Putting a smile on the culture of safety frame work rev27 may2013


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Most frameworks involving a “culture of safety” place patients at the center of the care delivery model (Sammer & James, 2011). In view of health policy, Ostrom (2007) stated that frameworks are meant to organize inquiry through identification of elements and potential relationship, but not intended to specifically test, explain, or predict behavioral outcomes or strengths of association as theory would test. In the healthcare setting patients occupy the center prominence of our safety efforts; however, we offer that care providers play an equally important role in optimizing patient safety and caregivers hold a position of equivalent actors in such frameworks. Furthermore, extrinsic factors such as government agencies are at times excluded in these discussions and some frameworks are structurally complex making it difficult for end users to retain, remember, and apply concepts consistently in practice.

Although a culture of safety is serious business (Denham, 2007a), it does not have to be implemented with a grim face. Joy and spirit of caregiving is also linked to patient safety. Joy comes from witnessing successful patient outcomes, and seeing the patient and family experiences of their healing journey (Hinz, 2011). Leape (2013) offers that joy and meaning will be created when the care providers feel valued, safe from harm, and being part of the solutions for change.

How then do we approach a complex system framework, such as patient safety, with a program that is meaningful, sustainable, and consistently recognizable, if not marketable, to the bedside caregivers? We have found that correlation of thoughts plays a significant role in retention and recognition of information for our multicultural staff. Gigerenzer (2007) posited that the strength of recognition surpasses that of simple recall in humans. When recall memory is impaired, recognition memory often remains (Gigerenzer, 2007, p. 111).

One way to strengthen recognition and information recall is through the use of mnemonics (Bakken & Simpson, 2011). Mnemonics encode complex information in which unfamiliar information to be learned is linked with known information, pictures, or symbols (Bakken & Simpson, 2011). Visual cues and auditory reminders enhance meaningfulness of new information and promote overall strength of association between novel learning and known or familiar patterns (Mastropieri, 1988).

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Putting a smile on the culture of safety frame work rev27 may2013

  1. 1. Putting a “SMILE”  On the Culture of Safety frame work Presented at The Patient Safety & Quality Congress Middle East 16-19 March 2014
  2. 2. Joint Presentation • Krishnan Sankaranayanan MS, MBA, CPHQ – Senior Safety Officer / Tawam Hospital • Steven A Matarelli RN, PhD – Chief Operating Officer / Tawam Hospital
  3. 3. Learning Objectives • Attendees will be able to retain, remember, and apply SMILE concepts consistently in practice • Attendees will find the SMILE frame work meaningful, sustainable, and consistently recognizable.
  4. 4. Google Search……….
  5. 5. Culture of Safety Is A Serious Business
  6. 6. Can it be done with a SMILE!!
  7. 7. SMILE as a Mnemonic
  8. 8. Use of Mnemonics
  9. 9. Popularly used  Mnemonic in messaging
  10. 10. Mnemonics & Memory • Correlation of thoughts plays a significant role in retention and recognition • Strengthen recognition and information recall • Encodes complex information
  11. 11. Mnemonics & Memory Recognize Retain Remember
  12. 12. Strong Influence Joy and meaning will be created when the care provider’s feels valued, safe from harm, and being part of the solutions for change” Caring for those (employees), who care for the patients. Employee engagement, getting them excited about providing good service to patients, which reflects on patient loyalty and good outcomes
  13. 13. SMILE- Model S - Systems & Support M -Morale & Motivation I - Information & Open Communication L - Leadership & Commitment E - Empowerment & Engagement
  14. 14. Missing elements in the conventional Frame Works Health Policy Makers Regulatory agencies Care providers
  15. 15. SMILE Frame Work • External Constructs – Health Policy Decisions – Regulators – Healthcare Leaders • Build on a solid foundation – Commitment and Engagement
  16. 16. SMILE Frame Work • Internal Constructs – Patient • Respect -patients treated with respect; without any discrimination of race, color and religion • Information- communicating clearly in an easily understandable manner • Care- unrestricted access to care – Care Provider • System- creating forced functions • Empowerment- opportunities to speak up • Support- principles of natural justice
  17. 17. Conclusion • Although patients are at the center focus in healthcare. • Care providers hold equal prominence in the patient safety movement • Delivering safer care is linked to external and internal constructs that influence and drive the SMILE philosophy.
  18. 18. References • Bakken, J. P., & Simpson, C. G. (2011). Mnemonic strategies: Success for the young-adult learner. Journal of Human Resources & Adult Learning, 7(2), 79-85. • Buckingham, M., & Coffman, C. (1999). First, break all the rules. What the world’s greatest managers do differently. New York, NY: Simon & Schuster. • Conway, J. B., & Weingart, S. N. (2010). Leadership: Assuring respect and compassion to clinicians involved in medical error. Swiss Medical Weekly, 139(1-2), 3. • Denham, C. R. (2007a). The new patient safety officer: A lifeline for patients, a life jacket for CEO’s. Journal of Patient Safety, 3(1), 43-54. DOI: 10.1097/PTS.0b013e318036bae9 • Denham, C. R. (2007b). TRUST: The 5 rights of the second victim. Journal of Patient Safety, 3(2), 107-119. DOI: 10.1097/01.jps.0000236917.02321.fd • Deskin, W. C., & Hoye, R. E. (2004). Another look at medical error. Journal of Surgical. Oncology, 88, 122–129. DOI: 10.1002/jso.20122. • Devers, K. J., Pham, H. H., & Liu, G. (2004). What is driving hospitals' patient-safety efforts? Health Affairs, 23(2), 103-115. DOI: 10.1377/hlthaff.23.2.103 • U.S. Department of Health and Human Services (DHHS; 2012). Partnership for patients: Leadership/board engagement. Retrieved from • http://www.nmhanet.org/quality/nm-hospital-engagement-network-hen/Leadership.pdf
  19. 19. References • Edgman-Levitan, S., & Cleary, P. D. (1996). What information do consumers want and need? Health Affairs, 15(4), 42-56. • Foley, M. (2004). Caring for those who care: A tribute to nurses and their safety. Online Journal of Issues in Nursing, 9(3). • Gigerenzer, G. (2007). Gut feelings. London, England: Penguin Books. • Graham, S., Brookey, J., & Steadman, C. (2005). Patient safety executive walkarounds. Advances in Patient Safety, 4. Retrieved from: http://www.ahrq.gov/professionals/quality-patient-safety/patient-safety- resources/resources/advances-in-patient-safety/vol4/Graham.pdf • Hinz, C. (2011). What might patient safety have to do with the joy and spirit of caregiving? Patient Safety Monitor, 10. Retrieved from: http://www.patientsafetymonitor.com/patient-safety-monitor-journal/2011 • Institute of Medicine. Committee on Healthcare in America. (2000). To err is human: Building a safer health system. L.T. Kohn, J. M. Corrigan, & M. S. Donaldson (Eds.), Washington, D.C.: National Academy Press. • Johnson, J., Horowitz, S., & Miller, S. (2008). Systems-based practice: Improving the safety and quality of patient Care by recognizing and improving the systems in which we work.Agency for Healthcare Research and Quality, Retrieved from: http://www.ahrq.gov/professionals/quality-patient-safety/patient-safety- resources/resources/advances-in-patient-safety-2/vol2/Advances-Johnson_90.pdf • Laschinger, H. K., Almost, J., Tuer-Hodes, D. (2003). Workplace empowerment and magnet hospital characteristics: Making the link. Journal of Nursing Administration, 33(7–8), 410–422.
  20. 20. References • Latter, C. (2009). And justice for all. Prevention Strategist, 2(4), 46-53. Retrieved from: http://legacy.justculture.org/media/Prevention_Strategist-_Justice_For_All.pdf • Lucian Leape Institute at the National Patient Safety Foundation (2013). Through the eyes of the workforce: Creating joy, meaning, and safer health care. Retrieved from http://www.npsf.org/wp- content/uploads/2013/03/Through-Eyes-of-the-Workforce_online.pdf • Mastropieri, M. M. (1988). Using the keyword method. Teaching Exceptional Children, 20(2), 4-8. • Ostrom, E. (2007). Institutional rational Choice: An Assessment of the institutional analysis and development framework. In P. A. Sabatier (Ed.), Theories of the policy process (pp. 21-64). Boulder, CO: Westview Press. • Reason, J. (1998). Achieving a safe culture: Theory and practice. Work & Stress, 12(3), 293-306. • Sammer, C., & James, B. (2011). Patient safety culture: The nursing unit leader’s role. The Online Journal of Issues in Nursing, 16(3), Manuscript 3. • Weinberg, J., Hilborne, L. H., & Nguyen, Q. T. (2005). Regulation of health policy: Patient safety and the state. Advances in Patient Safety: From Research to Implementation. Agency for Healthcare Research and Quality, 405-422. • Yeh, J., & DeName, K. (2009). Patient handoffs in obstetrics and gynecology: A vital link in patient safety. Clinical Medicine: Women's Health, 2, 17-27
  21. 21. Thank You