Why you should never leave your wing man’

Hospital’s safety culture wins award

Red rules have earned Sentara Norfolk (VA) General Hospital a golden award. The hospital won the American Hospital Quest for Quality Prize from the American Hospital Association for creating an "institutionwide cultural transformation" with a commitment to safety. The prize: $75,000.

The staff and administrators at Norfolk General have worked hard to build a safety culture focused on both patient and worker safety. They learned a new lingo to go with it. "Red rules" are the two or three most important safety edicts in a department. For example, when maintenance workers are working on a piece of machinery, "lock out/tag out" is a red rule to make sure no one can energize it and inadvertently put them in danger.

"Never leave your wing man" is a slogan taught to employees about behavior-based expectations. Just as Navy pilots don’t abandon their crew, employees are supposed to back up each other, and coach or counsel them when necessary. So a unit secretary can remind a physician about washing his hands before seeing a patient by lightly adding, "I’m supposed to be your wing man."

With four other behavior-based expectations, the hospital has made safety both a job requirement and a badge of honor. "It’s a long-term commitment to make this stick and really change the culture," says Joe Savala, director of construction, engineering, maintenance, and clinical engineering.

Support for the safety culture is top to bottom at Norfolk General — a strong commitment from administration and the buy-in of employees. In fact, the administration encourages employees to speak up about safety, even when it’s not a situation in their department.

For example, the manager of the air-conditioning shop questioned a call from a nurse who wanted a room converted to negative pressure. He knew that the rooms on the floor usually had positive pressure.

He visited the floor and contacted infection control. It turned out that the transplant patient actually needed a positive-pressure room to prevent outside air from entering; he prevented an error that could have jeopardized the patient.

"The [air-conditioning manager] had the courage to speak up and say, This doesn’t look right,’" Savala notes.

Other behavior-based expectations include: Pay attention to detail. Communicate clearly. Have a questioning attitude. Provide an effective handoff of information and/or patients.

Jeanette D. Rice, SLS, employee safety program specialist in occupational health, used those behavior-based expectations to reduce needlesticks by an additional 3% last year. First, she reviewed needlestick reports to see why they happened.

She used the patient safety coaches, specially trained employees on each floor, to help spread the word about prevention techniques. For example, "pay attention" means focusing before performing a phlebotomy.

"Have a questioning attitude" means checking the sharps containers to see if they are full before using the sharp. If the container is overfilled, "their wing man needs to be there to help them change that out to avoid possible injury," Rice notes.

Every month, the safety coaches meet to discuss what more they could do to promote safety. Everyone in the hospital — all 4,000 employees — has received four hours of training in the safety culture concept and behavior-based expectations.

The Quest for Quality judges were impressed when they spoke to employees. "They actually saw that we were walking the walk," says Rice.

How do you keep staff motivated to focus on safety? Well, winning an award helps. The hospital held a recognition party in the auditorium, applauded staff who have shared "safety success stories," and gave everyone ice cream sundaes on each shift.

The hospital has its own expectations and rewards. "We set a goal in 2003 related to patient safety, having to do with the behavior-based expectations. We did meet that goal," explains Jennifer Chiusano, RN, director of cardiac services and a member of the hospital’s safety team. "The employees were given a bonus."

Meanwhile, Norfolk General continues to collect safety success stories. In one case, the emergency department (ED) manager noticed an unattended ladder leaning against the outside wall of the ED, leading to the roof. It remained there for several days.

She asked safety officer about it, and he determined that a part-time contractor was leaving the ladder at night rather than taking it down, even though it gave unauthorized people direct access to the roof. The hospital instructed the contractor to remove the ladder nightly.

In another case, a nurse and paramedic landing at an accident scene noticed an unusual change in the sound of the rotors of the Nightingale Helicopter Ambulance.

They told the pilot, and while they worked on the patient, the pilot climbed up on the helicopter and found a plastic bag wrapped up in the rotor. It could have damaged the mechanism. He removed it, and the helicopter returned safety to Sentara Norfolk General Hospital.