Vital Signs: A Podcast for Sentara Providers

Patient Safety Series - Episode 2 - Joel Bundy, MD, Shannon Sayles, MS, MA, Kathy McCoy, MBA, BSN, RN-BC

• Physician Education • Season 2 • Episode 2

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Speaker 1:

You are listening to vital signs, a podcast for Centera providers. Welcome to episode two of the patients safety series. In today's episode, we are joined by Dr. Joel Bundy, chief quality and safety officer, along with Shannon sales and Kathy McCoy system directors for safety and performance excellence. Before we turn things over to the team, let's go over some important CME announcements. This episode has been accredited for AMA PRA category one credit for detailed accreditation designation and disclosure information. Please visit the show notes. This information can also be found on our website www.sentara.com forward slash physician education, as well as reaching out to us via email@physicianeducationatsentara.com. Now here's Dr. Bundy.

Speaker 2:

Hello everybody. This is toll Bundy again. I hope you're doing well. Um, I'm Dr. Joel Bundy. I'm the chief quality and safety officer for Sentara healthcare. And today we wanted to talk more about patient safety. Um, and there's very specific part of that, that, um, our team has noticed has been, um, at the, at the root of some of the problems that we have seen in the healthcare system. And, and one of the, share those with you and sort of add some tools to that as well, so that people understand a little bit more about it. You know, patient safety is, um, is the Keystone of a lot of what we do in healthcare. And I do believe that when we peel the onion on safety events, we often find that communication is at the, um, the bottom of it and specifically a lack of effective communication. And when we think about it more, a lot of times it's about the fact that we did not escalate concern. Somebody knew something was going on and they didn't escalate it. And there's a lot of reasons for that. So we want to have a conversation about that today. Uh, I am very, very fortunate to have with us on the podcast today, two experts in the system. These are our, uh, Sentara safety directors, uh, Kathy McCoy and Shannon sales. And I just wanted them to introduce themselves so that you can hear from them. Uh, Kathy, if you would say hello to everybody,

Speaker 3:

Hello, this is Kathy. So I've been in safety and reliability at Sentara for the past 10 years and have a nursing background.

Speaker 2:

Thank you. And Shannon sales,

Speaker 4:

Everybody. It is nice to be here and join you and talk about a really important subject Kathy's partner in safety recently returned to Centerra back in December for the last 12 years, I've been working as a consultant in safety and reliability, and I'm delighted to be back here and spend time with you.

Speaker 2:

Thank you both. And I would say, um, oftentimes when we're looking at safety events, these two that are on the podcast with me today, they actually help us to solve for problems and come up with solutions, uh, working with, uh, divisional teams and other people out there. So it's truly a team effort and, um, uh, tickled pink to be able to talk to them today. So, you know, getting back to communication and we know that it's a common failure in many safety that's why do you think, why do you think that poor communication or ineffective communication continues to be an issue for us? Not just in Sentara, but, uh, across the healthcare industry.

Speaker 3:

Yeah, this is Kathy and you're exactly correct. When we do look at the safety events that we do have at Sentara, many of them involve escalation or lack of escalation. The employee does have a question about a patient's condition, and maybe we'll not escalate that concern at all, or they will escalate it, but not necessarily receive the answer that they needed to hear, but that escalation then stops. So what we really need to do is encourage the staff to continue asking those questions until they received the answer that they're comfortable with, or that they, they feel is correct to help fix that unsafe condition. Employees may feel like they do not have the power to speak up. And this could be employees who felt like they were in more of a subordinate role. So if a newer employee has a concerning and maybe has to go to it to a physician and a physician will give them an answer, maybe it's not the complete answer that they need to reverse that condition, but they may not continue to question that physician because they've already received an answer.

Speaker 2:

Yeah. That's, that's absolutely spot on, you know, Shannon that made me think of, you know, we often talk about how our gradient and authority gradient, um, could you sort of add a little bit to that? What, what Kathy was saying about those gradients?

Speaker 4:

Yeah, I think that's true because, you know, I think people want to communicate effectively with each other part of the communication failures we have, or sometimes we're just not clear with each other, but as Kathy, so rightly pointed out when we need to speak up or have something that doesn't make sense to us, we've got up say something to somebody, but very often that person could be an authority figure to us. It could be someone that, that is literally our boss. It could be someone that we report to. It could be someone that, that we feel so, so they're in this line of authority, if you will, but there's another element of why difficult to speak up. And that's something called power, distance, power, distance, isn't just authority levels. It's also the perception that someone's got more power than me. The power could be their knowledge, their education. It could be, I'm just a nursing care partner. I'm just a housekeeper something doesn't look right to me. And I'm not going to say something to the nurse, or it could be the nurse who thinks, I don't know this, physician's worked here, you know, and she's the chairman of the department, but something's not right here. And I just don't feel like I can speak up about that. And so, as we're shaping this more effective culture and encouraging and allowing and expecting people to speak up and say, something's not right, I need to share something or you're not doing what I think is the correct thing to do that. We create this environment, this culture that it's okay to speak up, that went. And in fact, what some organizations do is to set up kind of a mantra, if you will. That's essentially saying when it's about safety, we're all equals,

Speaker 2:

Uh, you know, that reminds me, uh, there have been several studies out there looking at perceptions of communication and that, uh, I'll speak as a physician that physicians often think that on the team that they're working in, um, that communication is much better than others on the team. So if we're looking at a physician and a nurse, both on the same team, it's not uncommon for the position to think that communication is excellent and the nurse to think, no, not really as much. And so again, I, you know, those gradients are things that we need to work through. The power distance as you described is something that we have to have to focus on. Um, and I, I think that, you know, those are the reasons why people should raise a concern, because as you said, when it comes to patient safety, um, we should never not raise a concern. And at the end of the day, we might find that that was okay. And, but we never want to feel like we wasted time because it's so, it's so important. Well, how, what kinds of things? So if I'm out there, uh, at the bedside, uh, what kinds of things should people escalate if, if they sort of run across those so they can sort of have an idea. So it's not just that conceptual concept that we're talking about today, but there's actually some pragmatic application.

Speaker 4:

Well, certainly at a minimum when you have that gut feeling that something's not right. Um, the actions people are taking or how things look, how that patient looks. So it, you know, is unsafe care, what we're actually doing or what we're doing might look right, but the patient's not responding and I'm concerned about something. Um, it's also about the conditions and the situations in which we work. We've of course experienced that a lot over the past year and a half, as we had to learn new ways of doing things with, with our experience, with, with COVID the COVID pandemic, um, and feeling like people, aren't sure that they know what to do. Um, they're asked to do something and they're uncomfortable with it, perhaps a procedure they're asked to help with, and they're just not sure, or a medication they're asked to give, and they've never given it before. And we need to be able to say, um, I'm not sure about that. Let me go check it out or let me get someone to help with that. But as we talked about earlier, it could be hard to do that because I might say that, but I don't want Dr. Bundy to think that I don't know what I'm doing. And so I'll kind of give off this feeling of, okay. Okay. But in my heart, I'm thinking, I'm not sure, Kathy, what else do you think are things?

Speaker 3:

Yes. As Shannon mentioned, the safety phrase that we use at Sentara is I have a concern. So anytime you hear someone say, I have a concern that is really our cue to stop and listen to them because they think we're getting ready to make a mistake or getting ready to, um, harm a patient, which is not what we want to do. So we really want to create that environment that makes it easy. And non-threatening for a staff member or a coworker to speak up when they feel that there is a safety concern.

Speaker 2:

I like that. Um, can you walk through a little bit more about that verbiage? I have a concern. How does that fit in with, with our safety tools and habits?

Speaker 3:

Sure. So I have a safety concern is a very non-threatening means to start a conversation, to help change an unsafe, a potentially unsafe condition. And we have a tool for that at Sentara called it's an acronym called arc, and it helps us speak up for safety. It's using the lightest touch possible. And the, a stands for ask a question, and if you receive the response that you feel were real resolve, that unsafe condition you stopped at that time, you don't have to continue with the acronym. But if you ask that question and you don't get the response that you are comfortable with you, then you would move it up a level. Now you're making a request. So the R in arc, so that you are now requesting that something changed, because this is unsafe for the patient. Again, if you get the request that, or the answer that you believe will reverse the unsafe condition, you stop. If you're still concerned, then you continue with the acronym. And now we're at the first C, which is concern. So you're voicing a concern on the issue that, or the problem that you think may happen with this patient or coworker. And then finally, if there is no success, we're using our chain of command. So we're involving someone else to help resolve this unsafe condition.

Speaker 2:

Yeah. I liked that. And I think that, um, so for people that are being escalated to, if someone on the team, if they're getting to that third question, they've asked the same thing three times in three different ways, increasing the questions. Every time we need to make sure that we stop and we really, we should on the first time, but sometimes we don't. Um, I like that, you know, if, if we just pick up Dr. Bundy, if someone brings to him and they're asking the same type of question three times, and they've got to have a concern, hopefully I would have listened to already, but if I didn't, I really need to pay attention. Um, because otherwise then it's going to be escalated to someone in leadership in the hospital, uh, or outside of the hospital. And a lot of times we can, we can solve for these and sort of deal with a lot of these, um, these concerns right there at the bedside or locally Shannon, any, anything you wanted to add to the, um, art tool?

Speaker 4:

No, I think it's a good tool. It's an escalation tool. And it's based on some experience from other industries about what they've learned over the years about you've got to speak up when things just don't seem right, or that you're concerned. In fact, as Kathy was talking, I was thinking that, you know, our examples we're talking about are appropriately, so very patient care oriented, and that's the most important thing, but it's about each other and how we're working with each other and are we keeping each other safe? So there could be other things and harm things that could go wrong could be host physical harm and emotional harm. There could be things like employees or coworkers bullying each other, or, or being afraid that, that something's not going right in, in, in kind of the actions that people are taking. And they're worried that something somebody's doing something wrong. And so what the art tool does is give you a, a logical way to not go right to the don't do that, but to kind of get to it because most people will respond to the, the, a, the ask a question, are you sure you're doing the right thing? And probably most people would go, yeah, I think, oh, no, I'm not, thank you so much for that. But if they looked, listen to you and say, yeah, I'm doing the right thing, what's your problem. And then it's like, well, I need to ask to make a request that I think you really do need to put that we'll use a PPE example. I think you really need to put the, that, that, you know, PPE on. Remember we said, we've got new rules now for how that goes. So I really need to ask you to do that. Don't worry about it. I'm not going to touch a thing. It's just not gonna happen. Um, now I'm gonna kind of get at no, this is not okay. And that's what the, the first C is, is I've like Cassie said, I have a concern that should stop people in their tracks, even if they're not wanting to do what you want, that should stop them in the tracks, but you do have your backup plan. Um, I need to go get help. I think it's a great tool.

Speaker 2:

It seems so simple. I mean, we've talked about, you know, the safety events, um, going sideways and at the heart of that is communication. We've talked about all the different things, why we should communicate better and how to escalate. We talked about the tool. Why aren't you doing this? I mean, it seems like we should be. I mean, what, what, what do you see as impediments for our teams? Uh, escalating, Kathy? Any, any thoughts on that?

Speaker 3:

Yeah, well, I think that, you know, the use of art falls under our safety habit to never leaving your wing man. And, you know, it is that T a technique to assist with our assertion and escalation. But if you don't practice it, it is difficult to use, especially for a newer employee. Um, so what I'd like to offer myself and Shannon to be available, if you would like arc training for your team, uh, we can do that. And that way we can tailor the examples to be those wins in which your, your staff bay encounter. Um, but something else you can do that to help staff be comfortable in and learn how to escalate is when you are rounding or with your, your coworkers, you know, asking them, which patient are you most concerned about today? You know, which patient may you think have a medical response team call today to help them begin to, to think about, you know, what are those sicker patients that they may need to escalate concerns or those that they feel may not have the orders that they need to be able to keep them safe? Yeah. Yeah.

Speaker 4:

I think, you know, I would add to what Kathy has said also is, is, is both the tools and, and Cathy and I can help people those tools. But the other thing that we can build into the conversation and how leaders of any type on the subject is also that foundation of, of the culture of the department or the working team, and the culture includes this sense of something that's called psychological safety. It's that feeling that I can and should speak up without fear of people thinking badly of me or getting into trouble it's trust. How do we build that, that feeling of trust? It's okay. I can say what I need to, there's been a lot of writing on that subject, and it's an important topic. And maybe perhaps it could be a subject for another podcast in more depth in the future. But I think working on psychological safety and leaders of any type can keep reinforcing that it's okay. It's important. In fact, I'll throw one more tool in the conversation. As people do speak up and say something, even if it turns out that they're stopping something, that's okay, they didn't need to stop. It's not a problem. The person that's getting stopped, whoever they are, be they a leader or someone of an authority figure said, no, it's okay. Let me tell you why it's okay. But I'm so glad you said something, because if it seems odd to you, I want you to speak up and I tell you if, if someone in authority or in, in a power position does say something to the other person, I guarantee that they're going to keep speaking up. They've now been encouraged to do the right thing.

Speaker 2:

Yeah. That, you know, thanks for bringing that up, that comes from Toyota, you know, stopping the line and, and, and the culture and, uh, those Japanese factories, um, they would celebrate people that stopped the line production sets down and, and it costs them money, but they had a concern. They stopped the line and the foreman and the other leadership would, would praise those people for doing that. I think that's where we need to get to, rather than people saying, if I escalate this and I'm wrong, will I get in trouble? We really have to work through that. So go ahead. And Kathy,

Speaker 3:

I was gonna say, uh, you know, just culture as James reason says, it's really creates that atmosphere of trust in which people are encouraged to provide even rewarded for providing safety-related information, but which they are clear about where that line must be drawn between acceptable and unacceptable behavior. And I think this, this will be another podcast also where we could go through our performance management decision tool, which is our tool that leaders can use to make sure that we are treating a or staff fairly when they are involved in a, um, unintended error or an error that, um, we would look at to make sure that we are delivering fair consequences.

Speaker 2:

Absolutely. And I'll put up a plugin for a book. If you haven't read it, you both of you maybe think about when you're talking about trust in a team, um, the five dysfunctions of a team, it's an easy book. It's a pretty short, um, but that is certainly the foundation and the bedrock of having a successful team. So I just want to say, thank you, both of you very much for a great discussion, um, talking about, um, why we need to escalate things. I think it's pretty clear, and I think a tool that we need to practice as the arc tool, let us know how we can be of service to help teach and, and emphasize these tools. And we thank you very much for your time and attention today. And, um, I'm looking forward to talking to you again in a couple of weeks. Everybody have a great day. Bye bye.

Speaker 1:

Thank you for joining us and be on the lookout for the next episode of the patient safety series with Dr. Bundy, you've been listening to Sentara health peers, vital signs, a podcast for Sentara providers. As a reminder, read today's show notes for information about claiming your continuing education credits. Well, that's it for now, but we will be back soon with another episode of vital signs, a podcast for Centera providers, the podcast that provides evidence-based education programs for physicians and healthcare providers on the go.