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Model piloted at Wellmont facility
Penny Romeo, RN, CPHQ, quality coordinator for Wellmont Holston Valley Medical Center in Kingsport, TN, may have as good an idea as anyone about the prospects for the Safest Hospital Alliance — after all, for the last six months she has been installing the model at her facility.
The structure involves groups of leaders called safety mentors and quality facilitators, as well as transactional assistants, or TA's, all of whom Romeo oversees. "You can't separate safety from quality," she explains.
When safety problems are noted they are 'called out,' the TA's responsibility is to see the condition is made safe for the patient immediately. The safety mentors, all RNs, conduct a root cause analysis. They identify problems that cross several department lines — "macro" performance improvement initiatives, if you will. "They get bundled over to the quality facilitators," Romeo says. At present there are six safety monitors, two (non-clinical) transactional assistants and four nurse facilitators.
How are the problems first identified? The safety mentors and TAs, Romeo explains, are involved with all the areas of the hospital, clinical and non-clinical. "We all do 'work-arounds' every day," notes Romeo. "The first issue is to identify this as a problem."
"Say, for example, Tylenol cannot be found in Mrs. Jones' drawer," suggests Anthony Oliva, DO, chief medical officer of Wellmont Health System. "Instead of just working around the problem, we call it out, and see if someone can determine the root cause. We have someone get the Tylenol, but then we ask why it wasn't there and how we could prevent that in the future. Nurses, the pharmacy, the techs, and so forth, work in an immediate time frame."
"These problems are prioritized by the quality facilitators," adds Romeo. "After they begin to solve the problems by getting to the root cause, they then go to the manager and the front-line workers to come up with a solution."
The facilitators, she notes, are discouraged from coming up with the solution themselves because they do not know the process. "They help implement the solution, and then monitor the results," she says.
This model will be used at all the hospitals in the alliance. "I have learned so much," says Romeo. "We are just constantly looking to see where we are on the learning curve. We started by setting competencies for the safety staff, followed by training — both one on one and in the classroom."
The safety staff has "uncovered things that we at the management end would not have known about had they not been here," Romeo says. One simple example involved order entry. "We found out about a simple thing like the unit secretary putting in an order for a swallowing study, but the order not going to the appropriate place," she shares. "It was called out as a problem by the speech therapist; the order was going to radiology and then to the therapist. We fixed our computer system, so now the order goes directly to the therapist."
Currently, she says, all the safety mentors and leaders and transactional assistants from each Wellmont hospital spend time at Holston every week to train together "to make sure we are standardizing our approach," says Romeo. Oliva is coordinating with the other systems.
That sharing will be facilitated by the installment of a web-based program that will allow all staff at every hospital to get information in real-time. "We will share problems across the system as they occur; every manager will know what problems in their area have already been resolved and/or are still problems," Romeo explains. "Everyone in the organization needs to learn how to recognize a problem and solve it."
There are two reasons Romeo is convinced this approach will be successful. "For one thing, it's real-time, so you are not just looking at things retrospectively," she says. "Then, as problems are resolved, staff members who called them out see we really helped fix these things, and that makes a real difference in how they feel about safety."
[For more information, contact:
Penny Romeo, RN, CPHQ, Quality Coordinator, Wellmont Holston Valley Medical Center, Kingsport, TN. Phone: (423) 224-5268.