Safety and 'silos' don't mix TJC says in new alert
Involve nurse, physician, administration
"No unit is an island" might be the theme of a new Sentinel Event Alert from The Joint Commission (TJC).
"Health care leaders can . . . break down the barriers between clinical, operational, and financial 'silos' by developing and recruiting leaders who understand the importance of all three areas working closely together in order to create safety," says TJC in its Alert. (For more excerpts from the Alert, see box below. To access the complete Alert, go to www.jointcommission.org. Under "Sentinel Event," click on "Sentinel Event Alert," then "Issue 43: Leadership committed to safety.")
ED managers agree that such silos, whether between different areas of the hospital or different disciplines within the department, are barriers to the successful creation of a safety culture. "You have to have representatives [from every unit] at each other's meetings, as well as a [hospitalwide] quality meeting that focuses on safety every month," says Kevin Klauer, DO, FACEP, director of quality and clinical education for Emergency Medicine Physicians, Canton, OH, and a staff emergency physician at Barberton Citizens Hospital and Lodi Community Hospital, both in the Akron/Canton area. "You've got to make sure safety is institutionalized into one system design — not 30 different ideas of what it is and what it means."
India Owens, RN, director of emergency services at Clarian West Hospital in Indianapolis, says, "I think that most of the things we do, most of the processes we use, cross every one of our disciplines. This central approach is important because more often than not what you have difficulty with, I have difficulty with." (The multidiscipline approach is reinforced at Clarian West by its Safe Passage Committee. See the story to the right. For additional information on creating a safety culture, see the story on p. 140.)
Accordingly, while there are corporate goals around safety, each department keeps a "scorecard" of its performance, and every department has its own goals to feed into the overall corporate goals, Owens says. The system is totally transparent, so the ED can view the scorecards of all the other departments in the hospital. "If I have a goal to reduce labeling errors and I wonder what kind of approaches should be used, I can go and look at what other units have done," she explains. "If another unit has a higher score in this area, I can review and discuss their tactics with them."
Methodist Hospital in Sacramento, CA, held collaborative meetings between the physician staff and nursing. "You need the support of both to be effective," says Cindy Myas, RN, MSN, director of emergency services. At Methodist, the triage process recently was overhauled to enhance patient safety. The triage nurse was put in the waiting room to serve as the "greeter." She quickly determines if a patient should go home, requires further diagnostics and should be placed in the waiting room, or if they require an ED bed.
"If we were not all working in the same direction, this would not have worked," Myas says.
During a series of meetings, both groups voiced their concerns, and everyone had to agree on the new processes, she says. "Our motto was, 'If you come to the meetings, you get to make the decisions,'" Myas shares.
Administration also was a critical element, she says. "They had to be supportive," Myas says. "They actually needed to sign on to what the leadership in the ED recommended because this hit our bottom line." More staff were required to make the new process work, she explains. Administration approved the addition of two RNs to each shift, a midlevel physician's assistant, and another physician for the busiest times in the ED.
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