Safety culture is a facet of organizational culture that captures attitudes, beliefs, perceptions, and values about safety. A culture of safety is essential in high reliability organizations and is a critical mechanism for the delivery of safe and high-quality care. It requires a strong commitment from leadership and staff. In this course, a safe culture is promoted through the use of identifying and reporting patient safety hazards, accountability and transparency, involvement with patients and families, and effective teamwork.
Cross-unit Collaboration
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En provenance du cours de Johns Hopkins University
Setting the Stage for Success: An Eye on Safety Culture and Teamwork (Patient Safety II)
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Strengthening Safety Culture Through Teamwork
Research shows that many errors can be attributed to breakdowns in teamwork and communication. In this module, participants will learn how safety culture can be strengthened though teamwork and communication. Participants will learn skills critical in the prevention and mitigation of medical errors.
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Eileen Kasda
Thank you for watching this video on Cross-unit Collaboration.
Previously, we've talked about how to move from an individual expert to
an expert team and what that takes and what
interventions are available and how we can assess,
how we're doing on the journey of building team expertise.
In this video, we're going to talk about larger issues of
coordination across our organization that will impact patient outcomes.
We're going to talk about cross-unit collaboration.
We're going to talk about what we mean by a multi-team system and
how we can start managing those more effectively.
For a point of reference,
to illustrate the issue that we're trying to address,
this is a diagram of patient movement data over three months in our organization.
Each of the bars is a specific physical location.
The larger the bar the more patients pass through that area.
Each of the gray lines are patient transfers from one area to another.
As you can see, this is a pretty complex workflow and we initially did this to start
identifying some risk points for hand-offs and
transitions of care that we could start managing more effectively.
What we found is that there's really
a lot of complexity in how patients move and that we may not
always be mindfully managing all of
these different interconnections and it's
a huge challenge to manage all these interconnections.
We want to think about the outcomes that we really care about
for the patient are a product of people throughout this journey.
What can we do to help them coordinate those efforts more
effectively were still managed in geographic silos,
in disciplinary silos and in departmental silos.
So we need some structures that help bridge those to connect the dots for
patient care across their entire experience in our organization,
and those are really
multi-team system interventions, multi-team system interdependencies.
There's a team in each of those bars but their work is dependent
on teams in other bars as patients move from unit to unit.
By multi-team system, we really need two or more teams that interface
directly and interdependently in response to
environment contingencies and were working towards collective goals.
It is very much the teamwork definition that we introduced before,
a real team extended to this idea that we have
multiple teams that are
accountable or should be accountable for the ultimate outcomes that we care about,
interdependent with each other to achieve the patient outcomes we care about.
We can think about this in terms of traditional organizing and what that looks
like in multi-team system organizing and what that looks like from the literature.
We can define a traditional kind of
organization where we have essentially self-contained work units for
the most part if there's connections between
them that usually happens at the managers level so
there'll be committee meetings or other things where there's connections between one
another but the specific people in those areas don't interact very much.
We are members that identify with their team more than the whole system.
Within those units, we have a lot of variability in the practices.
People have their routines,
the tools and technology that they use and they're really loosely coupled
in terms of any accountability or reward system so,
really, a traditional hierarchical organization with compartmentalized units.
You think about what a multi-team system approach to organizing might look like.
The units are a lot more interdependent and membership is little more diffuse,
people's identity is really in
the larger system and not necessarily the work area that they're in,
and boundaries spanning is really critical for making this work.
We have people that travel from all of those different areas and
it can help bridge the gaps and understanding the differences and work practices.
We have people moving horizontally
to help coordinate work and we have them more tightly coupled accountability, right.
We're all held responsible for
outcomes that we care about or the organization cares about.
In health care, you can identify different pieces from each of these columns.
To some extent we still look like a traditional organization in many ways
but as illustrated in the graph previously our work is actually
organized and there's multi-team system way where there's lots of interdependence across
these areas but we might be set up to manage a more traditionally compartmentalized way.
This, from team steps curriculum,
shows or illustrates what
one version of a multi-team system in healthcare might look like.
Of course, the patient at the center or the top of the organization,
you have a core team member with anyone who has
kind of hands on direct patient care responsibilities,
you have a contingency team that comes in for
a very specific purpose for a very limited amount of time.
This could be a procedural team,
this could be a rapid response team,
things of that nature and you have some coordinating team which might be
the local unit leadership and
management and you have some support services which could be environmental services,
imaging, those types of things, pharmacy nutrition.
Then, you have an administration layer, of course.
For the comprehensive unit-based safety program.
One of the features of that structure is that it tries to include executive leaders as
a part of improvement teams run by the core team and the coordinating team.
The leadership and the frontline providers are on the same team with the administration.
That's an effort to introduce some boundary
spanning functions which are part of the multi-team system into our improvement efforts.
That helps to tackle some of
the vertical breakdowns we see in
organizations and our teams and how we're able to coordinate,
but we also need to think more horizontally across those patient care pathways,
how are we coordinating our efforts for care but also for improvement.
One way to start addressing these multi-team system issues is
a very simple practical approach called the teamwork across
units tool and this is really designed to surface,
prioritize and address inconsistent expectations
around coordination across these clinical units.
Imagining you're implementing this in
two units whose work is tied together quite closely,
this could be a suite of operating rooms and
ICU or step down unit or something to that effect.
What you would do is go start with one unit and ask
them what they need from the other units, right?
We're generating coordination needs, communication needs.
What do I need most from this other unit in order for me to take good care of
this patient and what do I most frequently not get.
That helps generate a list of priorities of things we can start working on together.
We do that within one unit,
the second step is to bring staff together
from these units and share what those priorities are.
This can elicit a lot of
interesting feedback and ideas because it's very
difficult to understand what other people may need from you.
We get very focused of course on the work that we do
and it's not that easy to understand how it's going to
impact someone once a patient gets moved to
a totally different area and is undergoing totally different types of treatment.
And then collaboratively as a cross unit team,
identify what those top priorities are for improving coordination across the units.
This is much like bringing to cusp teams together,
to improvement teams together where you ask them individually first,
what do you need, what do you struggle to get,
bring them together to share those priorities
and find something that we can work on and improve over time.
That is one more bottom up way to engage
staff in better managing these multi-team systems,
better managing coordination of care
across the patient's entire journey throughout an organization.
In this short video,
we introduce this idea of multi-team systems
and talked about some of the drivers of effectiveness and
ineffectiveness and provide a practical tool
for surfacing some improvement needs and in following up with those.
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