Paul Moore from the National Health System has called risk management “the most pressing business issue of our time” – and that fact was certainly confirmed by the number of attendees at a patient safety webcast sponsored by HIROC and the OHA.
250 employees performing a wide range of jobs in healthcare facilities and organizations around the province tuned in to hear Greg King, VP Finance at HIROC and Malcolm Eade, President and CEO at Salus Global Corporation. According to both presenters, the weak link in our patient safety efforts is communication. It’s either not happening at all, or when it is, the right things are not being communicated.
“With close to 700 subscribers, HIROC has an unmatched database of claims data,” said Greg. “The highest percentage of our claims costs – 37 per cent – comes from obstetrics.” He cited some of the other risks for acute care that appear on the list: patient and visitor falls, misinterpretation of laboratory tests and critical test results not being communicated, medication errors, and failure to appreciate a deteriorating patient condition in the ER.
Although healthcare professionals possess the skill and knowledge to make the right assessments of patients, King pointed out how the real problems occur when they delay or fail to communicate. He then provided two key communications strategies HIROC recommends for improving outcomes in the obstetrics area: implement processes to ensure the effective communication of fetal status and maintain an environment that supports questioning and challenging of care provided.
A Call to Action that can’t be ignored
Concerned about their own obstetrical risks, many hospitals around the country have been listening to the Call to Action put forth by Salus Global Corporation. Created in 2007 to globalize an obstetrical patient safety program developed in 2002 by the Society of Obstetricians and Gynaecologists of Canada, Salus has built a strong following for its highly effective MOREOB program. As Eade explained, “The program drives ownership and empowerment across all disciplines and this leads to safety.”
The hospitals that commit to implementing the MOREOB program – and 300 have, with good results – know from the start that they are committing to three years of work around building a culture of communication, teamwork and shared decision-making.
Although Eade is the first to say the program is “complex in design, simple in execution”, he admits that culture change is a massive project. "You’re talking about hundreds of interactions every week that need to be improved upon. You need constant coaching because people are always slipping back." As head ‘coach’ and ambassador for MOREOB – and now its offshoot Performance Enhancement Process (PEP), a program that strengthens underlying relationships among teams in all parts of the hospital – Eade says good outcomes are possible when hospital administration is fully behind and supportive of the program. "And when things fall apart, it’s usually because either physicians or administration, or both, are not on board," he says.
Just shrink the holes
But when they fully embrace the program, the numbers tell the story of an altered safety culture. In Alberta, where MOREOB has been implemented in 65 hospitals across 9 regions in the province, they studied the impact of the program on 50,000 births. The results, after completing three modules over three years, were impressive:
- Infants on a ventilator: reduced by 31%
- Severe infant morbidity: reduced up to 24%
- Infant mortality: reduced by 18%, and,
- Hypoxic ischemic encephalopathy: reduced by 33%
For Eade and the team at Salus Global, it’s a simple matter of plugging the holes – “Our own defenses against the hazards in obstetrics (referred to as ‘the Swiss cheese’) are fallible and safety is often compromised,” he says. “But with MOREOB, we shrink the size of the holes in the Swiss cheese.”
There are many potholes on the way to implementing a culture of quality and safety, but both Eade and King agree that it starts at the top. Greg cited a study from The Joint Commission (TJC), which found that between 2012-2104, the most frequently identified root causes of sentinel events in the healthcare setting are leadership and communication. “Effective change happens,” he said, “when leadership encourages a culture where communication is seen as valued rather than as an effort or a nuisance.”