On Point: Safe Spaces

For surgical facility leaders, safety is everything. You meet rigorous quality and care standards, practice evidence-based medicine, use cutting-edge technology and adhere to meticulous, comprehensive checklists to ensure patients who walk through your doors leave without incident, injury or complication. Of course, protecting patients is only one part of the equation. You must also take care of your staff so they're available to care for patients. Otherwise, you're ultimately compromising the safety of both staff and their patients. "Workload intensity, working conditions, disruptive behavior and increased stress caused by burnout all contribute to unsafe working conditions and errors," says Michael Kost, DNP, CRNA, CHSE, FAAN, director of healthcare simulation at Einstein Healthcare Network in Philadelphia.

Organizations that embody a true culture of safety encourage everyone to speak up if they have a concern. "Leadership must embrace an environment of open and honest communication, so staff don't fear repercussions for reporting an event," says Barbara Pelletreau, RN, MPH, senior vice president of patient safety at CommonSpirit Health in San Francisco. "All safety-first organizations adhere to rigorous protocols and safeguards because it's the right thing to do."

Encouraging staff to sound the alarm at the first sign that something's amiss is what all safety-centered organizations have in common. "We want our frontline team members to be very comfortable raising concerns to leadership," says Lisa Clark Pickett, MD, FACS, chief medical officer at Duke University Hospital in Durham, N.C. "We don't want staff who speak up to be seen as troublemakers — we want to thank them for raising a concern so we can address it."

Once a concern has been raised, the real work begins. "Facilities need a mechanism to solve safety problems, not just put a Band-Aid on the problem," says Dr. Pickett. "You need to get to the root cause to prevent the problem from happening again."

In fact, Duke recently did just that — following a near-miss of a wrong medication administration that occurred when a staff member confused two similar-looking drugs. As soon as the issue was detected and raised, a pediatric pharmacist went on the offensive. "She's an excellent problem-solver; she got right to the root of the problem within 24 hours," says Dr. Pickett. The pharmacist understood the flow of medication administration and created a strategy to make sure the lookalike medications were labeled differently, and that every staff member was alerted and educated about the situation. Then, she created an audit mechanism to make sure the medications were stored in designated locations and shared the new process with the entire health system to ensure a near-miss did not happen again.

You're under more pressure than ever to keep patients and staff safe thanks to the COVID-19 pandemic that brought the healthcare industry to its knees and temporarily sidelined elective surgery. While many focus on the negatives — the expanded safety protocols an already stretched-thin staff is expected to follow, the fear that's causing patients to delay or cancel outpatient procedures — some safety experts see a silver lining that will improve staff and patient safety moving forward.

"The pandemic forced us to communicate better and learn to be more agile," says Dr. Pickett. "Proposed changes that used to take months for us to discuss had to be acted on in a day or two." Stressful? Absolutely. However, COVID-19 forced Duke to make decisions and move in a way that was significantly faster than it did in the past, which is improving the safety of the entire organization and allowing staff to share best practices in real time, adds Dr. Pickett.

"All safety-first organizations adhere to rigorous protocols and safeguards."
— Barbara Pelletreau, RN, MPH

Still, it's crucial for leaders to acknowledge the impact pandemic-based changes and increased pressure have had on their staff. "The psychological impact of a crisis stays with us long after the immediate crisis, so we're focused on helping our caregivers seek the care they may need and removing barriers that might discourage them from reaching out or seeking help," says Ms. Pelletreau.

To that end, CommonSpirit Health launched a virtual leadership program in mid-June. While the organization has always sought to support the well-being of its staff, this program focused specifically on the effects of COVID-19. "The goal of this program is to help physician leaders address their colleagues' stress and anxiety in working through the pandemic," says Ms. Pelletreau.

Dr. Kost, who also serves as the director of the Frank J. Tornetta School of Anesthesia at Einstein Medical Center Montgomery, says the pandemic has showcased the true value of simulation training — programs that can be conducted in settings ranging from acute care hospitals to free-standing ambulatory surgery centers — to bolster safety. "Simulation programs provided organizations with the opportunity to finalize technical procedures specific to COVID-19, and adapt new protocols as they evolved and the pandemic unfolded," he says. This should carry over to other facets of patient safety.

Ultimately, facilities that create and maintain safe spaces for patients and staff have a collaborative, team-based culture where all disciplines and service lines play critical roles. "Embracing a culture of safety includes promoting psychological safety, accountability, teamwork, communication skills and healthcare leadership that advocates for a hierarchical challenge, which encourages the respectful practice of challenging others if patient safety is compromised," says Dr. Kost. Encourage your entire staff to challenge one another to protect their patients ? ? ?— and themselves. OSM