Improving Patient Safety A journey in Care Transformation

1. Improving Patient Safety A journey in Care Transformation Susan M. Grant, MS, RN, FAAN Chief Nurse Executive Emory Healthcare Nurse Leadership Institute June 5-7, 2013

2. Emory Healthcare

3. Emory Healthcare Overview • Clinical Arm of Robert W. Woodruff Health Sciences Center of Emory University • Emory University Hospital • Emory University Hospital Midtown • Emory University Orthopedic and Spine Hospital • Wesley Woods Geriatric Hospital • Emory University Johns Creek Hospital • Saint Joseph’s Hospital • The Emory Clinic • 1,830 Licensed Beds and over 15,000 employees. • Only Academic Health System in Atlanta. • All EHC Hospitals are NDNQI Members. * Denotes Academic Medical Center ** Denotes Magnet Facility

4. 1999 • 44,000 to 98,000 U.S. deaths annually due to hospital errors • Hospital errors the 8th leading cause of death • System errors • 2001 • “Between the health care we have and the care we could have lies not just a gap, but a chasm.” • “Trying harder will not work…”

6. Story of Harm

8. Strategic Agenda: 2008 – 2012

11. Partnering with our Patients • Ongoing collaboration with patients and families to design the best with them: from point of care to facilities planning. • Partner with more than 100 Patient and Family Advisors who provide insight into how we can improve quality, processes and service.

12. Embedding Care Transformation Principles into organizational processes • Staff training on CT concepts and cultural attributes • EHC Quality Academy and Transformational Leader Program. • Multidisciplinary team training • Patients and families included in hospital orientation, leadership planning meetings and retreats. • Shared governance structure • Learning from Stories of Harm and Stories of Charm • Unrestricted visiting hours – supporting family presence

13. Standardization of practices • Bedside Change of Shift Report “bundle” • Structured Interdisciplinary Bedside Rounding • Unit Practice Councils • Standard clinical attire

14. Daily Bedside report Bundle data collection sheet Facility: ECLH EUH WW Calculate values for each day at bottom of the table Unit:Transfer daily totals at the bottom to the weekly summary sheet.

15. Bedside Change of Shift Report We’re All About YOU! Nurses will change shifts several times throughout the day and night. During shift change, both nurses will see you and the on-coming nurse will learn about your condition and treatments. Because this is all about you, the nurses value your input and the input from your family members you choose to be present. Bedside Report on this unit is done at approximately: 7am 3pm 7pm 11pm

16. Bedside Shift Report (BSR) • 6G Medical Unit BSR • Compliance and Resulting • Patient Satisfaction Rankings

17. EUOSH Patient Satisfaction Scores from opening to end of year 2012 Average Patient Satisfaction : 96.4

18. Challenges • Lack of understanding of PFCC • PFCC means “no limits” • “What about confidentiality?” • Changes in work flow processes and team dynamics • Patients and families becoming a part of the team • “What about our colleagues”… on our teams?

19. The Pledge We will treat each other the way we want to be treated. We will… • treat everyone as professionals and with respect and dignity • greet each other by name • welcome and encourage new team members • be honest and open in all interactions • be respectful of everyone’s privacy • be culturally and racially sensitive We will not… • raise our voices in anger or use sarcasm or profanity • be passive-aggressive • make culturally or racially derogatory remarks • undermine each other’s work • criticize each other and Emory in public spaces We will cultivate a spirit of inquiry. We will… • ask “why” when we have questions or concerns, especially about safety • ask for a pause when we think someone is about to make a mistake or do something unsafe • thank each other for raising concerns • declare our openness to the inquiry of others We will not … • respond with anger or sarcasm when someone requests a pause • intentionally belittle or respond in a threatening or condescending manner when someone asks a question • tolerate rudeness • stifle learning We will defer to each other’s expertise. We will… • encourage each other to offer different perspectives • recognize that all members make important contributions to the team • seek help when we don’t know the answer We will not … • belittle or ignore the ideas and perspectives offered by each other • assume that expertise is overruled by age, profession, or rank We will communicate effectively. We will… • listen thoughtfully and ask for clarification when we don’t understand • check that others have understood when we say something important • remain respectful with our body language and tone of voice • remain calm when confronted with or responding to stressful situations • use scripts, read-back, repeat-back, or other techniques where appropriate to reduce the chance of misunderstanding We will not … • stifle clarifying questions • interrupt our team members unnecessarily • say “it’s not my job” or “it’s not my responsibility” We will commit to these behaviors in support of Emory Healthcare Care Transformation We will… • encourage and support each other • hold each other accountable for the behaviors identified in this Pledge

20. Improving Patient Outcomes

21. Improving Patient Outcomes Note: Data includes EUH, EUHM, EUOSH, and WWH only

22. Improving Patient Outcomes EHC includes EUH, EUHM, EUOSH, and Wesley Woods Hospital (WWH); 100% is a perfect score

23. Lessons Along the Way • Changing culture takes time and is hard work. • Nursing and Nurses can play a pivotal role in changing culture. • We continue to better understand the true definition of patient- and family-centered care/Patient engagement. • It is critical to tie metrics to evaluate the impact of process changes on patient outcomes. • New processes require ongoing reinforcement, refining and periodic measurement to validate effectiveness. • Leaders, staff and physicians require ongoing education, updating and review of Care Transformation concepts. • Continuously bring in new PFAs with fresh perspectives and ideas.

24. ImprovementsQuality Leadership Award 2011, 2012University Health System Consortium • 2006 Rankings #63 EUH and #73 EUHM • 2011 Rankings: • #10 Emory University Hospital/Emory University Orthopedics & Spine Hospital ranked • #11 Emory University Hospital Midtown ranked • 2012 Rankings: • #2 EUH !!! • #6 EUHM!!!

25. Questions?