Overcoming Red Flags In Your Organization

The ability to recognize the warning signs of a building error chain is a skill developed in LifeWings training and can be used independently or as a team. These warning signs are commonly called red flags.

Teach your team how to detect and respond to red flags. Below are two examples of red flag situations:

1. Not Communicating: Team members are not asking for or offering input to one another. Additionally, one team member may ask another a question, but receive no reply. "Not communicating" does not always mean there is no talking among the team. Often, there is "talking," but no real communication. For example, comments may not be acknowledged or questions may go unanswered.

2. Confusion: A situation characterized by doubt as to what is really going on. Two behaviors are associated with this red flag-unanswered questions from one team member to another, and thinking, "This is stupid," "This doesn't make sense," or "Why is it/the patient doing this?"

Knowing what action to take when red flags are detected is as important as recognizing the red flags in the first place. There is an easy red flag response process when dealing with red flags:

SEE IT-Be able to recognize red flags and if you see one, look for others.

SAY IT-Speak up and communicate what you see.

FIX IT-take actions as appropriate.

See it, Say it, Fix it is just one of many skills that LifeWings incorporates in their training program. Be sure to check out the next issue for more helpful hints to share with your organization.

Improved Nursing Communication With Physicians That Resulted In A Reduction In Nurse Turnover

In a hospital in the central U.S. we worked with the Chief Nursing Officer to reduce Nurse turnover in two of the hospital's ICUs. Friction between physicians and nursing staff had increased dramatically due to poor communication styles and lingering resentments. Morale was at an all time low and turnover and its associated costs were at an all time high. Poor teamwork and physician and nursing communication had affected the quality of care and near misses and adverse outcomes had risen.

The CMO and unit managers wanted to reduce turnover by creating a sense of teamwork among the staff and physicians.

LifeWings created specific tools to allow for team building, and provided focused communication training to improve information flow in a defined and precise way. Additionally, the staff was equipped with a system to provide for early detection of warning signs that coordination was breaking down.

Our training and tools were successful. Turnover in both ICUs decreased by 23% and 35% respectively. The cost savings in reducing turnover provided a Project ROI of over 223%.

How To Handle "Hot Grounders"

Are you thinking about implementing a CRM-based training program, but concerned that others won't want to play? Well, here's some tips on how to handle "hot grounders," so you can deftly deal with the tough questions.

A successful CRM-based project changes the way healthcare providers do business. Change is always hard. People resist change. A leader must be prepared to meet the resistance head on. One form of resistance often comes in the form of loaded questions. Skillfully responding to loaded questions is similar to a third baseman fielding a hot grounder. It takes skill and practice.

Here are two common examples of loaded questions, or "hot grounders":

1. Isn't this just airline stuff? How can you prove it works in healthcare?

2. With all this financial pressure this organization is under, why are we spending money on this?

Like a third baseman has practiced developing skills and tools to field a fast ground ball, a leader, too, must have the skills to handle the hot grounder questions. A tip to deftly handling the tough questions is to practice LifeWings' Restate, Respect, and Respond technique.

1. RESTATE. Always restate the question to give yourself time to formulate the best response, ensure you have heard it correctly, and show respect to the questioner by making sure you have heard his/her question correctly.

2. RESPECT. Always start with the word "yes," even if it doesn't really fit, just say the word. It prevents you from saying "but." "Yes" says you care about the input, value the question, and desire participation.

3. RESPOND. The key to responding to the question effectively is listening for and understanding "the real message" or the "real question."

When formulating your response, follow the same process for each commonly asked question, and for any other common lines of resistance developed in your organization.

Doctors Get Personal With Their Patients

Only 1,000 American children are diagnosed with cystic fibrosis a year, 3-year-old Annie Page was one of them. When our lives and the lives of our children are on the line, an "average" doctor is unacceptable. The cystic fibrosis program at Cincinnati Children's Hospital, where Annie was treated, was rated well below average. With increased attention being placed on patient safety and as publicly reported data begins to saturate the media, more pressure is put on hospitals to perform well. The doctors at Cincinnati Children's Hospital wanted to sit down with their patients, explain how poorly the program results ranked, and announce to them their improvement plan.

Vanderbilt University Medical Center (VUMC), Nashville

VUMC, our LifeWings partner, has vowed to train their entire hospital on Crew Resource Management, which is roughly 6,500 personnel. To date, we have trained over 2,500 personnel in the hospital and they are well on their way to reaching their goal. We begin work in their Ophthalmology department in mid July and expect to have 3 full days of training.

Prior to implementing the system, VUMC had a "wrong surgery" rate comparable to the national average. After their collaboration with LifeWings, their "wrong surgery" rate improved to ten times better than the national average, earning them the number one spot in patient safety indicators for the 2005 Leapfrog Hospital Quality and Safety Survey.

The Nebraska Medical Center (NMC), Omaha, NE

The NMC became a client of LifeWings in August of 2005 and contracted to begin the CRM process in their CV and Orthopedic Surgery departments. Steve Harden and Dr. Rhea Seddon conducted a Leadership Development Institute (LDI) for the hospital's leaders in November 2005 and training began shortly thereafter. LifeWings conducted two sets of Hardwired Safety Tools after the training was complete and all tools have been implemented to date. We have completed 95% of the contracted services with Nebraska and they have already achieved some significant results.

NMC realized that LifeWings services and patient safety initiatives were saving lives so they signed a follow on contract to implement CRM into their General, Vascular, Trauma, and Transplant Surgery departments. We are well into their second contract and conducted a week long Train-The-Trainer course for two of their hospital staff in June so they can continue the CRM process in-house. LifeWings conducted a tools development session for these areas in April and all the developed tools will be implemented in mid July.

Missouri University Healthcare (MUHC), Columbia, MO

MUHC began its CRM project with LifeWings in 2003 and continues to conduct training and Hardwired Safety Tools development workshops on a regular basis. LifeWings has started to conduct the next set of training and tools, which took place at the end of June. Beginning in June 2005, MUHC has taken the lead in providing training on CRM to all their new residents. They have scheduled classes for all the new residents during the upcoming training dates.

The University of Texas Medical Branch (UTMB), Galveston, TX

UTMB and LifeWings are in the process of completing the first contract that was started in April 2005. We trained 628 staff from Surgical Services in 18 training sessions and have implemented Hardwired Safety Tools. LifeWings is in the process of completing a web based new hire training module providing them with the ability to continue the CRM process in Surgical Services. They are extremely pleased with the results and have asked us to continue the LifeWings process in women's and infant's services. Training should commence with a mini-LDI sometime in September 2006.

Holy Cross Hospital (HCH), Taos, NM

HCH became a LifeWings client June 1st of this year, and has begun phase one of their contract with a safety climate survey at the end of June. Steve Harden will conduct a LDI this August in Taos and training will begin after this event is completed. They will implement CRM into their Surgery, Intensive Care Unit, and Emergency Departments.

Vassar Brothers Medical Center (VBMC), Poughkeepsie, NY

VBMC completed training their surgical services department in March of this year and have implemented the tools that were developed with our help. Dr. Tim Dowd, the Chief of Anesthesiology, said this about the LifeWings program, "Out of all the training programs Vassar has implemented in the past, LifeWings is the real deal. This program will save lives." LifeWings has changed the way VBMC provides healthcare and they are thrilled with the outcome. We signed a new contract with VBMC and will begin our lifesaving services in their LDRP and ED departments this August.

Be sure to check out our next newsletter for more updates on current projects with our clients.

Take Five Lessons From The Geese:

1. As each goose flaps its wings, it creates a "uplift" for the birds following. By flying in a "V" formation the whole flock adds 71% more flying range than if each bird flew alone.

LESSON: People who share a common direction and sense of community can get where they are going quicker and easier because they are traveling on the thrust of one another.

2. Whenever a goose falls out of formation, it suddenly feels the drag and resistance of trying to fly alone and quickly gets back into formation to take advantage of the lifting power of the birds immediately in front.

LESSON: If we have as much sense as a goose, we will join formation with those who are headed where we want to go.

3. When a lead goose gets tired, it rotates back into formation and another goose flies at the point position.

LESSON: It pays to take turns doing the hard tasks and sharing leadership - with people, as with geese interdependent with one another.

4. The geese in formation honk from behind to encourage those up front to keep up their speed.

LESSON: We need to make sure our honking from behind is encouraging - not something less helpful.

5. When a goose get sick, wounded or shot, two geese drop out of formation and follow their fellow member, to help and provide protection. They stay with this member of the flock until he or she either is able to fly again or dies. Then they launch out on their own, with another formation, or to catch up with their own flock.

LESSON: If we have as much sense as the geese, we'll stand by one another like they do.

No matter what accomplishments you make, somebody helped you.

- Althea Gibson