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Safety- A View from the CEO’s Office
Eight Principals to Lead By
David Shulkin MDPresident and CEO, Beth Israel
[email protected] ColloquiumAugust 19th 2008
Hospital’s In the Future – A View from the CEO’s Office
• Hospitals will be challenged by Overbearing Regulators, Demanding Purchasers, Empowered Patients, ASC’s and Other Physician Joint Ventures, Competitive Bidding, and Foreign Competition
• So How Do You Prepare Your Organization?
1- Set the Game Plan• Patient Safety Assessment
• Goal Setting and Accountability
• Management and Clinical Leadership Incentives
• Train Future Leaders
• Empower Employees- Red Rules
• Frequent and Consistent Messages
• Recognize and Celebrate Results
2- Empower Patients
CEO Support for Patients
• Preparing the Patient – Setting Expectations
• Prompting the Patient to Ask the Right Questions
• RRTs for Patients
• Patients on Quality and Safety Committees
Encouraging Patient/Family Involvement in Care
• Prepare and Teach Patients/Share Care Plans • Beside Rounds with Families• Review Daily Goal Sheets• Provide Test Results• Encourage Questions from Patients/Families• Be Transparent with Problems/Thoughts• Encourage Families to Remain with Patients• Patients and Families to Call RRT’s• Ask for Patient/Family Feedback
Patient’s Advocating for Their Safety
Cincinnati Children’s Medical Center Charting and Documentation
Involving Patients Has Other Benefits
3- Addressing Access, Affordability and Diversity
Warranty’s on Medical Care
4- Embrace Transparency
5- Anticipate Needs of Patients
Over 1000 Genomic Tests Are About to Hit the Market
6- Design for Safety
• Rubber Floors
• Red Lights for the Sink
• Lighting and Visualization of Rooms
Teamwork level felt to be “high”
0%
10%
20%
30%
40%
50%
60%
70%
80%
Attending SurgeonsAnesthesiologistsSurgical NursesAnesthesia NursesAnesthesia Residents
Sexton, British Medical Journal, 2000
Culture of Safety Survey Aim For Statements with >75% Agreement
• Mistakes have led to positive change • Patient Safety is never sacrificed to get
more work done • Staff will speak freely if they see
something affecting patient care • Staff feel free to question decisions • Important patient care information is not
lost during shift changes
8- Ask What’s Missing ?
8- Identify What’s Missing
• Professionals that are not engaged- (e.g. House-staff, Respiratory therapy, Environmental Services)
• Off Hours Care
Data on Nights and Weekends
• Mortality Rates are Higher (1)• Readmission rates are higher (2)• Surgical Complications are higher (3)• AMI one year mortality is higher (4)• Stroke mortality is higher (5)• Extubations in ICUs is higher (6)• Less appropriate antibiotic rates are higher (7) • Medication error rates are higher (8)
