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Safety Counts! a newsletter highlighting safety at Hallmark Health System
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Vol 3, No. 6, June 2015
In football, the huddle is used to communicate up-to-the-second information, to strategize and to motivate team members. In health care, it’s pretty much the same.
As part of its service excellence program, Hallmark Health System is spreading the practice of lean-based daily huddles (a concept aimed at continuous improvement) among small groups of staff who work together. This is an evolution of the existing daily huddles in the organization. Early adopters include the leadership team of William Doherty, MD, executive vice president and chief operating officer; the Medical 4 nursing staff at Melrose-Wakefield Hospital; the laboratory and radiology leadership teams; the quality team; and the pharmacy teams at both Hallmark Health hospitals.
Huddles average 5-15 minutes each day and are limited to discussion of a structured list, tailored to each area, of questions about issues that have arisen in the last 24 hours. Lists include touch points on each of five cornerstones: people, quality, service, finance and growth. “Daily huddles serve several purposes,” said David Marshall, director of performance improvement. “They facilitate team communication, help build strong teams, identify and address issues in a timely manner, and align team activities with department and organizational objectives.”
Huddles also help improve patient safety. “We know that good communication and patient safety go hand in hand,” said Marshall. “Having the daily huddle gives team
members an opportunity to speak up on issues they see every day, things that may seem small or may otherwise go unidentified, but that, when fixed, can improve safety for patients and staff.”
For example, Mike Biskup, director of laboratory services, said: “As part of lab huddles, we discuss any instrument issues. Recently, our main coagulation analyzer malfunctioned. While our technician caught the problem right away, we discussed it later during our huddle, which involves all lab locations. This enabled other lab areas to be on high alert for similar malfunctions, which could have resulted in inaccurate results being sent to clinicians.”
More areas will begin huddling this summer, with continued rollout throughout the system in fiscal year 2016.
Sometimes safety hinges on the smallest things, like hinges.
The last time The Joint Commission visited Hallmark Health System as part of its accreditation process, one of the site visitors (who had been a psychiatric nurse) pointed out that the hinges on doors in the 22-bed adult psychiatry unit (called Medical 6) at Melrose-Wakefield Hospital could present a safety risk to behavioral health patients who might seek to harm themselves.
Changing door hinges – even on the 39 doors in the unit – seems like a small fix, but it became a major renovation project, involving reframing every door to accommodate the new, non-protruding hinges. “The unit is more than 35 years old,” said Tom Gunning, BSN, RN, patient care director of behavioral health. “It wasn’t built initially to be a locked unit for patients with behavioral health issues, and the requirements, including safe environment building regulations, for caring for this population have changed. We used this opportunity to make several safety-related changes to protect our patients and staff.”
Besides the new door frames and hinges, improvements included purchasing new tamper-proof furniture that cannot be disassembled, upgrading patient bathrooms with hidden piping and integrated toilets, and installing door handles that release if too much pressure is applied.
The project took three months and involved closing half the unit at a time to accommodate the renovations. “We’re pleased with the result and confident that we have improved
safety on the unit for patients and staff,” said Gunning.
Engineering and safety leaders perform weekly safety, maintenance audits at hospitals
Environment-of-care rounds at the Hallmark Health System hospitals combine preventive maintenance, safety inspections and staff coaching – all in the name of improved patient and staff safety.
A team of environmental services leaders spends a good part of every Friday afternoon making the rounds at either Melrose-Wakefield Hospital or Lawrence Memorial Hospital of Medford. “We take one floor each week,” said Hugh Kelleher, vice president of support and ancillary services. “We go into every room on that floor unless there is a patient who
can’t be disturbed, including offices and storage spaces.”
The goal is to identify and correct deficiencies – from damaged walls to broken TV remotes to unsecured oxygen tanks. “We look at everything,” said Justin Ferbert, system director of engineering and safety. “We look in the supply storage area to make sure there are no expired products. We check fire extinguishers and emergency doors. We look for dents in
walls, coffee stains on floors and wobbly chair legs.” Work order forms are placed on the spot. “Our goal is to get these things taken care of within three to five days,” said Ferbert, “so they don’t become safety hazards.”
The rounds also include conversations with staff, not only to ask about any facilities issues they have observed but also to seize a teachable moment and review fire safety and other emergency protocols and ensure that staff are conversant with Joint Commission safety standards.
Like all complex organizations, hospitals conduct surveys. There are dozens of types: patient safety, satisfaction and engagement; benchmarking and best practices; employee satisfaction and engagement; compliance; and many others. “Hallmark Health System employs tools such as surveys to take the pulse of our environment and develop strategies for improvement,” said Maureen Pierog, RN, MS, vice president of quality and patient safety. “While we sometimes face challenging results, we are committed to regularly hearing what’s top of mind for our stakeholders.”
Frequently, survey results can be gratifying. One example is a recent culture of safety survey of staff involved in direct patient care about patient safety. Part of the survey explored “communication openness” – whether staff felt free to speak up or question the decisions of someone in authority when they saw a potential patient safety problem.
Pierog attributed the positive result – a nearly 5 percent improvement over the previous survey – to a couple of specific efforts.
Investigating errors. “We take a no-blame approach when we look into a major adverse event. Most such events are caused by system failures rather than people failures. Our goal is to let everyone involved tell their story in a neutral atmosphere – to be nonpunitive and to put in place fail-safes so that similar events don’t happen again.”
Patient safety reporting.With a new RL6 patient safety reporting system, “it’s much easier for staff to enter a safety concern or issue. And unlike with our old system, they can also track its progress once it’s submitted.”
Feedback from this culture of safety survey will be analyzed along with results from a recently completed employee engagement survey. “There are some similarities between the two,” Pierog added. “I’m sure we will see some common themes emerging, from which we can develop action plans that will further build on our commitment to a culture of safety at Hallmark Health.”
Hallmark Health System's employee newsletter, The Insider, highlights the inside story about our workplace and its people. At Hallmark Helath, the important and impacful work we do starts from the inside. These pages are dedicated to sharing news, features and ideas from across the system.