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PSO: An evolving, critical role in health care quality
Reporting structure varies from facility to facility
Whether they are called patient safety officers (as many now are), patient safety managers, or some other title, individuals whose overall responsibility at their facility or health system is minimizing errors and complying with safety standards such as The Joint Commission's National Patient Safety Goals are gaining in both prominence and responsibility.
In fact, according to a new article in the Journal of Patient Safety, this new breed of patient safety leader " . . . must be an educator, a diplomat, an analyst, a student, a negotiator, a communicator, and a person who understands broad strategies and granular tactics."1
The authors continue: "To be an agent of change, they must not only have a high intelligence quotient (IQ) but also, perhaps more importantly, a high emotional quotient (EQ) – that is to say that they must have solid people skills.
"Most of all, they must be leaders who earn the respect of those who can influence the behaviors of everyone up and down their organizations because their impact will be made through others."
These daunting skill set requirements are reflected in those who hold such positions. Take, for example, Marion Martin, RN, MSN, MBA, patient safety officer at Moses Cone Memorial Hospital in Greensboro, NC.
"I think my timing was perfect when I was asked to take this position," she relates. "I was director of emergency services, which really did prepare me; after all, they were looking for someone with a quality background, able to handle the ED, with 30 years of nursing experience, familiar with state and federal guidelines for Medicare and Medicaid, and someone who has dealt with The Joint Commission."
In addition, she says, there is a "big focus" on process improvement. "And we are very involved in the quality piece as well."
Different structures used
The title's meaning and reporting structure can vary quite a bit from organization to organization. "I have held the equivalence of this position from its inception, but the very use of the term Patient Safety Officer is significant," notes Lori A. Paine, RN, MS, patient safety manager for Johns Hopkins Medicine in Baltimore. "At Hopkins it is reserved for the corporate officer under whom patient safety resides — in this case, the vice president of medical affairs. "I am his one lieutenant responsible for everything in patient safety."
In other organizations, she notes, the position reports through the quality structure, while in others it flows through risk management. "It's interesting to consider under what structure [the position] reports to," notes Paine.
Both Paine and Martin agree the scope and importance of the position are growing. "Just look at what's going on in terms of folks with this title," says Martin. "As I get out and about and look at some of the national initiatives, such as IHI [Institute for Healthcare Improvement], with its new 5 Million Lives campaign, and The Joint Commission, with its National Patient Safety Goals, there is a huge focus on safety — and I am involved with all of those."
Paine agrees that the position is "definitely" growing, as evidenced by the aforementioned reporting structure. "Our reporting structure makes an important statement about patient safety in our organization," she asserts.
At an academic medical center like Hopkins, she explains, the physicians have a reporting structure aligned with the university, but they also are aligned as employees of the hospital. "It's difficult to have a hospital [safety] position and try to accomplish anything multi-disciplinary," says Paine.
At Moses Cone, patient safety originally had been part of the job description of the risk manager, "but it's an overwhelming role," notes Martin. "There's a lot of responsibility, and the risk manager couldn't do both. You need one person to look at patient safety, and then work with risk management; it really requires a new culture, with one person overseeing the building of that culture."
In smaller organizations, says Paine, it might be necessary [for a single person] to multi-task, "but I argue that every organization should devote at least one person to patient safety; there's a lot to do."
Patient safety officers spend a good deal of time interfacing with other departments. "Our quality and risk departments are separate, but we all must collaborate," says Paine.
For example, she notes, she is responsible for the event reporting system. "We get 250 [events] reported a week," she shares. "My staff goes through all of those events individually — regardless of level of harm."
At the same time, risk management performs a similar task, but only for those events where harm has occurred. "We parse those off to risk management, but we look at those events in the lower harm range, and examine risks and opportunities for improvement," says Paine.
The quality department has a very defined role: They are "officially" responsible for monitoring follow up of sentinel events, and making sure action items get followed up on, says Paine. "Every department has a PI or QI nurse assigned to them; we encourage them to use the data out of our event reporting system to help those departments see their own opportunities for improvement," Paine adds.
At Moses Cone, Martin and the risk manager meet weekly to discuss adverse outcomes, so they can learn how to prevent similar events in the future. "We work very closely with the risk management specialists in developing a plan of action, and we have created a culture of safety," she says.
As her responsibilities also touch on the building itself, Martin is involved in the physical safety of employees, and compliance with OSHA. "Also, infection control reports to me, which I highly recommend as a strategy," she says. "We meet daily to talk about things like flu epidemics, what to do with patients when we see a growing population coming into the hospital with community-acquired conditions, and so forth." She also interfaces with pharmacy on issues such as high-risk medications.
The position itself is part of the quality department, so she reports to the chief quality officer, who in turn reports directly to the CEO. "As [this position] grows, it may change down the road," Martin predicts.
At present, the chief quality officer assigns Martin projects, and together they discuss all adverse outcomes and review public reporting data. "We have created a dashboard for looking at the National Patient Safety Goals and how we are performing," she adds.
For a job that has only existed for three-plus years, its "plate" is a full one. Martin also interfaces with hospital Six Sigma "black belts;" when patient safety issues are identified, they discuss how to turn those issues into projects, and share learnings from those projects. "This way, there is a patient safety component in all QI projects," she explains.
She also works very closely with the medical staff, meeting weekly to review Joint Commission standards.
Keys to success
What are some of the personal qualities that will help ensure success in such a position? "You've got to have passion around patients — being a patient advocate and seeing things through the patient's eyes," says Martin. (For example, on the hospital web site, www.mosescone.com, Martin reports responses to the question, "What would make me feel safe when I come to the hospital?")
"You have also got to have strong leadership skills," she continues. "You need to see things as the physician sees them, as the nurse sees them, and as leadership sees them, and be able to present the issue in such a way that it hits all the diverse groups you work with." (List of tips for success.)
Paine says that one of the major responsibilities, and, therefore, a key to success, is "to be knowledgeable and an agent of change of the organization's culture. Unless you understand and appreciate the culture of the organization, I'm not sure how you could do it."
That's because every organization is different, she notes. "I could go into another organization and not be able to accomplish the same things the way I did here; you have to be respectful of where they are in their journey," she says.
Another key to success, Paine continues, is to be able to tolerate ambiguity, and be able to take risks. "Four years ago when I took this position, I did not know what I was getting into," she concedes. "They called it a 'coordinator' position, but once you start having someone to turn over these 'rocks,' you start finding stuff, and the more you find, the more work there is."
In addition, she says that organizations "have to be prepared to act on the things we reveal." This, in turn, results in a "groundswell" around staff requirements. "At first it was just me; now two people do event reporting, another helps me with CUSP [Comprehensive Unit-based Safety Programs] and the safety newsletter, and Joint Commission readiness."
Who would make a good candidate for the position? "I think somebody with a clinical background — not necessarily a nurse, but a nurse would do very well," says Martin. "It could also be a physician; I have met several."
In general, she says, the ideal candidate "probably has great experience in quality processes, and has the ability to use all the tools available. It also takes someone who has the ability to make presentations to many diverse audiences, someone who has the ability to respond and be able to plan actionable items, and who can figure out how to measure outcomes."
1. Denham CR. The new patient safety officer: A lifeline for patients, a life jacket for CEOs. J Patient Saf 2007; 3:43-54.
For more information, contact:
Marion Martin, RN, MSN, MBA, Patient Safety Officer, Moses Cone Health System, Greensboro, NC. Phone: (336) 832-7659. E-mail: firstname.lastname@example.org.
Lori A. Paine, RN, MS, Patient Safety Manager, Johns Hopkins Medicine, Baltimore, MD. Phone: (410) 955-2919.