Workforce Safety: We have a problem and we can solve it

Stephen E. Muething, MDChief Quality OfficerProfessor of PediatricsCo-Director, James M Anderson Center for Health Systems Excellence

Disclosure

• Dr Muething receives some salary support from Solutions for Patient Safety

• Dr Muething is a member of a group of faculty who contributed intellectual property to HIVE Networks

Objectives:

• Participants will understand current state of healthcare workforce safety and the compelling reasons to address this problem.

• Participants will see an example of potential solutions at the local level and national level.

• Participants will hear potential steps that can be taken by every hospital leaders almost immediately.

Cincinnati Children’s Snapshot Over 15,000 employees and 678 Beds More than 20 sites of care, >120 mental health

beds >1.2 million patient encounters Patients from 50 states and nearly 70

countries, employees from >90 countries >2600 students; >380 residents; >640 fellows >1200 new employees every year >100 continuous clinical trials

Vision:To be the leader in improving child health

OSHA recordable injury: Injuries requiring more than first aid. Also includes blood-borne pathogen exposures.

DART Injury:Days Away,

Restricted duty or Transfer

6000 36001500 10

17104

$33 million

Respect Belief and Buy-In Inextricably Linked

Employee and Patient Safety

16

Pyramid of Harmpatient and employees

SSE’s & Lost-time injuries

Serious harm index & OSHA

recordable injuries

Events of minimal to moderate harm & all

employee injuries

Near-miss eventsPatient and Employees

17

SSE’s & Lost-time injuries

Serious harm index & OSHA

recordable injuries

Events of minimal to moderate harm & all

employee injuries

Near-miss eventsPatient and Employees

Pyramid of Harmpatient and employees

SSE’s & Lost-time injuries

Serious harm index & OSHA

recordable injuries

Events of minimal to moderate harm & all

employee injuries

Near-miss eventsPatient and Employees

Pyramid of Harmpatient and employees

0 10 20 30 40 50 60 70 80

Slip, Trip or Fall

Overexertion

Other

Motor Vehicle Accident

Exposure

Caught / Struck

BBP Exposure

Aggressive Patient

Fiscal Year ComparisonJuly - April

FY17 FY18 FY19

21

Creating the Culture

RESPECT Members

Darin EnglandOP MRI

Susan SharpRadiologist

Jordan BrownBase Radiography

Michelle GramkeUltrasound

Kyaira WaltonNuclear Medicine

Alex TowbinRadiologist

Ethan SmithRadiologist

Meg CareRadiologist

Carl MerrowRadiologist

Jonathan DillmanRadiologist

Abbey SzabadosCT

Bernadette KochRadiologist

Catherine LeopardChild Life

Steve KrausRadiologist

Yinan LiFellow

Cathy WielandBase Radiography

Abby SchmitzBase MRI

Rachel SmithQI

Billie HowardOP Radiography

QI

Stephanie SnellingReading Room

Theresa VogelsangOP Ultrasound

Beth WiesmanOP Radiography

255 frontline employees, managers, and faculty

PathologicalWho cares as long as we’re

not caught

ReactiveSafety is important - we do a lot every time we

have an accident

CalculativeWe have systems in place to manage all

hazards

ProactiveSafety Leadership and values drive continuous

improvement

High ReliabilityIt is how we do business

around here

Radiology Safety Culture Curve

Radiology Themes

Communicatio

Safety Reports

Frontline Involvement

Training and Onboarding

Radiologist-Technologist Interactions

Radiology Action Items

• Interactions:– Active work to improve interactions between faculty/fellows and frontline staff

• Communication:– Daily Pulse Survey, Radiology Round Tables, Town Halls, etc.– Implementing new process for trying patients without anesthesia in MRI

• Training and Onboarding:– Active work on improving our onboarding and training for new hires– Implemented fellow proficiencies in Fluoroscopy

• Frontline Involvement:– New equipment ordered after frontline trial and feedback– Frontline representation on all improvement initiatives

Faculty/Fellow and Frontline Interactions

Radiologist Coverage

during Conference

Established…

PDSA 1: Fellow Observations in CTPDSA 2: Phone scriptsPDSA 3: Go-to …

PDSA 1: Fellow Observations in RadiographyPDSA 2: Shared individual feedback with Radiologists…

40%

50%

60%

70%

80%

90%

100%

% V

ery

Goo

d an

d Ex

celle

nt In

tera

ctio

ns

Bi-Weekly

% Very Good and Excellent Interactions betweenFrontline Staff and Radiologist/Fellow

% Very Good and Excellent Interactions Median Goal

Food ServiceSafety Culture Curve Exercise

Employee Safety Culture

Collaborative:

“Making Safety Safe”

Where do you all feel that your department/division falls on the curve?

1

2

3

4

5

Frontline Staff Score Manager Score

ReactiveSafety is important - we do a

lot every time we have an accident

CalculativeWe have systems in place

to manage all hazards

ProactiveSafety Leadership and values drive continuous improvement

Food Services Results

PathologicalWho cares as long as we’re

not caught

High ReliabilityIt is how we do business

around here

Average Frontline staff score: 3.23Average Leadership score: 3.68

Communicatio

Lack of Trust

Work Environment

Fear of Repercussion

FOOD SERVICE THEMES

Communication and Trust:• Refresh the Safety Committee to allow new members

to join and request continued commitment from current members

• Communicate a safety update at each all employee staff meeting monthly

• Implement new programs promoting safety-focus item each month, safety concern box

FOOD SERVICE ACTIONS

Workforce Safety Across SPS

33

Working together to eliminate serious harm

across all children’s hospitals in the United States

OUR MISSION:

34

Employee Safe Safety-DARTSPS Network Aggregate

Year 1 Key Drivers

oStrategic goal to reduce work force injuriesoSenior leadership review of workforce safety data

as close to real time as possible (at least monthly)oRobust injury review and reporting processoMulti-professional team chartered to improve

workforce safetyoLearn from other organizations via site visits or

comparative opportunities

Questions? Pushback? Discussion?

38

Workforce Safety: We have a problem and we can solve itDisclosureObjectives:Slide Number 4Cincinnati Children’s SnapshotSlide Number 6Slide Number 7Slide Number 8Slide Number 9Slide Number 10Slide Number 11Slide Number 12$33 millionSlide Number 14Slide Number 15Slide Number 16Pyramid of Harm�patient and employeesPyramid of Harm�patient and employeesPyramid of Harm�patient and employeesSlide Number 20Slide Number 21Creating the CultureSlide Number 23Slide Number 24Slide Number 25Radiology Action ItemsFaculty/Fellow and Frontline Interactions Food Service�Safety Culture Curve ExerciseFood Services ResultsSlide Number 30Slide Number 31Slide Number 32Slide Number 33Slide Number 34Slide Number 35Slide Number 36Year 1 Key DriversSlide Number 38