15 minutes to a safer hospital
Daily meeting makes difference at VCU
When the CEO of Virginia Commonwealth University’s health system said he wanted to be "the safest health system in America," six years ago, he wasn’t just talking. He spent money to help make the system into a high reliability organization, and made the mission "safety first, every day." It was leadership followed by everyone down the line.
One of the first things that came out of his mission to excel in safety was a daily check-in meeting that started in November 2008 with administrators and nursing alone, and eventually spread to include support staff and professional services.
According to Shirley Gibson, MSHA, RN, FACHE, associate vice president of nursing at VCU, there wasn’t a whole lot of structure to the initial meetings, and people were slow to bring issues forward. Now, with every department participating, she is proactive in asking each about significant near misses, safety events, or other issues of concern. Each is asked for the daily census, there is a report of activity in the OR and ED, and how many cases are expected for the day. "We try to figure out what the tension will be in the organization that day," Gibson explains. For instance, there was a community bike race recently that led to some closed streets. Questions were asked about how patients and staff would get to work.
The meetings are conducted via conference call — although people will go in person to the room where Gibson sits for the meeting if they are on that floor. If an issue is raised, someone in the meeting will take responsibility for any follow-up needed. If an issue is of concern for multiple parties and requires extra time, Gibson explains that they will stay on the line after others leave the call to deal with it.
Initially, the calls took as long as an hour, but now they are rarely more than 15 minutes, even though there are up to 75 people on the line every morning and up to 25 departments reporting. Initially, the meetings were voluntary, not mandatory. What got people interested in coming was seeing how many longstanding problems were quickly being fixed due to the meetings. "It kind of snowballed from there," she says. "Once you went to one, you wanted to go back."
Currently, the organization is in the midst of a program called 52 Weeks of Safety. Each week features a different topic, and during the daily meeting, there is an update on the topic of the week. They have covered hand hygiene, falls, and pharmacy resources.
A typical call starts with an update on the safety topic for that week, followed by an unchanging introduction from Gibson: "Our vision is to be safest health system in America. Our goal is to have zero events of preventable harm to patients, staff and visitors."
She emphasizes that staff and visitors are included in the goal, something that can be left out of the equation when talking about safety. Then the departments report, although not everyone reports every day. "Even pastoral care will report if they have useful intelligence for us."
The results have been pretty spectacular: a 51% reduction of serious safety events since 2012. There was an initial increase when they first started, but that was expected as reporting increased. "The greatest thing is the situational awareness and accountability. It all comes out of things going in the right direction."
Safety a core value
A couple of things have changed over the course of the six years. They now have a run chart of serious safety events, so they can see a trend line. "We used to know when things happened, but there is a greater accountability now that we can see the numbers."
Safety is the core value of the organization, she says. "People take it seriously, and if there is a safety issue, it is transparent, it is recognized as a system issue, not a personal one. That helps make people more willing to report and that makes the whole system safer."
Any organization can do this, she says, noting that many hospitals have joined in on the calls over the years to see how VCU does what it does. They have then gone back to their own facilities to replicate it. "Some require everyone to go to a room and do a stand-up meeting — because standing up ensures it won’t last to long."
She recommends doing a pilot test of whatever method you choose for safety meetings. Make sure you put in a good structure, too. Then start spreading the meeting out into the organization.
For more information on this topic, Contact Shirley Gibson, MSHA, RN, FACHE, Associate Vice President of Nursing, Virginia Commonwealth University, Richmond, VA. Email: [email protected].
