I’m not sure if you folks follow my HCPro colleague David LaHoda’s OSHA Healthcare Advisor e-newsletter and blog, but there’s an item this week that I think bears bringing to your attention in case you didn’t see it.
Earlier today, I was conducting an EC/EM interview session with a very participative group and I was complimenting them on their ability to speak to improvement efforts in areas that are not necessarily in their scope of practice. Now, my experience has been that the folks most familiar/expert with the EC function being discussed tend to dominate the conversation (sometimes in a good way, sometimes not) and I thought it was cool that these folks were so familiar with what others in the group felt was important. To my compliment, the observation was made (and I thought this was absolutely the grandest definition of what a high-performance team can achieve) that they mind each other’s business. In that simple turn of phrase (not an exact quote – sometimes paraphrase is the best I can do), the whole concept of what the EC team can embrace and accomplish was crystallized: It’s not about what may or may not be “somebody else’s job” (or “not my job”); it’s actually using the team concept to make and sustain improvements. In the old days we used to call that type of organizational behavior “silos,” which is OK if you’re storing grains and such, but when the goal is organizational improvement, we want to be more like a snack mix with all sorts of nuts and fibrous bits.
And please keep in mind, it’s not necessarily about never having any issues to correct. As long as there are human beings in the mix, there will be corrections to make – be assured of that. But if you can harness the power of a group of committed individuals who accept responsibility, hold each other accountable, and care enough to “mind each other’s business,” you can accomplish so much. There’ll always be stuff to do, but think about the power of getting stuff done.
Brings a smile to my face – how ‘bout you?
A quick note of interest from the survey world –
A recent survey resulted in a hospital being cited under the Infection Control standards (IC.02.02.01 on low-level disinfection, to be exact). In two instances, someone had the temerity to forget to close the cover on a container of disinfectant wipes. Can you believe such risky behavior still exists in our 24/7 world of infection prevention? It’s true, my friend, it is true!
The finding went on to say that, as the appropriate disinfection of a surface depends on wet contact with the surface being disinfected, leaving the cover open would partially dry out the next wipe, impairing the ability of the wipe to properly disinfect the surface. Now, I suspect that the person to use that next wipe might somehow intuit that the moisture content in the wipe was not quite where it needed to be and maybe, just maybe, go to the lengths of (wait for it) – pulling out an additional wipe (or two, or three). Now my experience has been that sometimes those wipes are not what I would call particularly well-endowed in the moisture department. And the use instructions for these products usually indicate that you should use as many wipes as it takes to ensure that the surface to be disinfected stays wet long enough for disinfection to occur.
I’ve always been a pretty big fan of the slowly-becoming-less common sense, so I’m not quite sure how we’ll be dealing with this one – thoughts, anyone?
A couple of weeks ago, a client was asking me about who should be performing the weekly checks of eyewash stations. A clinical surveyor consultant had given them the impression that this should be the responsibility of maintenance staff. Now, I’m not sure if this direction was framed as a “must” or a “would be a good idea,” but what I can tell you is that there is no specific regulatory guidance in any direction on this topic. I do, however, have a fairly succinct opinion on the topic—yeah, I know you’re surprised to hear that!—which I will now share with you.
Certainly we want to establish a process to ensure the checks will be done when they need to be done. I agree that maintenance folks are typically more diligent when it comes to such routine activities than clinical folks often are. However, from an end-user education standpoint, I think it is way more valuable for the folks who may have to use the device in the area to actually practice its operation. If they do have a splash exposure, they would have a moderately increased familiarity with the location, proper operation, etc., of the device. Ideally, the eyewash will never have to be used because all our engineering controls and PPE will prevent that splash (strictly speaking, the eyewash is a last resort for when all our other safeguards have failed or otherwise broken down.
I’m also a believer (not quite like Neil Diamond, maybe more like Smashmouth) that providing for the safety of an organization is a shared responsibility. Sure, we have folks who call ourselves safety professionals help guide the way. But real safety lives at the point of care/point of service, where everyone works. So it’s only appropriate that each one of us take a piece of the action.
A few weeks ago, I was reading “the nation’s newspaper” (USA TODAY, of course,) and I noticed an article on the front page (below the fold, but definitely front page) about a chain of boutique hotels that has invested in body language training for staff in order to more efficiently identify client needs–just by looking for non-verbal cues. Now, those of you who have been following this blog for a while may remember that my formative years in healthcare were firmly planted in the environmental services realm, so I’ve had what you might call a front row seat for the transformation of certain elements of healthcare from a purely service-oriented pursuit to one that embraces the concept of hospitality.
As safety professionals (and in recognition that sometimes our roles go way past safety), we’re always on the lookout for new trends and this article struck me as, maybe, just maybe, an indication of things to come in how are patients’ expectations may evolve (the evil part of me wants to say mutate, but we’ll leave that be for the moment) based on their experiences in other hospitality/service settings (Catch phrase idea: “Putting the hospital into hospitality.” feel free to make any use of it you might). Depending on the size and complexity of your organization, any number of you folks have responsibilities for front-line staff, be it support services folks, security officers, etc., the number of customer encounters can be rather extensive. I know from my own practice that those types of encounters can be very powerful indeed when it comes to managing the overall patient experience.
So, the question I have for you this day, boys and girls, is: How do we work toward a more customer-focused hospitality sensibility without completely negating our focus on regulatory compliance (basically enforcement of the rules)? I suspect, and perhaps you can confirm or debunk, that this is going to become an increasingly delicate balancing act. Can we still hold the ideals of safety while enhancing the patient experience? What say you, good readers?
This is a public service announcement—with guitars! (Okay, maybe not guitars) or perhaps this will work:
Money well spent…imagine that.
Every once in a while I like to share stuff that folks are developing in other areas of concerns/disciplines, and I think this one is a peach. In fact, I think it’s so useful, I’m just going to thank my good friend and colleague Marge McFarlane for sharing this with me, which helps me to share with you, and then shut the heck up:
The American College of Emergency Physicians is proud to announce the release of its newest training, Hospital Evacuation: Principles and Practices. The training can be found here.
We hope that you take the time to view the course and pass the information along. A description of the course can be found below:
“Healthcare facilities must be ready to tackle anything that comes their way. In times of disaster, natural or technological, they must remain open, operational, and continue carrying out their functions. When the situation escalates to a level that endangers the health and/or safety of the facilities patents, staff, and visitors, evacuation of the endangered areas is necessary. Safety and continuity of care among evacuees during a disaster depend on planning, preparedness, and mitigation activities performed before the event occurs. At the completion of the course, hospitals and other healthcare providers with inpatient or resident beds will have basic training and tools to develop an evacuation plan. This one-hour course will take the participant through the stages of preparing for a facility evacuation. It begins by performing an assessment of possible vulnerabilities and the resources available to a facility. Next, the course walks the learner through the development of a functional plan for a healthcare facility, and identification of key personnel positions implemented when a facility evacuates and the roles and responsibilities of each. The course concludes by addressing recovery issues, both plan development and operational.”
Good stuff, and I encourage each one of you with anything more than a passing interest in such things to check it out.
Dipping into the mailbag once again, I recall a conversation I had with a client who was, with increasing frequency running in to the “everybody is so busy that they are being careless” situation. At that point, the folks around the table would nod their heads and the discussion would come to a screeching halt. Now the characterization of this (please excuse use of the congressional vernacular) filibuster was “counterproductive,” a characterization with which I could not agree more. So in thinking about this perennial sticking point, I offer the following:
There is no doubt that everybody is really busy these days and it is just as clear that the “busyness” contributes to accidents. So it boils down to being able to move beyond the busyness excuse/defense to make a real difference in behaviors.
The fact of the matter is that everyone is really busy, and that has only increased over the last decade—we don’t have more staff, more money, more time—all we have is more to do. Clearly there is a challenge to work “smarter” but sometimes getting to that smarter level takes more time than the end results provide as benefit. So then folks tend to “hide” from anything that might be representative of a “real” change—operationally, behaviorally, etc. So the question then becomes how do we decide what can we afford to be “too busy” to do? As I noted in an earlier blog entry, just after Christmas last year, I read “What If Disney Ran Your Hospital” by Fred Lee. Now I will absolutely say that not everything in the book was of particular value in this discussion, but one point that I keep returning to is the Disney concept of a ladder representing what things are most important: an actual hierarchy, as opposed to a lot of what is common in healthcare, like pillars, which all have (more or less) equal value. The Disney ladder places safety at the top—so naturally I am a bit biased—but one of the things I’ve always noted (and not particularly liked, to be honest) about the Studer columns and Magnet pillars, etc., is that neither structure truly gives safety its due. It’s like cleanliness—if a place isn’t clean it is almost impossible to control infection, but it’s frequently something of an afterthought—and left in the capable hands of the lowest compensated folks in the mix.
So, I guess it comes back to the decision point of “this is where we are too busy to worry about: being safe, providing an appropriately clean environment, whatever issue we are dealing with in the moment. I would like to think that folks could at least agree that something is important enough to merit some attentions, so maybe the follow-up question becomes—how can we be safe, be clean, be attentive, in a way that doesn’t get in the way of other things? I’m a great believer (coming from the land of the New English) that common sense, simple approaches can bear substantial fruits, but it’s back to the forest and the trees—picking the simple path is not always so simple.
Hopefully there’s something in there that’s useful. To close on the Disney thought, at orientation, Disney employees are instructed to hold safety as the most important part of their job, regardless of their “role.” If they see something that is unsafe, the expectation is that they will act on that. If we can get everyone (or even more than half) to actually live that, I think we’ll find that a lot of the stupid stuff will resolve itself before it gets to the point of conflagration. There will always be malcontents (discontents?) in the crowd, but we need to get the rest of the folks to recognize that type of attention-seeking behavior for what it is and understand that it brings nothing to the table in terms of moving things along/ahead/forward.
Our sister blog OSHA Healthcare Advisor has a good post to read about a substantial fine to a California hospital for alleged violations to that state’s new aerosol transmissible disease standard.
California’s OSHA agency issued a $101,485 penalty against Alta Bates Summit Medical Center in Oakland stemming from concerns about a staff member’s exposure to bacterial meningitis.
Federal OSHA has indicated that it will also look into an aerosol transmissible disease regulation, which would be big news for hospitals beyond California.
A terrible shooting at Parkwest Medical Center in Knoxville, TN, on Monday — one victim and the alleged gunman are dead, two other victims are hospitalized — proves how rapidly a security incident can unfold. It’s likely the suspect shot his victims and then killed himself before police and security officers even had a chance to help.
In such cases, it seems the priority is [more]
Anyone who’s ever seen healthcare security expert Fred Roll speak knows he packs his discussions with details and examples, so we’re bound to have a lively discussion about ED violence when Roll appears at our 4th Annual Hospital Safety Center Symposium May 6-7.
Roll will look at how to better prepare the ED for workplace violence and pandemic surges. When developing this session, we thought it made sense to focus on one of the most problem-prone areas of the hospital when it comes to security concerns, so attendees will walk away with specific ideas to bring back to their EDs.
You still have plenty of time to join us live in Las Vegas for the Hospital Safety Center Symposium. If eduation budgets remain tight at your facility, you can also participate virtually via a live Webcast of the event.
I encourage you to check out our full agenda and speakers for this exciting program, and whether it’s in person or on the Web, I’m looking forward to meeting many of you.