You’ve invested in software that you know will help support your patient safety and quality goals. There’s just one problem: how do you ensure that everyone is onboard and using the system to their best ability? In the following stories you’ll learn from RL experts about how they have engaged staff across the organization, with dedication, persistence and a lot of creativity.
Everyone is Risk Management: Create Advocates
Risk management in healthcare is dependent on information. What happened? Who did it happen to? Where did it occur?
A lot of that information comes from incident reports voluntarily submitted by staff members. But as the Director of Clinical Risk and Patient Safety at McLaren Health, Kevin Smart is focused on something else: the incidents that don’t get reported and why.
Since stepping in to the role in early 2018, Kevin has been performing weekly rounds. Through his discussions with staff on the floor, he discovered that fear of punitive action was one of the biggest actors discouraging staff from event reporting.
“I think we made the mistake early on of just going out and telling people what we wanted them to report and not really backing it with why it’s important to report,” says Kevin.
Kevin has been dedicated to changing the culture around reporting, working closely with department managers. “My goal is for everyone to understand that I’m not just there when things are bad, I’m a support system they can reach out to at any time.
A core focus of these conversations has been to stress the importance of reporting near misses – even when the errors are caught well in advance of an error reaching a patient. Right now, Kevin has been spending a lot of time working with the nursing department, but soon he hopes to include managers from the ER, OR and other units that, according to McLaren’s data, only report when an adverse event occurs.
Making RL Work with McLaren Staff Workflows
As Kevin was visiting departments and having conversations with staff, another barrier to reporting quickly became clear. There was a lot of confusion around what information should be reported and staff were put off by the extra work it added to their day.
In response to this feedback, Kevin’s team made some changes in their RL risk management software to make the process of reporting easier on staff. They started by reducing the number of mandatory form fields so that only essential information was required. The result? It now only takes an average of four minutes to file a report.
To help staff remember what information to include and when they should file a report, Kevin’s team distributed tip sheets and placed laminated copies at nursing stations. And while they may seem simple, each of these small adjustments have helped shift the culture around reporting and increase the number of reports filed each month. From 2015 (when McLaren went live with RL) to 2017, reporting increased by 20 percent. So far this year it has already increased by over 11 percent.
“I think it’s really just having those conversations with people and getting their feedback, making them part of the process, making them excited and passionate about it,” says Kevin.
Kevin will drop by departments and deliver small treats with thank-you notes for staff that consistently report. His team also administers monthly “great catch” awards, and the corporation is currently working towards implementing a new program called The Safety Champion. Kevin says this will likely include a ceremony where one of the “great catch” winners will be selected as a Safety Champion and rewarded for their hard work.
“Everyone is risk management and everyone is a patient safety officer,” says Kevin. “We all have to be advocates.”
RL Office Hours: Engage Staff with One-on-One Training
Written by Tiffany Pinto-Gruno, a Risk and Quality Specialist and the system administrator for RL at Mass. Eye and Ear.
At Mass. Eye and Ear we continue to reap the benefits from RL safety event reporting. With the implementation of a great reporting tool like RL Solutions it also brought its challenges. One of the struggles we faced was keeping staff educated on how to enter safety incidents and reinforce that everyone has the ability to enter them.
We learned early on that we needed to provide a convenient way for users to get the specific training they needed and a reliable source to address questions. Whether it be a director needing a refresher on how to fully complete tasks so they disappear from their File Info Center, or a physician who is unsure on how to add documentation, or a front line user that has never used RL, monthly “Office Hours” were created to encourage all staff to stop by and get on-on-one training.
Office hours take place on the third Friday of each month from 11 am to 1 pm and are held in the same conference room (conveniently located around the corner from our cafeteria). The conference room has a large projection screen and a hospital-system computer so staff can sign in as themselves so we can review the issues they are having and answer questions.
Office Hours Promotion Tools
- Emails: Each month we send out a reminder email to all the hospital directors, VPs, and other staff that have licenses. The email encourages not only the managers to attend but to also send their staff. Note: It is important to update the distribution list regularly since managers and staff responsibilities can change frequently.
- Newsletter: E-Forum is a hospital wide electronic newsletter that is sent to all staff every week. E-Forum has evolved over the last year or so into a very popular forum for hospital news and announcements. Feedback indicates that staff have been prompted to attend Office Hours because of the E-Forum reminder.
- Monthly Director Meetings: Every month the Quality team meets with each hospital nursing director to go over quality related items including RL safety event reporting. We use this opportunity to remind the directors to send their staff or to attend themselves to review functions they are unsure about.
- Annual E-Learning: RL is reviewed in our Compliance module that every new employee completes and then reviews on an annual basis.
Attendance varies from session to session. We can get anywhere from 2 to 5 employees that stop by. While the numbers might not seem high, we’ve found that the ratio is quite ideal as it allows for one on one training and provides sufficient time for questions and practice. We are also a small, specialty hospital, so larger organizations may experience a higher turn-out.
Within the past year we have had a range of staff members from physicians, directors and managers, VPs, front line users and staff with new licenses (various positions). The sessions can also prompt people to contact me that were not able to attend but would like to set up a meeting to go over an issue or need a refresher.
Popular Discussion Items
- The new Info Center set up
- How to complete a task
- How to clean up their Info Center
- How to enter follow-up
- How to add attachments
- Questions about the types of files they are receiving
- Report requests
Develop a Unified Staff Education Program
Written by Cristine Neff, a Safety & Quality Improvement Coordinator at Abraham Lincoln Memorial Hospital, an affiliate of Memorial Health System.
Memorial Health System has worked very diligently to create a unified comprehensive training program for all RL users. The program is divided up into frontline staff education, file manager education, and basic admin user education (which we call Super Users). Each affiliate hospital has one identified Super User.
Frontline staff receive their initial education during their new employee onboarding session. We take them into the system, provide a high-level tutorial, discuss what types of events can and should be submitted, including top submissions for each general event type. Then, we show them what it looks like to submit an event. We also listen to manager feedback. If a manager is seeing trends and key issues that frontline staff are struggling with, we can push out an FAQ in our company’s memo. The system is very self-intuitive for frontline staff, so we try and keep it as simple as possible.
File Managers get more-in depth training, in a classroom setting with hands-on experience. We keep the training small (less than 10 people to a class) so that everyone has time to chime in as we go along and ask questions. First, a demo of the system is provided. We start out by showing what it looks like for frontline staff to submit an event. That way, if their employees have questions, or if they need to submit an event themselves, they are supplied with the tools they need to answer any questions. Then, once the file is submitted, we take them in through what it looks like once they receive a submitted event for their area of responsibility and go over the file manager responsibilities in great detail.
So, okay, you’ve received your first event for your area, now what? We discuss how they will be alerted to a new file, how to locate and open the event, and then take them in through managing the file from beginning to completion. In this portion, I point out all file manager features, such as how you find out who all was alerted to a specific event (alerts), how to assign someone access into the event (tasks), if something has been updated in the file, how to find out what was changed and who changed it (audit feature). We also discuss redacting personal information from the file to protect PHI, especially with most events being reported to our Patient Safety Organization.
After the demo has occurred, I’ve created a hands-on training session that the students participate in. Each student gets a step-by-step training packet that they work through individually. We are there to answer any questions that they might have as they work through the exercise. Students login to the training environment, practice submitting an event, manage the event from beginning to end, and practice key features of the system, such as creating and sending tasks.
After the in-class training session is over, file managers receive a welcome packet via email that includes who to contact if they need any assistance, a copy of the hands-on training and education that they just received, file manager tips & tricks, FAQ’s, severity level definitions, and file manager expectations. Basically, a nice, handy, packet of information that they can quickly reference when they start receiving events.
I also designed a Super User Role (Basic Admin) program that was created for each affiliate hospital to optimize and standardize training across our health system. Each Super User is responsible for managing all user-specific tasks for their facility, such as identifying and setting up new users, maintenance of users, providing file manager training to those individuals, and troubleshooting all issues. To get the Super Users capable of handling the tasks, they first go through the file manager training themselves. We also come together as a health system on a quarterly basis to optimize the program, identify any training needs, and discuss trends, as well address any issues that we are seeing.
We want everyone to be able to take these events and use them as a learning opportunity, so I really focus on showing file managers how to redact information, such as who submitted the file, patient, staff, and physician names, etc., so they can print out or save the document to take to a staff meeting to discuss the learning opportunity. I think that is a very important piece in not only creating a culture of safety, but in showing staff that we are paying attention, listening to their concerns, and ensuring the hospital is a haven for our patients.
Create a Comprehensive Approach
Comprehensiveness and consistentcy are two cornerstones of Hackensack Meridian Health’s approach to staff education about RL’s software – and it’s an approach that helps create excellent staff engagement.
According to Dan Lindberg, Systems Analyst, and Marie Loch, System Administrator, the key to bolstering staff engagement is to focus your efforts on staff and what they need.
Dan and Marie oversee a variety of programs and initiatives that not only help staff understand how to use the RL software, but also why it’s so important.
“One avenue that really helps people see the value in reporting are our morning huddles,” says Dan. Each morning all unit managers and representatives from the risk management and quality departments meet – roughly 20 people in total. The risk management team brings a 24-hour report, created in RL, that gives them a snapshot of everything that happened in the last 24 hours.
"They use the report when the managers are going over the different things that happened on their unit,” says Dan. “It really helps keep everyone engaged and is a constant reminder for managers to get back to staff on their units with their information.
“In its own way,” adds Marie, “The huddles reinforce that the tool is being used and that the reports entered into the system aren’t going nowhere – people are using it and the information is being seen.”
In fact, the 24-hour report approach was so popular, that some members of hospital leadership now receive their own custom 24-hour report every day.
“The overall process of entering into RL has made everyone more aware of what’s going on,” says Marie. “In my opinion, RL has helped improve the communication across the organization.”
Taking Training to the Trainees
In addition to programs like morning huddles that bring awareness to how RL software is being used and what its impact is, Dan and Marie focus on training as another way to improve manager engagement with the software.
“We do site visits and spend 30 minutes or so one-on-one with managers,” explains Dan, stressing how different these visits are from a general, group training session. “What this allows for is for managers to really address their own personal needs and I found that’s really helped engage people who aren’t interested in using the system or don’t know how it can help them.”
This more personal approach creates an opportunity for Dan and Marie to tailor the content of their conversations to areas the managers are curious about or need help with – from adding follow-ups and completing tasks to running reports and drilling down into their data.
“When you sit and you talk to them one-on-one or in a small group, they get to understand why they’re doing it,” says Marie. “It becomes more about the impact and less about it being just an IT tool.”
These efforts have helped increase uptake in use of the software – but it has also created a shift, where RL is now synonymous with Hackensack Meridian’s values.
“The system is part of our culture now,” says Marie. “You hear the name being used in conversation on the floor and that’s one of the ways that we know what we’re doing is working.”
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