Treating Harm to Dignity as Preventable Harm

1
Treating Harm to Dignity as Preventable Harm Team
Elizabeth Crowell, Patient-Family Advisor, Erica
Dente, Patient-Family Advisor, Patricia
Folcarelli, HCQ, Jane Foley, Nursing and Patient
Care Services, Lachlan Forrow, Palliative Care
and Ethics Support Services, Harvey Freishtat,
PCAC Member, Shari Gold-Gomez, Interpreter
Services, Jennie Greene, Communications,
Stephanie Harriston-Diggs, Volunteer Services,
Nancy Kasen, Community Benefits, Barbara Sarnoff
Lee, Social Work, Lynn Mackinson, Critical Care
Nursing, Kathleen Murray, Performance Assessment
and Regulatory Compliance, Stephen ONeill,
Social Work and Ethics Support Services, Kenneth
Sands, HCQ, Lauge Sokol Hessner, Medicine and
HCQ, Melinda Van Niel, HCQ
The Interventions
Lessons Learned
The Problem

• Define the terms respect and dignity
• Determine the categories of harm events that
  occur at the medical center regarding respect and
  dignity, and add these to the preventable harm
  dashboard
• Conduct interviews to better understand
  under-served populations perceptions of respect
  and dignity to ensure our definitions are
  complete
• Complete a retrospective look at the patient
  safety databases that track concerns to obtain a
  baseline figure
• Present the concept to leadership teams to get
  their feedback and buy in
• Integrate harm to dignity into the existing
  preventable harm framework, including high level
  case review

At BIDMC we have a process and strategy for
identifying physical harm to patients, assessing
whether that harm was preventable, and creating
systemic solutions to stop the preventable harm
from recurring. However, we recognized that
sometimes our patients also experience harm to
their dignity and disrespect at BIDMC, and we
want to prevent this harm from occurring as well.
At the same time, the Moore Foundation
challenged us to incorporate respect and dignity
into our preventable harm work in the ICUs, and
we saw an opportunity to develop an
institution-wide strategy to address disrespect
and harm to our patients dignity, and improve
the Patient Centeredness of our culture.

• We need to recognize the contributions of system
  factors, focus on learning rather than judging,
  and support providers so they can improve in a
  just culture.
• The severity of these events is difficult to
  determine, because there is no existing scale and
  there are so many perspectives involved including
  the patient, the provider, the health care
  quality staff. We continue to revise our own
  scale to create the most accurate measure
  possible.
• It is important to account for the perspective of
  those patients who are not speaking up about the
  harms they have suffered. We will continue to
  engage with community health centers and
  marginalized populations to make sure their
  voices are heard.

The Results/Progress to Date
Next Steps
We have created new categories for the
preventable harm dashboard . We have also
educated staff on our efforts around harm to
dignity and have created a way for them to report
such incidences in the RL6 reporting system to
make it easy for staff to identify and report
these occurrences.

• Implement a review process for adverse events and
  put several cases through the existing QI
  Structure for review and corrective action
  generation (i.e. QI Directors, Chiefs, Patient
  Care Assessment Committee)
• Report the Respect and Dignity harm outcomes on
  the dashboard to a variety of leadership groups.
• Continue to engage staff and patients, around
  this work and encourage them to report events and
  support the review process.

Aim/Goal
To identify the major categories of harm to
dignity, assess their frequency through tracking
and trending, add these categories to the BID
Preventable Harm Dashboard to increase
visibility, and begin to address the problem of
harm to dignity by replicating the thorough,
tiered review process already in place for
physical harm.
2
RD Section - PREVENTABLE HARM AT BIDMC RD Section - PREVENTABLE HARM AT BIDMC RD Section - PREVENTABLE HARM AT BIDMC
RD Section - PREVENTABLE HARM AT BIDMC RD Section - PREVENTABLE HARM AT BIDMC RD Section - PREVENTABLE HARM AT BIDMC
FY15 FY15 FY15 FY15
  AIM FY15 Target   Q1 15 Q2 15 Q3 15 Q4 15
Disrespectful Communication (Severe) ? 0          
                Language Related ? 0          
Etiquette Related Total Reviewed 6 ? 0          
                Failure to be Patient-Centered Total Reviewed 38 ? 0   5      
Prejudice or Discrimination that Affects Care Total 1 ? 0          
Minimization of Patient Concerns (incl. Pain Management) Total Reviewed 8 ? 0   2      
                Failure to Conduct or Incorporate Advance Care Planning Total Reviewed 1 ? 0          
Adverse Event Related Total Reviewed 1 ? 0   1      
Failure to Maintain an Environment that Preserves Dignity (Severe) ? 0          
                Privacy Violation Auditory/Information Total Reviewed 4 ? 0   1      
Privacy Violation Physical ? 0          
                Visitor Mismanagement ? 0          
Prolonged unclean conditions Environment . Total Reviewed 3 ? 0   1      
Prolonged unclean conditions Personal ? 0          
Failure to Provide Appropriate Care after Death (Severe) ? 0          
Body Mismanagement ? 0          
Bereavement Related ? 0          
Failure to Care for Personal Possessions (Severe) Total 6 ? 0          
Other Disrespect Causing Harm to Dignity (Severe) ? 0          
TOTAL 68 Q1 Events Reviewed ? 0   10 0 0 0
3
Sign in to Portal Click on Report an Incident
4
Click the link to the reporting system
5
Login with your BIDMC username and password
6
Wait for the screen to come up find Respect and
Dignity Icon, and click.