The Application of Patient Safety Principles

MOREOB and MOREEX

Guy-Paul Gagné MD, FRCSC, FSOGCDirector MOREOB Québecgpgagne@salusgc.com

The situation in Health Care

“What has eluded us thus far…is maintaining a consistently high levels of safety and quality over time and across all health care services and settings.

… Along with some progress, we are experiencing an epidemic of serious and preventable adverse events”

The concept that I believe can and should change this is: “High Reliability.”

2Dr Mark R. Chassin, president, JACHO, Health Affairs, April 2011

Patient safety

“The magnitude of medical error is enormous. The fault lies with poorly

conceived systems rather than irresponsible people.”

– Dr. Lucian Leape

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Dr. L. Leape, Adjunct Professor of Health Policy at Harvard University at the National Patient Safety Foundation Meeting, Boston, Mass. 2004.

Patient Safety

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Dedicated, well-intentioned professionals work in complex,

error-prone systems that are unsafe for patients and unhealthy for caregivers.

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A new culture of safety

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The IOM report - • Health care organizations must develop a

“culture of safety” such that their workforce and processes are focused on improving the reliability and safety of care for patients.

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Culture : a definition

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A culture is made of share values and beliefs that interact within an organization in order to produce behavioral norms or:

“How we do things around here”

It is determined by how individuals and teams learn together and work together

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A culture of safety

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One way to achieve this:

C-U-S-P or

Comprehensive unit base safety program

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http://www.hopkinsmedicine.org/quality_safety_research_group/our_projects/stop_bsi/toolkits_resources/cusp_toolkit.html

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From MOREOB

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To MOREEX

High Reliability Organization

Air traffic control Aircraft carriers Nuclear power plants

Technical side of banking

KH Roberts. Some characteristics of high reliability organizations,1990

HRO Principles

1. Safety is the priority and is everyone’s responsibility

2. Communication is highly valued

3. Operations are a team effort

4. Emergencies are rehearsed

5. Hierarchy disappears in an emergency. Decisions on safety issues can be made at any level of the organization

6. There is multidisciplinary review of events & routines

American Society for Healthcare Risk Management (ASHRM). Reprinted with permission.

Relational Coordination

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High QualityRelationships

High QualityCommunication

Shared goals

Shared Knowledge

Mutual respect

Frequent Timely

Accurate Problem-solving

Gittell JH. High performance healthcare. New York: McGraw-Hill; 2009.

Relational Coordination and Airline Performance

Relational coordination index, is measured on a five-point scale, based on an employee survey.

Airline performance is an index of quality:customer complaints, mishandled bags and late arrivals, as well as efficiency: gate time per departure and staff time per passenger.

Gittell JH. High performance healthcare. New York: McGraw-Hill; 2009

Relational Coordination and Surgical Performance

Relational coordination, is measured on a five-point scale, based on an employee survey.

Surgical performance is an index of quality: patient satisfaction, post-operative freedom from pain and post-operative functioning, as well as efficiency: length of stay.

Gittell JH. High performance healthcare. New York: McGraw-Hill; 2009

The MOREOB Program builds and sustains a culture of safety through the development of knowledge, skills, attitudes, behaviors, and practices that make safety the #1 priority for everyone, all of the time.

Module 1Learning Together

Use the MOREOB Program elements to:

Embed safety practices in the infrastructure

Identify and solve patient safety issues

Module 2Working Together

Module 3Changing the Culture

MOREOB PlusBuilding on Success

Communities of Practice

Failure Mode and Effect Analysis

Root Cause Analysis

Event Review

Disclosure

Audit

Teamwork Tools

Communication Tools

Emergency Drills

Workshops/ACEs

Skills Drills

Personal Learning Projects

Content Chapters

The MOREOB Program Step by Step

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Workshops/ACEsSkills DrillsClinical content ChaptersPersonal Learning Projects

AuditTeamwork ToolsCommunication ToolsEmergency Drills

Root Cause AnalysisFMEAEven ReviewDisclosure

Embed safety practicesIdentify and solve patient safety issues

Successful changes in knowledge, skills, and attitudes.

• As a nurse, it solidified what I had learned. I feel more confident and that everyone has the same level of knowledge

• Increased knowledge – people feel in control of bad situations when they arise - builds confidence and empowerment

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Confidence and Competence

Caregiver Satisfaction

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Culture Assessment Survey– Participant Averages

07/31/2010

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Average answers 1 - Never2 - Rarely3 - Sometimes4 - Often5 - Always

MOREOB in Alberta

J Obstet Gynaecol Can 2010;32(8):749–755

Conclusion: The MOREOB program was associated with improvement in selected maternal and fetal health outcome indicators. When a patient safety program is introduced as an intensive, long-term continuing education and quality improvement initiative, health outcomes can be significantly impacted.

Alberta Study Results

Frick C and all J Obstet Gynaecol Can 2010;32(8):749–755

• Length of stay ≤ 48hr*: increased by 12% (first two years of the Program*)

• Infants on ventilator*: reduced up to 31% by Module 3

• Severe infant morbidity*: reduced up to 24% Severe morbidity is an index of multiple conditions (respiratory distress; bacterial sepsis; omphalitis; cerebral, intraventricular or subarachnoid hemorrhage due to birth injury; intracranial non-traumatic hemorrhage

• 3rd and 4th degree tears*: reduced by up to 22%  

• Infant mortality: reduced by up to 18%

• Hypoxic ischemic encephalopathy: reduced by up to 33%

• Admissions to NICU: reduced up to 11% (centres with + 1,000 births)

Total Incurred Costs Trend lines

HIROC Data taken from 39 participating MOREOB hospitals

07/31/2010@ 2011 Salus Global Corporation. MOREOB is a registered trademark of Salus Global Corporation. All rights reserved

What can I do on Monday?

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Assemble an interdisciplinary Safety Team Get support from administration All activities should be multidisciplinary Organize basic skill drills or workshop Use simulation and emergency drills for

communication and team training Train all staff in the science of safety Measure and celebrate the results Be patient, this is a culture change

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Thank you!

Questions?