t he dangers of non - accountability susan gallagher, rn phd celebration institute, inc...
TRANSCRIPT
THE DANGERS OF NON-ACCOUNTABILITYSusan Gallagher, RN PhDCelebration Institute, [email protected]@celebrationinstitute.com
WHAT IS ACCOUNTABILITY IN THE HEALTHCARE SETTING?
PURPOSERecognize the dangers of non-
accountabilityHand washing – the most basicCarrot and stickUnderstand the threat of
organizational dysfunctionPutting it all together
DANGERS OF NON-ACCOUNTABILITY Annual cost exceeds $9 billion Annual rate of underreporting is 50 – 96% Exceeds the total rate of MVA, general and
commercial aviation crashes, suicide, falls, drowning and poisoning
Misunderstanding the “near miss”
Charney W. Epidemic of Medical Errors and Hospital-Acquired Infections: Systemic and Social Causes. CRC Press: Boca Raton. 2012
HAND WASHING – THE MOST BASIC
“I notice you always wash your hands after we play. Frankly I find that quite offensive.”
HAND WASHING – THE MOST BASIC
“ There are billions of germs, bacteria and microbes living on my body, and I still feel so alone!”
HAND WASHING – THE MOST BASIC
Employees MUST NOT wash their hands before returning to work.
HAND WASHING – THE MOST BASIC
“I use so much alcohol-based hand sanitizer, my hands had to join a 12-step program.”
“Wait, this one’s s a lawyer. We better wash our hands.”
HAND WASHING – THE MOST BASIC
It is not funny! Symptom of a bigger issue
Infection is the #1 reason for mortality among hospitalized infants
Antibiotics lend a false sense of security Gels do not control all infectious agents Annual rate of hospital-acquired infection – 1.7
million 99,000 deaths related to hospital-acquired
infections each year Hand-washing is the primary deterrent to
hospital-acquired infection
Charney W. Epidemic of Medical Errors and Hospital-Acquired Infections: Systemic and Social Causes. CRC Press: Boca Raton. 2012
WE KNOW THE FACTS Viruses and bacteria can live from 20 minutes
to two hours or more on such surfaces as cafeteria tables, doorknobs and desks
Eighty percent of all infectious diseases are transmitted by touch
Ninety-five percent of the population say that they wash their hands after using a public toilet. However when 8,000 people were monitored across five large cities in the US, they found the actual number to be more like 67%
http://www.hardydiagnostics.com/articles/hand-washing.pdf
WE KNOW THE FACTS
One study demonstrated that hand washing guidelines were followed 25% of the time during times when the floor was overcrowded and understaffed. Compliance rose to 70% when the floor was properly staffed and not overcrowded with patients.
http://www.hardydiagnostics.com/articles/hand-washing.pdf
WE KNOW THE FACTS A poll of pediatric ICU physicians showed that
they claimed their rate of hand washing between patients was 73%, but when followed and observed, the hand washing rate was found to be less than 10%.
A recent study showed that 21% of the health care workers in ICU had varying counts of Staphylococcus aureus on their hands
http://www.hardydiagnostics.com/articles/hand-washing.pdf
HAND WASHING – THE MOST BASIC Hand-washing facilities that are adequate and
convenient Time enough to adequately hand wash, clean
the healthcare environment, and also bathe patients
Effective equipment such as quality gloves, gowns that fit, and soaps and towels that do not threaten skin integrity
Enough equipment to use for isolated patients Employer-based pens, stethoscopes, clothing
and shoe covers
Charney W. Epidemic of Medical Errors and Hospital-Acquired Infections: Systemic and Social Causes. CRC Press: Boca Raton. 2012
HAND WASHING – THE MOST BASIC Adequate staffing in all departments,
including infection control, housekeeping , sterile processing, and direct care staff members
Effective cleaning with chemicals that are easy to use properly
Effective isolation practices Furnishings simple to clean Sick policies which are not punitive
Charney W. Epidemic of Medical Errors and Hospital-Acquired Infections: Systemic and Social Causes. CRC Press: Boca Raton. 2012
NON-ACCOUNTABILITY IS KILLING PATIENTS
Fifty percent of all health complications are associated with hospital-acquired infections
Five percent of all admissions are effected One death every six minutes!
Charney W. Epidemic of Medical Errors and Hospital-Acquired Infections: Systemic and Social Causes. CRC Press: Boca Raton. 2012
CARROT AND STICK The parable of the carrot and the stick Must refocus on sustaining meaningful long-
term momentum for accountability The role of teamwork What is a bully, and how does this impact
accountability?
Gallagher SM & Gallagher SM. The carrot and the stick: recognizing the danger in the debate. JSPHM. 2013;3(1).
Center for the American Nurses Association. Lateral Violence and Bullying Fact Sheet. Accessed May 12, 2012 at: http://www.centerforamericannurses.org/associations/9102/files/LATERALVIOLENCEBULLYINGFACTSHEET.pdf
BULLYING AND ACCOUNTABILITY Thirty-eight percent of healthcare workers
report incidents of one or more types of bullying
Forty-eight percent report verbal abuse Workers who experience bullying have
significantly lower levels of job satisfaction, increased job-induced stress, and a greater intent to leave a position
Fifty-three percent of student nurses report bullying behavior by a staff nurse
Additional adverse outcomes have included poor morale, decreased productivity, and increased errorsCenter for the American Nurses Association. Lateral Violence and Bullying Fact Sheet. Accessed May 12, 2012 at: http://www.centerforamericannurses.org/associations/9102/files/LATERALVIOLENCEBULLYINGFACTSHEET.pdf
WHEN THINGS GO WRONG
Recognizing the need for a Crucial Conversation• Opinions vary• Stakes are high• Emotions run strong
Understanding the autonomic nervous system Reactions of others Reaction of self Evolution through time – fight or flight!
Gallagher SM, Steadman A, Gallagher SM. Tackling tough conversations: recognizing societal bias as a barrier to crucial conversation. Bariatric Times. 2010;7(6):1, 24 – 28.
MAKING IT HAPPEN
Gallagher SM, Steadman A, Gallagher SM. Tackling tough topics: recognizing societal bias as a barrier to crucial conversation. Bariatric Times. 2010;7(6):1, 24 – 28.
THREAT OF ORGANIZATIONAL DYSFUNCTION
Constant state of change Imbalance in funding Frontline care team members not included in
decision-making Unclear guidelines Poor communication Fail to seek innovative solutions
Gallagher SM & Gallagher SM. The carrot and the stick: recognizing the danger in the debate. JSPHM. 2013;3(1).
PUTTING IT ALL TOGETHER Must have the following in place:
Influential leadership InnovationSupportive workplace
How is this accomplished?
Gallagher SM & Gallagher SM. The carrot and the stick: recognizing the danger in the debate. JSPHM. 2013;3(1).
PUTTING IT ALL TOGETHER – PRACTICAL IDEAS
Do team members feel their contributions are essential to the organization?
…involved in facility decisions, especially where his contribution makes a difference?
…consulted before making any decision impacting her position?
…helped in his own development initiatives as well as those designed by the organization?
…evaluations are based on accountability?
Gallagher SM & Gallagher SM. The carrot and the stick: recognizing the danger in the debate. JSPHM. 2013;3(1).
CONCLUSION