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In a recent webinar for our ActionCue clients, Prista’s panel of experts answered questions about healthcare innovation and the role of leadership in creating action that improves patient safety and quality.

A total of 12 questions were addressed in depth by our panelists. In this article, we will discuss the second three questions and cover the remaining six in future posts. Check out the first three questions here if you missed them. Before we begin, let’s do a quick introduction to the panelists in this webinar.

As President and Founder of Prista, Don Jarrell brings more than 30 years of technology experience in products management, application design, technology strategy and intellectual property management licensing. Don has provided the vision for Prista and for the ActionCue application.

Billie Anne Schoppman is a Registered Nurse and CPHQ (Certified Professional in Healthcare Quality) with more than 30 years of experience in the healthcare industry. As the Chief Mission Officer at Prista, she brings her passion to create the most efficient environment for improvement.

Dr. Jake Redden is a member of Prista’s Advisory Board with expertise in patient safety, healthcare quality, human factors, crew resource management, and safety culture, and is certified in healthcare quality and patient safety.

 

4. How much value is there in the UI/UX and design of a new application if the staff has already learned how to use another quality and safety system?

 

Don Jarrell: The design of the user interface and user experience is really important when people are first trying to learn how to use the application, but in my experience, it’s even more important once the people are routinely using an application in production.

Rather than just the aesthetic or the intuitiveness of the application itself, UX is about users getting things done relative to their whole job. The user’s objectives can really be supported when the application is designed from a standpoint of understanding the mindset and the needs of the user as they are starting to engage the application for a task, when they’re actually doing the tasks, and what they are likely to want or do next. Of course, it helps when the integration extends not just to the activities within the application, but to the real 24 or eight hour-a-day job of the various users.

By improving the productivity and making the process enjoyable, people have a subliminal relationship with the application making them positively disposed toward the work that they’re doing in the application.

With all of that going on, you really do want the people to enjoy using the application. You don’t want it to be frustrating, unpleasant or a drag on their productivity.

When we’re talking about reporting, we can also get into some very interesting benefits from understanding the perceptive science or neuroscience of a user and injecting that into the application. When you present data in a way that conflicts with the natural functioning of the brain and perception of the user, it can be bad.

We’ve all been to quality council meetings or governing board meetings where people jump around with all sorts of differently formatted spreadsheets and graphs and illustrations of various kinds, many of which are badly designed in terms of neuroscience. Often people leave those three and four hour meetings with a headache, not just because of the subject matter that they’re dealing with, but because of how it was presented.

We spend a lot of time trying to make sure that we bring in the neuroscience, the perceptive science, the technology design work and so forth. This approach is equally fed with an understanding of the workflow and environment in healthcare and the settings in which our applications are used, but we bring all of that together for a satisfying and productive user interface and experience.

We also carry that one step forward into what we call enterprise experience (EX), which is important when you’re talking about workflows and collaboration among many people. So, while we’re satisfying the individual users in terms of their engagement with the application to perform their tasks, we’re also satisfying the corporate objectives to get the overall work involving many people done effectively, efficiently and enjoyably.

 

5. How does executive management support or lead to a culture of quality?

 

Dr. Jake Redden: Culture truly is the heart of where we’re going to make a lot of our improvements in hospitals, and it has to be led by our executive teams. There have been countless studies documenting how tough this is because of the considerable variations in the perception of safety culture across organizations, and even within a single hospital across different staff roles.

Safety culture has been defined and it can be measured. A lot of us do annual or semi-annual measurements of where our culture is. A poorly perceived safety culture has been directly linked to increased error rates. However, achieving sustained improvements in safety culture has been difficult.

Culture improvement efforts such as the ones Billie Anne mentioned, like executive walkthroughs and unit based safety teams, have all been associated with improvements in safety culture measures, but they have not yet been shown to lower error rates.

Other methods, including SBAR, structured communication methods, and different rapid response teams, have all been implemented to help address cultural issues in a hospital such as rigid hierarchies and communication problems. Again, the effects of these methods in improving overall safety culture and error rates remain unproven.

All experts agree, however, that culture and leadership is where we have to start. There is no blanket approach to improving patient safety. You can’t just bring someone in and expect them to make everything better. It has to start within our own walls and how we’re addressing these issues. We have to be innovative with the information we have in our hospitals.

I’m not going to belabor the value of building a reporting culture. I think most risk managers today are aware that a patient safety reporting program is a must in every healthcare organization. Of course, having employees who want to report involves the presence of a just culture, which is another common discussion point for executives today.

Let’s take a look at two lesser known aspects of safety culture: the informed and learning cultures. I’m a huge fan of these two aspects because they speak directly to the two tenets of high reliability organizations: the reluctance to accept simple explanations for problems and sensitivity to operations.

In an informed culture, every member of the leadership team is aware of not just the most serious safety events or those associated with our publicly reported metrics, but everything that our frontline staff, who are the experts that we should be deferring to, is saying needs to be addressed. Once leadership is aware or informed in an actionable way, then we can address redesigning the work environment.

The reluctance to accept simple explanations for problems helps develop our learning culture. Once we stop letting others give easy answers for negative events or people that are trying to protect their turf or cover up what happens on their units, we can really start to develop higher reliability work processes. We fix things more effectively the first time, and when frontline sees how informative the executive team is, it grows support, enthusiasm, and an overall improved safety culture.

As mentioned, safety culture is a local problem. Wide variations in the perception of that safety culture existing within a single organization further complicate how we approach the work that we do in improvement. These variations regularly contribute to the mixed record of interventions or attempts at making improvement. That’s why we see cycles of things we fixed in the past creeping back in as we continue to try to play the management theme of the month.

Organizational leadership needs to be deeply involved and attentive to the issues that our frontline workers are facing. They must have an understanding of the established norms and hidden culture that often guide our unsafe behaviors.

 

6. Why should leaders who have been very successful in quality and safety organizations want to change their strategy, process and tools?

 

Billie Anne Schoppman: Healthcare leaders have been leaders in quality, risk and safety over several years and done an excellent job. We’ve operationally met our regulatory requirements, our financial requirements and worked really hard to actually meet our responsibilities, but as with anything else, things have to change. As Dr. Redden mentioned, we still have a lot of opportunities. There are a lot of things that keep coming around again and again because we really don’t fix them.

To become a high reliability organization, we need to stress some requirements. This is something that many organizations are already addressing, but it’s an ongoing process. It’s not something that you can implement and then walk away from it. It will not be hardwired unless you take the time to hardwire it. The safety culture is the sum of what an organization is and does every day in the pursuit of safety, and it involves everyone in the organization.

Let’s look at a couple of building blocks and things that we all need to think about. Instead of maintaining the status quo, focus on organizational activities that need to become daily a routine and can help you achieve those safe operations. Everything is important. Every way that you can get the visitors, patients and the staff involved in identifying safety opportunities is a change in the culture.

We talked about a blame-free environment, but does it really exist? Are people still focused on who instead of what? Instead of the process? I always liked Demings’ comment that 85% of the causes of customer dissatisfaction are the result of inefficiencies in systems and processes.

What we want to focus on to be a highly reliable organization is processes. Let technology take the place of a lot of the inefficient processes that you have. Let it work for you instead of you having to work for it all the time.

Let’s also talk about collaboration across the processes. Everything in healthcare is still siloed. Day shift, night shift, respiratory versus nursing, laboratory versus nursing, radiology versus nursing, etc. Much of that has been repaired, but there’s still the mentality of siloing operations, departments and processes.

We need to collaborate across those barriers. Nothing in healthcare is siloed, so every department needs to be involved in everything that’s happening. Think of the same thing as far as your systems. How many systems do you have that don’t talk to each other? How many systems do you have that may do one function instead of all three integrated functions, or instead of giving you information that you need at your fingertips so you can act?

Organizations also have to be committed to resources. Does your organization provide the system that you really need to identify safety concerns, track and trend them, and improve them?

Dr. Redden mentioned some of the tenets of a safety culture. I’m sure all of you are aware of the Sentinel Event Alert 57 that highlights the role of leadership in developing a safety culture. This is a great start. It’s a start for you to sit down, ask the questions and do a self-analysis. Take one thing at a time to start approaching your safety culture.

 

We hope you will keep reading over the next several weeks as we continue our series about Healthcare Innovation, Leadership and Action. Reach out to us via email or on social media if you have questions or comments, and let us know what challenges you’re facing and how ActionCue CI can make a difference for your patients.

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