| Steve Harden, President of LifeWings Partners LLC |
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The Pulse
A bi-monthly newsletter from LifeWings Partners LLC
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September 2007
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Sharpening the Saw:
A Message from The
President
Getting from "A" to "B"
"What do I really need in the way of assets and
support to succeed in changing the culture in my
hospital?"
This is the question everyone asks me as we discuss
whether or not they should proceed with a CRM-based
patient safety implementation. In almost seven years
of helping hospitals change their safety culture I've
come to understand the answer to the question is
almost identical to the basic roadmap for success in
of revolutionary warfare. And the answer for hospitals
is the same as the answer for any organization
wishing to change the status quo through revolution.
Nowadays, we sometimes get uncomfortable thinking
in those terms and using the language
of "revolutions." But, in principle, when you change the
culture, you are leading a revolution of sorts, and the
lessons learned over the years in guerilla warfare are
the same lessons any healthcare organization will
learn as they change their culture today.
There are three sine qua nons of guerilla warfare. In
all of recorded history no revolution (barring the
occasional coup d'etat) has succeeded without them.
Conversely, none have failed that have had all three.
This is also true of hospitals that succeed in changing
their culture.
The first element of success is the support of at
least 15% of the population. For the typical
Perioperative Services Department, at least 15% of
the physicians, staff and administrators need to
actively believe in and support the change initiative
with their words and actions. This is usually
your "tipping point" in terms of the numbers needed to
succeed. It is imperative that at least some of this
15% be physicians, with at least one or two very vocal
and active physician champions.
In my experience, this amount of support is not hard to
get, and LifeWings has set up its methodology to
ensure we have this before the training gets started.
What about the "rest" of the staff? It is only necessary
that they have an open mind or at least be indifferent
as they show up for the skills training sessions. They
will soon be swept along with the tide of success.
The second element of success in revolutions is
having a secure area from which the guerillas can
operate. In real warfare this is a mountain fortress
or an impenetrable swamp. In healthcare, the "secure
area" is the support of the leadership and
management team. Your project champions - the
nurses, staff and physicians that will do the actual
work of the implementation must have the support of
the leadership. As the project team (your guerilla
fighters) tries to get everyone to training, design and
implement safety tools, revise policies and check on
daily work practices, resisters and naysayers will
attempt to make end runs to management. These end
runs take the form of "threats" ("I'll take my business
elsewhere,") or "special deals" ("Can't you make an
exception for me?").
Without a "secure area" of support from which to work,
your internal project leaders are exposed and
susceptible to crippling attack. There is a tremendous
amount of "change fatigue" in healthcare and staff at
many facilities are masters at sabotaging what they
perceive to be the "next flavor of the month" project.
The third element of success for revolutions is the
help from a "foreign government." In hospitals, it
means the initiative has the complete and total
support of the administration, from the Board to the
CEO to the CMO and CNO to the Chief of Surgery (in
the Perioperative example), to the Director of Surgical
Services. It also means the leaders of the major
physician practice groups that exercise their privileges
in your hospital are also supportive. This support is
evidenced by time, mission statement, vision,
philosophy, policy, focus, priority and financial
investment. Any doubt or wavering in the "government"
will be exploited to the fullest by the resisters.
The leadership development
component of the LifeWings process will create a
structure whereby all of the elements needed to form
the "supportive government" are put in place. Properly
constructed, they leave no doubt as to the level of
support from the "government."
Our most successful clients, the ones who have truly
revolutionized their safety culture, have been those
who harness the lessons learned from history. They
spend their precious resources recruiting the key 15%
and supporting them with a secure base of operations
and making it abundantly clear they have the support
of administration and leadership.
When done successfully, their problem is not "How
can I get people to change?" rather it is "How can I
best manage my resources as everyone in the
hospital clamors to be the next department to get the
implementation?"
We were recently copied on an email from the
Chairman of Reproductive Medicine at a large west
coast hospital. In the email, he was asking the
hospital leadership for the OB area to be the next
department to roll out the program. Here's what he
said:
"I am most eager to ensure that the next phase
(installing checklists/monitoring communications) is
extended to the OB area.
The LifeWings coach from my session said he would
send his OB checklists but that is not
enough.
Please tell me how I can make this happen. I will
lobby, nag, cajole, whatever to get OB included in this
important initiative."
This is an example of the type of results that can be
reaped from the time honored principles of
revolutionary warfare.
Best regards,
Steve
Stephen W. Harden
LifeWings President
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Skills and Tools: Get Better Today
The Top Six Skills on How to Create a More
Effective
Team
Teamwork is the fundamental building block of the
LifeWings methodology. To create an effective
team, you must establish responsibilities, and a free
and open flow of communication. That way, every
member of the team knows exactly what to look for,
which will lead to better decision making. The skills
required to take a group of technically competent
individuals and bring them together as a team that
consistently performs well in high-risk, time critical
environments can be a challenge. Here are the Top
Six Skills on How to Create a More Effective Team:
Skill #1
Clearly provide and understand the big picture in
a "Pre-Brief." Outline the procedure/situation, discuss
critical points, specify duties and anticipate the
outcome.
Skill #2
Plan and discuss all likely contingencies.
Skill #3
Invite participation from the team. Explicitly ask team
members to provide information, express their
concerns and speak up when necessary. Encourage
the team to ask questions to verify their understanding.
Skill #4
Ask questions to check understanding and begin two-
way communication. Set-up a "pattern of response."
Ask questions that require more than a "Yes" or "No"
response.
Skill #5
Acknowledge all communication. Close the "loop."
This will confirm understanding.
Skill #6
Plan, but be ready to reassess and modify as
necessary.
Find out more about Skills Based Training
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Success Stories: Reported Results from Organizations Implementing CRM-based Safety and Quality Programs
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 Intensive Care Units. 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 Chief Medical Officer 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.
LifeWings' training and tools were successful.
Turnover in both Intensive Care Units decreased by
23% and 35% respectively. The cost savings in
reducing turnover provided a project ROI of over
223%.
Read about results hospitals are getting using an aviation-based patient safety program
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Leadership Toolkit: Skills for Sustaining an Enduring Cultural Change
Guidelines for Leaders When Working Toward
Project Success, Part I:
- Leave rank at the door (as much as possible).
- No whining over barriers, roadblocks and difficult
choices.
- Contribute: adapt, modify, revise, overcome and
share.
- Stay engaged: no "sidebar" discussions.
- Identify problems, but FOCUS ON SOLUTIONS!
*Adapted from Dr. Curt Rimmerman, The
Cleveland Clinic
"Our systems are too complex to expect merely
extraordinary people to perform perfectly 100% of the
time. We, as leaders, have a responsibility to put into
place systems to support safe practice."
James Conway, IHI Senior Fellow
Be sure to check out "Guidelines for Leaders When
Working Toward Project Success, Part II," in the
next issue of The Pulse (coming out this
November).
Find out more about Leadership Development
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For Further Reading: Our Featured Article
Nurses' Working Conditions: Implications for
Infectious Disease
Patricia W. Stone, Sean P. Clarke, Jeannie
Cimiotti, and Rosaly Correa-de-Araujo.
Columbia
University School of Nursing, New York, New York,
USA; University of Pennsylvania School of Nursing,
Philadelphia, Pennsylvania, USA; and Agency for
Healthcare Research and Quality, Rockville, Maryland,
USA
Staffing patterns and nurses' working conditions are
risk factors for healthcare-associated infections as
well as occupational injuries and infections. Staffing
shortages, especially of nurses, have been identified
as one of the major factors expected to constrain
hospitals' ability to deal with future outbreaks of
emerging infections. These problems are
compounded by a global nursing shortage.
Understanding and improving nurses' working
conditions can potentially decrease the incidence of
many infectious diseases. Relevant research is
reviewed, and policy options are discussed.
View full article here!
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News You Can Use: To Implement a CRM-based Safety and Quality Improvement Program
"Needlestick
Injuries: How to Improve Safety in your
Workplace" is an article written by Karen
A. Daley that appeared in the July 2007 issue of
American Nurse Today. Read about the incident that
made Daley become an advocate for protecting
healthcare staff from preventable needlestick injuries
and how to protect yourself.
"Cascade Learning
Using the Flip 'n Tell" is an article written
by Quint Studer, CEO of the Studer Group, which
explains the benefits of using a technique in the
workplace known as Flip 'n Tell. Flip 'n Tell was
created by The Medical College of Pennsylvania as a
tool to improve communication in the
workplace.
*May require website registration
"Better communication can improve
care and overcome nursing crisis, " is an
article written by Claire Murray, Chief Nursing Officer
and Senior Vice President for Seton Health, which
describes the importance of communication in a
healthcare setting.
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Ask the Innovators: Road Blocks of Aviation-Based Project Implementation
Q:
What could your organization have done better in order
to make aviation-based project implementation a
smoother
transition?
A:
The initial implementation of our aviation-based
project could have been smoother if an overview of
what to expect in each phase of the process was
shared with the physicians and nurses at the start of
the project. This would be the "road map" of the
different phases, including objectives with tangible
outcomes of each phase. After providing the
information and specifics on what each part of the
training could accomplish; round table discussions
as to specific unit goals should have been made.
We "winged" it and also relied on the assessment of
the LifeWings' coach for ideas.
In retrospect, having more staff members involved in
the tool building process would provide a stronger
support for the ongoing measurement, data collection
and subsequent tool development. The
measurement of the tools and success from concrete
data sources is still not clear. Sample tools could offer
some structure and best practice which is a pro. The
con is this could limit creativity, individuality and
thinking outside the box.
Initially there was executive team involvement, but
after the initial training there was minimal interaction
to keep the momentum going on an organizational
level. The OB team was very engaged but lacked
formal recognition of the successes that were in
progress.
"Prior to the LifeWings Leadership Development
Institute (LDI) I had difficulty knowing my specific role
& responsibility, but the LDI helped clarify what needs
to be communicated. I learned step by step what
actions need to be put into place and my roles and
expectations. The LDI was really personalized to our
issues. If you are considering attending a LDI, make
sure you do it and have all your leaders
participate."
Joan Cappelletti
Woman & Children's Service Line Administrator
Provena St. Joseph Medical Center-Joliet, IL
Recent Innovators:
Texas Medical Liability Trust
Fall Seminar Series
The Society of Thoracic Surgeons
Seminar
The University of California Health System
Surgical Services
Memorial Healthcare System-Hollywood,
FL
Surgical Services / Cath Lab
Mt. Carmel Health System-Columbus,
OH
Operating Room
Southeast Georgia Health System-Brunswick,
GA
In Patient and Out Patient Operating Rooms
Got a question that you would like to see
answered in one of our newsletters? Well, tell us
about it! Send your question to
kdebra@SaferPatients.com with the email
subject as "Road Block Question."
If you would like a reference for any of our clients,
please contact K.C. DeBra at
kdebra@SaferPatients.com or (901) 844-
9226.
Forward this newsletter now!
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Streams in the Desert: Thoughts and Stories to Inspire
Close Call
Our hospital had been trying to establish a pre-
op "time out" for a couple of years, but we found that
the variation in when, how and even if it was
performed was far from our goal of a universal safe
practice. Working with our OR leadership, our
LifeWings consultants helped us to standardize a
format for the time out.
The format adopted included not only the patient's
name, date of birth, and planned procedure, but also
included a check of allergies and a verification that pre-
op antibiotics had been administered. Over the
course of the next few months, the new time out
format was adopted by all of our OR teams. The
wisdom of this was borne out by a case that occurred
shortly thereafter.
A trauma patient was brought to the OR for emergency
surgery. As the set-up for the surgery was being
rapidly completed, the OR nurse announced to the
team that the time out would occur. After the team
rapidly verified the patient's name, DOB, and planned
procedure, the nurse asked, "Any allergies?"
Consulting the patient record, one of the team
members responded, "The patient is allergic to latex!"
All of the operative team immediately stopped and
looked at the latex gloves on their hands. This was
the first that any of the team members knew of this
patient's latex allergy, and they were moments away
from starting the case! The team quickly broke down
the set-up and converted to a latex-free environment.
The case started a few minutes later, with all of the
team members relieved that this potentially important
risk factor had been caught by the time out process.
Les Hall, Director, Clinical Effectiveness and
Associate Chief of Staff, Missouri University Hospitals
& Clinics-Columbia, MO
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Our Gift To You
In the last issue of The Pulse we had a drawing
to win a free copy of the book "Crew Resource
Management: The Flight Plan for Lasting Change in
Patient Safety" (a value of $99).
The winner was Brenda Faulkner, Clinical
Development Coordinator for Methodist LeBonheur
Healthcare in Memphis, TN. Congratulations Brenda!
For this issue we are giving away a piece of literature
written by President of LifeWings, Steve Harden
titled, "A Blueprint for Creating a Culture of
Safety." Please make sure to contact K.C. DeBra
at kdebra@SaferPatients.com immediately if
you are interested in obtaining the article because
there are a limited number of copies.
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Enhancing Patient Safety from Fox 6 News
Read about how LifeWings is teaming up with The
University of San Diego to improve patient safety and
quality of care:
Read article and watch video here!
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