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A hospital developed a process for conveying patient safety issues to executives. The process provides health and safety leaders direct access to the C-suite.
Some patient safety issues are so important that risk managers and other safety leaders need direct access to the C-suite so that concerns can be addressed quickly. Helen DeVos Children’s Hospital in Grand Rapids, MI, devised a harm collaborative that makes that possible.
The collaborative meets weekly so that risk managers and other safety or quality professionals can address the executive team about individual patient cases or trends that are concerning, says Laura Bailey, senior clinical risk manager with the hospital. The collaborative was developed in 2015 by Bailey’s predecessor in risk management.
“It originally was intended as a meeting at which we discussed every single harm event that affected a patient, keeping the leadership team aware of trends so they could improve safety efforts more rapidly,” Bailey says. “It has evolved a lot over time so that while we still talk primarily about safety events, it’s also a time for us to bring up any major process issues that we see or hear being reported. Maybe we haven’t necessarily had a safety issue with it yet, but we have a big cumbersome process that teams are struggling to solve. The executive team can help us escalate the problem so that we get faster solutions.”
Bailey collaborates closely with Heather Githu, senior safety specialist at the hospital, to determine which safety events should be discussed at the meeting. The risk manager primarily brings events that came through the hospital’s event reporting system, which involve patient harm or issues that the executive team should know about.
The meetings are informal, and executives often refer to it as their “don’t miss” meeting of the week because it is so informative, Bailey says. Usually, about a dozen senior executives and safety leaders participate.
Harm collaborative meetings last one hour and rarely are cancelled, Bailey says. Monthly meetings would not be as useful, she says, because incidents from three weeks earlier will not be as fresh in the mind and may be forgotten. Participants also will not remember as clearly what was discussed that long ago.
The simplicity of the meeting is part of what makes it work, she says. “In an informal manner, I’ll present the cases, and then we’ll open it up for discussion with the team to make sure I’ve done a thorough investigation, in case there are things I didn’t think of but that the senior leaders think need investigation,” Bailey says. “We will then talk about next steps, if they are necessary to resolve the problem.”
Githu often follows up with trend reports and a recap of her meetings with unit-level leaders and their safety concerns or process issues.
“Any time we do a root cause analysis or an apparent cause analysis, I bring the action items to the harm collaborative and go over those. That’s a place where we can get engagement with leadership to address any barriers we think might encounter on those action items,” she says. “Also, the executives are more aware of what’s happening in our entire health system, so they may be able to tell us that this action item is already slated to be addressed in the near future with a solution. They also may push back on some action items because they want to be sure the solution is really solid, which makes us use strong action items and not just fall into lower levels of effectiveness.”
Githu brings the nurses who performed apparent cause analyses so they can speak directly to the executive team about what they found. Bailey also brings in unit-level employees to speak to the harm collaborative because they often can describe the issue more effectively than she can, and answer the questions of the executives.
“It’s gotten so that I have managers reaching out to me now to say they know this issue isn’t a harm event but they’re really struggling with a process and they’d like to come to the harm collaborative to talk to the team about it,” Bailey says. “That’s a win because it makes the executive team available and approachable. It makes our frontline team feel safe enough to say they have a big problem and they need some help to solve it.”
Githu, who first participated in the harm collaborative as a unit leader, points out that it is important to give staff members a way to seek help without taking on all responsibility for fixing a problem.
“Too often, you hear about people saying they brought up a concern and then it got assigned to them to fix. But if I knew how to fix it, I wouldn’t have asked for help,” Githu says. “One thing this collaborative did for me was provide a way to say ‘I need help. I can’t fix this and I’m bringing it to you to escalate it.’”
Bailey reports to the executive team at subsequent meetings on the progress of action items and process improvements, which she says the executives appreciate.
“What would happen historically is that they would hear about an event one time and never have the opportunity to hear about the resolution, or if there was one. This way, they can be assured that these issues we raise aren’t falling off the side of the desk, and we’re actually acting on them in meaningful ways,” Bailey says.
Githu also asks unit leaders who performed apparent cause analyses to return for updates after their original presentations to the harm collaboratives. They tell the executives about progress with action items, any barriers they encountered, and any new instances of the safety event.
The harm collaborative works only because the executive team attends regularly, Githu says. They attend regularly because they find value in the meetings, she says.
Clarity about the goal of the meeting also is key to making them work, Bailey says. The meeting is not intended as a time to solve the problem.
“We will have good conversations about the potential solutions, but we don’t try to solve the problem then and there. We’re identifying the issue and deciding where to take the problem to be solved, making sure we’re engaging the right teams in it,” Bailey says. “It’s important not to go too far down the rabbit hole in this meeting, but rather to make a plan for how we will solve the problem after we walk out the door.”
It also is important to assign action item owners, Bailey says. Otherwise, the group may hold a robust discussion and enthusiastically endorse action items that are never addressed once everyone leaves the meeting, she says.
“We’ve gotten more proactive about saying that, for instance, ‘The director of surgical services will take this one.’ That helps keep it from being overwhelming to Heather and me, so we don’t feel like every single problem and event falls on just us to solve,” Bailey says. “This has really strengthened my relationship with the executive team and built my confidence up to know that I can go to them as a resource and they are actively engaged and willing to problem-solve with me.”
Building that kind of relationship with executives can be difficult if you do not create a purposeful environment in which you meet regularly, Bailey says. Participating in the harm collaborative has improved the risk management program and patient safety at the hospital, she says.
“Prior to the harm collaborative, there would be safety events that prompted multiple emails and communications between this person and that person. Different people would know about parts of the picture, but no one had the whole picture,” Bailey says. “Now that we get that core group together weekly, we can inform everyone, clear up any miscommunication, and talk about the event pretty close to when it happened. We eliminate the need for a lot of those side conversations because we know we can discuss on Thursday at the harm collaborative.”
Transparency is necessary for a harm collaborative to function effectively, notes James Bonner, LMSW, MBA, director of safety and patient experience for Helen DeVos Children’s Hospital. That comes from a just culture and must be conveyed from the top down, he says.
“There is some work around high reliability and just culture that has to not only be understood, but accepted and adopted by those wanting to do this work,” Bonner says. “It’s easy to read about something like this and think it sounds like something you should do, but it requires us as leaders to change and make these principles come alive. The ability to talk about harm in this way comes from leadership modeling.”
Financial Disclosure: Author Greg Freeman, Editor Jill Drachenberg, Editor Jonathan Springston, Editorial Group Manager Leslie Coplin, Accreditations Manager Amy Johnson, MSN, RN, CPN, and Nurse Planner Maureen Archambault report no consultant, stockholder, speaker’s bureau, research, or other financial relationships with companies having ties to this field of study. Consulting Editor Arnold Mackles, MD, MBA, LHRM, discloses that he is an author and advisory board member for The Sullivan Group and that he is owner, stockholder, presenter, author, and consultant for Innovative Healthcare Compliance Group.