Gynecology, Denver Health
Professor, Obstetrics and Gynecology
**High reliability organizations are those that
operate highly complex and hazardous
technological systems essentially without
mistakes over long periods of time.
High reliability patient care units are built on
a solid foundation of timely communication
and collegial teamwork to maintain patient
safety as a top priority.
** “Managing the Unexpected: Assuring High Performance in an Age of Complexity”
K. Sutcliff, MSN, PhD
San Francisco: Jossey-Bass; 2001
In these units…………
• Concise, real-time and constant
communication is valued
• Teamwork and collegiality characterize the
professional relationships
• Hierarchy is minimized
• Safety is the hallmark of the organizational
culture
• Their operations are viewed as potentially
dangerous
• Emergencies are rehearsed and the
unexpected practiced
Partnering Relationships
Are………………..
• Collaboration and teamwork that is an
authentic partnership in which power on both
sides is valued
• Each recognizes and accepts spheres of
activity and responsibility
• Each mutually safeguards the interests of
each other
• Each recognizes a commonality of goals
• Based more on respect and contribution than
power and dependency
Partnership is evidenced by
……
• Communicating with patient’s family and
healthcare providers regarding patient care and
all providers’ role in the provision of that care
• Collaborating in creating a documented plan,
focused on outcomes and communication with
families and others
• Partners with others to effect change and
generate positive outcomes through knowledge
of the patient or situation
Strategies to achieve a strong
partnership ethic include:
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Thinking expansively
Being flexible
Challenging assumptions
Abandon the comfort zone
Redefine boundaries
Realize the vision
Think Expansively, become
a “Totalist”
• Always learning and supporting the
changes that benefit the patient
• Thinks beyond the confines of own
experiences or knowledge
• Sees the whole picture
• Sees how people and processes work
together
Be Flexible
• Adapt to change
• When situations are not controllable, your
reaction to it is
• Work together to manage the surprises,
ambiguity, conflict or disorientation that are
part of every change
Challenge Assumptions
• Never blindly trust assumptions
• Build on knowledge and understanding
• Mistakes, errors, wrong turns and confusion are
often built on assumptions
• Knowing your partners is essential
• Believing assumptions to be true encourages a
lose-lose situation that fosters resentment,
confusion, delays and waste.
• Stop Making Stuff Up – check it out!
Abandon the Niche
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Step outside of your personal comfort zone
Understand your team
Cannot continue to do things in the old way
Be willing to trust others
Be willing to stretch and share our expertise
Be willing to work on projects that involve others
in the organization
• Be willing to take risks
Redefine Boundaries
• Let go of traditional roles
• Eliminate “turf protection”
• Remove barriers to cross-functional
interactions
• Think big and out of the box
• Focus on patient needs
Key Elements for success
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Partnership
Equity
Outcomes
Benefits
Barriers
Accountability
Ownership
Why Effective Communication and
Teamwork ?
• The overwhelming majority of untoward
events involve communication failure
• Somebody knows there’s a problem but
can’t get everyone in the same movie
• The clinical environment has evolved
beyond the limitations of individual human
performance
MD –RN: Different
Communication Styles
• Nurses are trained to be narrative and
descriptive
• Physicians are trained to be problem solvers “what do you want me to do” – “ just give me the
headlines”
• Complicating factors: gender, national culture,
the pecking order, prior relationship
• Perceptions of teamwork depend on your point
of view
Effective Communication Requires:
* Structured communication – SBAR
* Assertion/ Critical Language – key words,
the ability to speak up and stop the show
* Psychological safety – an environment of
respect
Situational Briefing Model
S-B-A-R
* Situation
* Background
* Assessment
* Recommendation
SBAR in OB
* S – Impending uterine rupture
* B – VBAC, dense epidural, persistent
breakthrough pain, complete
* A – I’m concerned, something’s
wrong
* R – I think she needs a C-S. I need
you now
SBAR
* Situation – the punch line 5-10
seconds
* Background – the context, objective
data, how did we get here
* Assessment – what is the problem ?
* Recommendation – what do we
need to do ?
Assertion
• Model to guide and
improve assertion in
the interest of
patient safety
GET PERSON’S
ATTENTION
REACH
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DECISION
PROPOSE
ACTION
EXPRESS
CONCERN
STATE
PROBLEM
The Difficult Conversation
* Focus on the common goal – high quality,
safe care
* 3rd person – depersonalize the
conversation – it’s not about you and me
* Avoid judgment; who’s right, who’s wrong
is a loser
* What needs to happen for us to do the
right thing here?
“Difficult Conversations”: Stone, Patton, Heen; Viking (1999)
Sustaining SBAR Use
• “Give it to me in SBAR”
• Use prompts and ticklers
– Checklists
– Phone labels
– Pocket cards
• “Thanks for using SBAR”
• Reward and recognize