Leveraging Front Line Expertise

1
Leveraging Front Line Expertise

• An intervention designed to improve culture of
  safety
• In conjunction with Stanford Universitys Centers
  for Health Policy/Primary Care and Outcomes
  Research (CHP/PCOR)

2
What is it?

• Four components
• Worksite visits Getting executives out to the
  front-lines of care, in the spirit of Gemba
  Kaizen
• Safety Town meetings Open communication forums
  designed to gather input regarding patient safety
  from front line staff
• Debrief, working meetings Organize and
  prioritize information gathered from worksite
  visits and safety town meetings to address safety
  issues
• Cross-institutional learning Conference calls
  among hospital senior leaders to share lessons
  and strategies for addressing safety issues

3
Agenda

• Overall aim for the intervention
• Why this intervention? Motivation behind
  Leveraging Front Line Expertise (LEFLE)
• Understanding patient safety activities at your
  institution
• Implementation Activities and Responsibilities

4
Understanding your institution

• Are there any current programs in place that
  entail senior executives spending time observing
  front-line care or processes?
• If yes, please describe these programs and their
  processes.
• Are there informal, unstructured instances when
  senior executives spend time observing front-line
  care or processes?

5
Understanding your institution

• Are there any current programs in place that
  foster safety-related discussions between
  front-line staff and senior executives?
• If yes, please describe these programs and their
  processes.
• Are there informal, unstructured instances when
  senior executives gather feedback from front-line
  staff regarding their perceptions of patient
  safety?

6
Overall Aim

• Intervention seeks to improve staff communication
  by increasing executive availability to patient
  care areas by
• Exposing executives to daily forces that work
  against patient safety (i.e. insufficient
  equipment, conflicting information, etc.)
• Shifting focus to macro level system
  improvements for patient safety

7
Differences in perception between senior managers
and front line staff

• PSCHO Survey Findings, 2001
• Senior management has a good idea of the kinds of
  mistakes that actually occur in this facility
• Senior managers 14 disagree
• All other personnel 21 disagree
• Senior management has a clear understanding of
  the risks associated with patient care
• Senior managers 11 disagree
• All other personnel 21 disagree

8
Implementation Worksite Visits

• Once a month for 18 months, executives spend
  30-60 min. on front lines observing work (please
  refer to sample matrix)
• Different, but related locations for different
  executives throughout the hospital
• Emergency room, ICU, operating room, medication
  administration
• Technique is also called Management by Walking
  Around, Gemba Kaizen, WalkRounds

9
Worksite visits A four step program

• Preparing for a visit Notify department manager
  to schedule time with host
• Beginning the visit Give host signed Tenets of
  Trust and copy of Host Feedback Form
• The visit Observe the work system factors to
  understand factors that help or hinder patient
  safety
• Follow up debrief meeting with other executives
  to share learning gain common understanding

10
Tenets of Trust for Worksite Visits

• None of these discussions will be used to
  discipline, punish, or in any way evaluate any
  employee
• We are interested in understanding and improving
  systems, and creating a blame-free environment
• We are committed to improving patient safety
  through better communication between employees
  and leadership

11
Implementation Safety Information Gathering

• Once every other month for 18 months (please
  refer to sample matrix)
• Executives gather front line, cross-functional
  feedback related to patient safety
• Can be gathered in multiple ways
• Open meeting (i.e. after staff meeting)
• Email solicitation of ideas
• Drop box on units with 3x5 cards
• Designated representative gathers information
  from peers
• Different areas within the hospital, tied in with
  the last 2 months worksite visits

12
Safety Information Gathering

• Preparation Notify department to arrange
  solicitation method and timing
• Generate Ideas Participants identify system
  factors that currently are strengths or
  weaknesses with regard to patient safety
• Compilation of Ideas After generating ideas,
  consolidate information into two concise lists
  (strengths, weaknesses)
• Prioritization Distribute lists to front line
  staff for voting on what they consider to be most
  important

13
Debrief Meeting

• Patient safety manager, Executives, Department
  managers, and Front line staff
• Compile information learned from the visits and
  information gathering
• Select high frequency or high impact items for
  resolution
• Assign follow-up responsibility
• Determine and implement countermeasure
• Track metric to see if countermeasure is having
  desired impact
• Create summary document including follow-up and
  share it with employees from the worksite

14
Communicate to Employees

• Communicate actions resulting from work site
  visits and information gathering meetings to
  employees
• Directly to those involved
• Posting on communication boards in the area
• Managers talk about during staff meetings
• Highlight success stories in hospital newsletters
• Also important to let employees know WHY action
  not taken on other items raised

15
Implementation Cross-institutional Learning

• Quarterly conference calls with other executives
  participating in the intervention
• Presentation by one site
• What was learned on visits
• What was selected for follow up action
• Metrics and countermeasures identified
• Discussion of obstacles and concerns

16
How will we know if LEFLE works?

• Incremental improvement in safety culture survey
  results over time.
• Reduced difference between responses of front
  line employees and senior leaders.
• Improved reporting and discussion of safety
  issues
• Improved morale
• Positive changes towards improving safety

17
Summary

• Our shared goal is to provide safe patient care
• LEFLE is designed to
• Help executives help staff have the tools they
  need to do their jobs
• Open communication between staff and senior
  executives
• Provide support to unit managers