4 Main Reasons You Need Safety Tools in a CRM- based Program

"Why do you need safety tools in a CRM program, why not just train the skills?" This question will be asked by almost every healthcare organization contemplating a CRM-based program. The reasons below best illustrate just how crucial the "tools" component is to program success.

1. Tools "hardwire" the right behaviors into the daily operating system

The tools within the system control the way business is done, regardless of who is doing it. Outcomes are guaranteed by the system rather than depending on staff to make "extraordinary" efforts.

2. Tools help make the complex become simple

The increasing complexity of healthcare makes it necessary to use safety tools. Using standardized ways of working (e.g., protocols, procedures, checklists), and communicating make it less likely that errors will occur and more likely that inevitable errors will be caught before they harm patients. Tools provide predictability for caregivers working in teams. Knowing one's specific job responsibilities and what to expect from coworkers for each situation make it much easier to focus on one's own job while being able to "back up" and cross-check other team members.

3. Tools capture "best practices" and ensure they are replicated by all members of the team

Today, many healthcare processes are quite well defined, but unfortunately they sometimes exist only in the heads of a few "experts," such as a senior nurse or highly experienced physician. The system either falls apart or limps along at reduced efficiency when the key employee is absent because no one else really understands the game plan. Physicians may complain about not getting to practice with the "A team." Results and job satisfaction both improve processes and incorporating them into useful tools makes everyone an A-team member.

4. Tools allow healthcare professionals to do what they do best: apply the art and science of healing

Tools are not "cookbook medicine." Having standard plans, processes, protocols, and "tools" for as many normal processes and contingencies as possible frees up mental capacity to deal with the difficult and complex situations that require knowledge-based performance.

Creating a culture of safety doesn't just happen. At each moment of truth, the caregiver must choose: "Will I follow the old way or the new way?" At that moment of truth, will there be a system safety tool in place to help the nurse choose the right course of action? Will her response be hardwired? As she chooses, will she say, "This is just the way we do business here?" Effective system safety tools that help her respond this way and that hardwire the right behaviors are critical components for achieving patient safety.

Reduction in Surgical Counts Errors

Specifically, in a hospital in the Mid-south LifeWings worked with the COO, the Director of the OR and the Director of Risk Management. Their goal was to eliminate counts errors in the OR. Counts errors were increasing, and costing the hospital in terms of increased procedure times, delays, efficiency, staff frustration, and patient harming errors.

The leadership wanted a way to reduce the counts errors and thereby reap improvements in cost, patient safety, and quality of care.

The LifeWings teambuilding training and tools provided those results. The teamwork and communication training improved the overall level of coordination in the OR, and the Hardwired Safety Tools created specifically to improve the counts process reduced the number of counts errors by 50%.

The results of this project appeared in a peer- reviewed journal. The reference is:

RM Rivers and Diane Swain and Bill Nixon, "Using aviation safety measures to enhance patient outcomes," AORN Journal 2003; 77:158.

Using Safety Tools in Healthcare

Many of the safety tools used in aviation are applicable to healthcare and have been successfully adapted at multiple institutions. Some examples include checklists, protocols, procedures, etc. Let's briefly cover the components of a briefing.

BRIEFING

Objective

The objectives of implementing pre-procedure briefings are to:

1. Establish a shared mental model within a complete team
2. Prepare the team to handle most likely contingencies

Principles of implementation

1. Briefings must be BRIEF and include the entire team
2. Briefings should be standardized and conducted from a written outline
3. Briefings should be conducted on time
4. Briefings should encourage input from team members

Background

In aviation, briefings are typically conducted prior to each flight. They constitute as a last minute check to ensure that all crew members understand the 'mission' and their individual responsibilities. Crew typically conduct a briefing prior to each major element of the flight. Examples include a pre-takeoff briefing and pre-landing briefing. Briefings have been successfully developed and conducted in healthcare organizations to focus entire teams on the objective for the day. Prior to establishment of these briefings, there was no single forum for coordinating efforts. Nurses held reports, attendings, and organized/briefed residents, but never did they discuss the mission at hand in a single forum. Note that briefings were never intended to replace planning. Planning has been compared to playbooks and practices of a football team. The pre-procedural briefing is comparable to the huddle prior to each play. Effective briefings require less than 2-3 minutes. The time investment pays enormous benefits in terms of efficiency and patient safety.

Elements of a typical briefing include:

1. Introduction of team members, to include support personnel and visitors
2. Introduction of the patient and procedure
3. Establishment of goals and priorities
4. Discussion of most likely contingencies
5. Invitation to speak up

Pitfalls of a briefing:

1. Failure to follow the recommended format
2. Failure to accomplish the briefing on time every time
3. Failure to establish procedures for updating the briefing

Procedures for establishment of a briefing:

1. Team chief (typically department head) discusses issue with the team;
2. Encourages input, asks for support and establishes policy;
3. Establishes dates for initial implementation;
4. Establishes ownership of briefing & methods for team to make input; &
5. Establishes a period for testing with surveys of team members.

Good CRM programs implement a system of safety tools that require and support the use of those error-detecting behaviors. It is the combination of both training and tools that catches errors, improves efficiency, protects the patient, and provides measurable results.

Sterile Cockpit
What Pilots and Doctors Can Teach Each Other

"Flying and performing surgery are very much alike. As a relatively low time pilot still, but experienced Cardiovascular Surgeon, the similarities are evident daily."

Successful leadership is a key component to any CRM program. Healthcare leaders must be on board with the project to achieve enduring results. Below are some key sources about leadership that may help you and other leaders in your organization.

Vanderbilt University Medical Center (VUMC), Nashville

VUMC, our LifeWings partner, continues strong with their CRM implementation initiative throughout their entire hospital. They have made the decision to conduct ongoing Error-catching Teamwork Skills Training on a quarterly basis. VUMC has recently completed CRM training in both Plant Services and Oral Surgery. To date, VUMC has trained roughly 3,000 nurses, physicians, and staff in various departments on CRM. They are well on their way to achieving their goal to train every employee providing care at their facility.

The Nebraska Medical Center (NMC), Omaha, NE

NMC has recently completed the implementation of all Hardwired Safety Tools in General, Transplant, and Vascular departments. A LifeWings instructor will be at NMC observing the implementation at the end of this month. NMC has also completed our Train-the-Trainer course and will begin conducting their own training of our classes toward the end of September.

The University of Missouri Health Care (UMHC), Columbia, MO

The next set of scheduled training classes for UMHC will take place at the beginning of October. UMHC conducts ongoing training and tools development with LifeWings, and has made it a policy to train all their new residents on CRM.

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

UTMB has extended their contract with LifeWings and is moving forward with Woman and Infant Services. The leadership course will take place at the end of September. UTMB plans on training 400+ staff, and will later implement safety tools.

Holy Cross Hospital (HCH), Taos, NM

HCH is currently completing the Leadership Development Institute. The next phase of their project with LifeWings, which is risk assessment, will begin in October.

Vassar Brothers Medical Center (VBMC), Poughkeepsie, NY

VBMC will begin LifeWings implementation in the ED and LDRP with our assessment phase at the end of this month. The teamwork skills training portion of their program is scheduled for the end of September. Safety tools development will be accomplished shortly there after.

Osler Medical (OM), Melbourne, FL

OM recently had their executive retreat in Orlando, FL on August 19th with LifeWings as their keynote speaker. LifeWings also provided a 4-hour training course to them the same day.

Community Health Partners (CHP), Lorain, OH

CHP has recently signed a contract with LifeWings to begin CRM work in their OB department. The first phase of their project, which is the Leadership Development Institute, is scheduled for the end of October.

Sentara Bay Side Hospital (SBSH), Virginia Beach, VA

SBSH has recently signed on with LifeWings to provide a 4-hour Error-catching Teamwork Skills Workshop to their staff on September 14th.

North Bronx Healthcare Network (NBHN), Bronx, NY

NBHN will kick off their contract with LifeWings with assessment in three areas including: Jacobi Medical Center ED, Jacobi Medical Center Radiology Department, and North Central Bronx Hospital ED. They will begin the risk assessment phase in mid-September.

Vanderbilt Children's Hospital (VCH), Nashville, TN

Members of the LifeWings' team have recently toured the facilities at VCH, and the project will kick off this fall, starting in ED and PCCU units. The first phase of the project will be the Leadership Development Institute.

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

A Mom's Journey
By Ilene Corina

"I soon began leaving my children and getting on trains and airplanes to go to conferences where healthcare professionals would say that there is a serious problem in healthcare safety. It was healing and invigorating to listen to. I needed to bring that feeling back home. I needed others to learn that there are many providers out there who also share their concern that the system fails, they know and they are trying to help."

Call or email to set up a FREE facility risk assessment. During this one day, on-site assessment we will examine both processes and patient flow (where appropriate) and the current level of staff teamwork.

Processes and patient flow: Our expert observers will assess the "system" within which your staff provides care. Often, the system, due to poor design, or decay of the original design, will produce conditions necessary for patient-harming error. We identify those conditions and bring them to your attention.

Additionally, our expert observers will assess the current level of teamwork among the staff using an over-the-shoulder assessment tool with specific, observable behavioral markers. These markers cover skill sets for communication, coordination, awareness, and decision-making.

The result of this visit? Your organization receives:

1. Identified patient safety risks;
2. Recommended process improvements; and
3. Pre-training teamwork and communication

To set up your free risk assessment visit please contact K.C. DeBra at (901) 844-9226 or kdebra@SaferPatients.com