Nursing Manager Rainbow Babies and Children's Hospital, United States
Abstract:
Introduction: A cornerstone of any clinical program must be the continual strive for optimal patient and team member safety. The often discussed aspirational goal of zero harm in any program or institution can only be achieved in a culture in which it is psychologically safe for team members to raise concerns and offer suggestions for improvement, even if controversial or sensitive in nature. The Heart Center and CICU can serve as a clinical microsystem to pilot such an approach for the larger institution.
Objective: To create a culture of engaged and empowered team members who thrive in a psychologically safe and positive work environment designed to optimize patient and team safety within a clinical microsystem.
Methods: Our Journey to Zero Harm for our patients and team launched in late 2020 with initiation of a multifaceted program that includes Leader Walk Rounds, interdisciplinary Safety Boards (center-wide and local units), educational sessions with a safety and culture focus, and a daily Heart Huddle that includes team members spanning the spectrum from frontline staff to leadership. The Heart Huddle has become the cornerstone of this multimodal program during which 15-35 team members gather each morning for a 10-min focused discussion of real and potential safety risks that could affect our patients, their families, and/or our team as identified in the prior ~24 hours. Eighteen months into our journey and five months after launching our Heart Huddle, we assessed our Heart team’s subjective sense of psychologically safety and comfort with participating in these initiatives and, more importantly, reporting real and perceived safety concerns through two anonymous surveys via the Qualtrics platform.
Results: A Heart Center wide engagement survey (n=89; 67% response) 18-months after program launch demonstrated that 83% (12% neutral) of respondents feel safe expressing patient/family and their own safety concerns and related suggestions for change. Similarly within the CICU, 83% (n=31) of team members feel safe expressing concerns. In a focused ‘pulse’ survey (n=28; 64% response) of key stakeholders 5 months after initiation of our Heart Huddle, 93% (3.5% neutral) of those surveyed feel this initiative is an effective approach to address and solve patient safety issues in a timely fashion. 86% (14% neutral) reported that the 10 minutes daily is an effective use of their time. And, most important, 93% (7% neutral) believe the Huddle provides a safe environment in which to raise concerns.
Conclusions: In composite, this multimodal, interdisciplinary approach to open, transparent communication of real and perceived safety concerns can promote a psychologically safe environment for team members to speak-up. This programmatic foundation supports the Heart team in general and CICU team locally to promote a psychologically safe environment as we work toward the aspirational goal of zero harm. The next step is to correlate improvement in psychologic safety to a reduction in patient harm events. Monthly data collection to assess such a relationship is in progress. Future initiatives in our journey to psychological safety and zero harm include semi-annual ‘culture camps’ and formal safety training for leaders and frontline staff.
