barriers to engagement are a threat to patient safety. a ... · 5994.2012.02766.x pmid:22616961...

salusglobal.com

Barriers to Engagement are a Threat to Patient Safety. A Call to Action.Jim Ruiter, MD, CCPEMedical Director and Vice President Salus GlobalKT&IS faculty, CPSI

2© 2020 Salus Global Corporation. All Rights Reserved. The Salus Global Logo, moreOB, moreEX, and all products denoted with ® or TM are trademarks or registered trademarks of Salus Global Corporation.

Disclosure

Jim Ruiter is a paid employee of the Salus Global Corporation


Who is Salus?

3

Transforming teams of experts into expert teams


Healthcare has evolved to disengage its own workersDisengagement of Healthcare staff is the norm

Quantum, Employee engagement in Healthcare industry report, Available at: https://www.quantumworkplace.com/employee-engagement-in-healthcare . Accessed March 20, 2018

Ruiter, J (March 2019), Disengagement in Healthcare: Today's New Culture. Can J Physician Leadership, vol 5 (3). ISSN 2369-8322

Braithwaite, J; Changing how we think about healthcare improvement BMJ 2018;361:k2014 doi: https://doi.org/10.1136/bmj.k2014

https://www.quantumworkplace.com/employee-engagement-in-healthcare

https://doi.org/10.1136/bmj.k2014


§ 2011: 67% HCP considered themselves engaged. § 2016: 55% HCP considered themselves engaged. § The Harm rate in Healthcare has stalled at 10%



Braithwaitte, J; Changing how we think about healthcare improvement BMJ 2018;361:k2014 doi: https://doi.org/10.1136/bmj.k2014

6

Why?




§ The Program of the Week§ Just Get It Done§ Seeking Buy-In§ Safety as distinct from Quality§ Data Swamp…

Disengagement: Healthcare’s New Culture


Gardam et al. 2017, Healthcare Quality Improvement Requires Many Approaches, response, Healthcare papers, 17:1

Flanagan M E, Welsh C A, Kiss C, et al. 2011. A National Collaborative for Reducing Health Care Associated Infections: Current Initiatives, Challenges and Opportunities. American Journal of Infection Prevention and Control 38(8):685-89

Zimmerman B, et al. Front-line ownership: generating a cure mindset for patient safety. Healthc Pap. 2013;13(1):6-22


Berwick D, Don Berwick's 7 Roadblocks to Improving Patient Safety. Available at: https://www.hhnmag.com/articles/8310-don-berwicks-7-roadblocks-to-improving-patient-safety . Accessed on May 20, 2017

Mannion R, Braithwaite J. Unintended consequences of performance measurement in healthcare: 20 salutary lessons from the English National Health Service. Intern Med J2012;42:569-74. doi:10.1111/j.1445-5994.2012.02766.x pmid:22616961


7


https://www.ncbi.nlm.nih.gov/pubmed/23803349

https://www.hhnmag.com/articles/8310-don-berwicks-7-roadblocks-to-improving-patient-safety

88

© 2020 Salus Global Corporation. All Rights Reserved. The Salus Global Logo, moreOB, moreEX, and all products denoted with ® or TM are trademarks or registered trademarks of Salus Global Corporation.

Generational change in positional power


Is it even disengagement?

1010


Gautam M. Workshop’s focus: ‘critical issue’ of burnout among women physicians. CSPL e-newsletter 2019;8 Jan. Available: https://tinyurl.com/ y4evutne (accessed 9 Jan. 2019).

"Burnout is an epidemic hiding in plain sight."


§ Human Error, Just Culture, and Deviance§ WAI vs. WAD in an ETTO World§ Complex Adaptive Systems § Care is not Linear

Patient Safety is in a New Age

Le travail prescrit et le travail réalisé; Ombredane & Faverge, 1955

Hollnagel E, In Safety-I And Safety-II. London: Ashgate; 2014

Hollnagel E. The ETTO Principle: Efficiency-Thoroughness Trade-Off, London: Taylor and Francis Group; 2009

Expert Panel report: The National Patient Safety Foundation, 2015. Free from Harm, Accelerating Patient Safety Improvement Fifteen Years after To Err Is Human; Available from: http://www.ihi.org/resources/Pages/Publications/Free-from-Harm-Accelerating-Patient-Safety-Improvement.aspx

Braithwaite J, Churruca K, Ellis L A, et al. (2017) Complexity Science in Healthcare – Aspirations, Approaches, Applications and Accomplishments: A White Paper. Australian Institute of Health Innovation, Macquarie University: Sydney, Australia

Ruiter, J (July 2019), Patient Safety in a New Age. Can J Physician Leadership, vol 5 (4). ISSN 2369-8322

12


13

Braithwaite, J, 2016

600+ policies, procedures and guidelines guidefrontline workers in their daily work.


§ Human Error, Just Culture, and Deviance§ WAI vs. WAD in an ETTO World§ Complex Adaptive Systems § Care is not Linear

Patient Safety is in a New Age

Le travail prescrit et le travail réalisé; Ombredane & Faverge, 1955

Hollnagel E, In Safety-I And Safety-II. London: Ashgate; 2014

Hollnagel E. The ETTO Principle: Efficiency-Thoroughness Trade-Off, London: Taylor and Francis Group; 2009

Expert Panel report: The National Patient Safety Foundation, 2015. Free from Harm, Accelerating Patient Safety Improvement Fifteen Years after To Err Is Human; Available from: http://www.ihi.org/resources/Pages/Publications/Free-from-Harm-Accelerating-Patient-Safety-Improvement.aspx

Braithwaite J, Churruca K, Ellis L A, et al. (2017) Complexity Science in Healthcare – Aspirations, Approaches, Applications and Accomplishments: A White Paper. Australian Institute of Health Innovation, Macquarie University: Sydney, Australia

Ruiter, J (July 2019), Patient Safety in a New Age. Can J Physician Leadership, vol 5 (4). ISSN 2369-8322

14

1515


The evolution of Safety Science

Safety I–II, resilience and antifragility engineering: a debate explained through an accident occurring on a mobile elevating work platform Alberto Martinetti , Maria MikelaChatzimichailidou, Luisa Maida and Leo van Dongena, International Journal of Occupational Safety and Ergonomics (JOSE), 2019 Vol. 25, No. 1, 66–75, https://doi.org/10.1080/10803548.2018.1444724


§ The status quo is not effective in § protecting our patient nor § supporting our front-line teams.

§ The inconvenient truth: § All who are disengaged now, were once upon a time fully engaged.

§ Staff will NOT re-engage because we asked them politely to do so.

16


§So what?


§ Engagement drives Quality

Sawka C, Ross J, Srigley J, Irish J. The crucial role of clinician engagement in system-wide quality improvement: the Cancer Care Ontario experience. Healthc Q 2012;15(special):38-41. doi:10.12927/hcq.2012.23157.

Employee engagement. Toronto: Canada Human Resources Centre; 2017. https://tinyurl.com/l923bjh)


§ Culture Drives Engagement

Karogiannis et al. An emergency department’s journey toward cultural change: a case study, Can J Physician Leadership, 2019; 5(4):213-221


§ Positive Culture is associated with Positive Outcomes§ Positive Culture is associated with Reduced Reportable

Adverse Events

Braithwaite J, Herkes J, Ludlow K, et al. Association between organisational and workplace cultures, and patient outcomes: systematic review. BMJ Open 2017;7:e017708. doi:10.1136/ bmjopen-2017-017708

Geary, M., Ruiter, P.J.A, Yasseen, A. 2018 Examining the effects of an obstetrics interprofessional programme on reductions to reportable events and their related costs doi:10.1080/13561820.2018.1543255


Culture + Engagement =

Positive Outcomes + Quality – reportable adverse events

The Equation:


§ What Healthcare has not traditionally valued is what is most important:

Unit Culture.

In the end….


§ Disengagement of Healthcare staff is the norm§ The Harm rate in Healthcare has stalled at 10%




23



2424


Unit Culture

“What wetolerate”

“The waywe do things here”

salusglobal.com

[email protected]

Jim Ruiter, MD, CCPEMedical Director and Vice President Salus GlobalKT&IS faculty, [email protected]

http://SalusGlobal.com

barriers to engagement are a threat to patient safety. a ... · 5994.2012.02766.x pmid:22616961...

Documents