How safe are we?

(From left to right) A recent team reviewing their learning after a ward round at Middlemore: Sioupolu Tavui, Charge Nurse Manager, Ward 11 Spinal Ward, Beverley McClelland, Nurse Leader, Professional Development, Professor Maxine Power, Director, Haelo (Centre for Innovation and Improvement, Royal Salford Hospital, UK), Michele Carsons, Nurse Manager (Medicine), Renee Greaves, Patient & Whaanau Care Advisor, Martin Chadwick, Director of Allied Health, Denise Kivell, Director of Nursing.
(From left to right) A recent team reviewing their learning after a
ward round at Middlemore: Sioupolu
Tavui, Charge Nurse Manager, Ward 11 Spinal Ward,
Beverley McClelland, Nurse Leader, Professional
Development, Professor Maxine Power, Director,
Haelo (Centre for Innovation and Improvement,
Royal Salford Hospital, UK), Michele Carsons,
Nurse Manager (Medicine), Renee Greaves, Patient
& Whaanau Care Advisor, Martin Chadwick, Director
of Allied Health, Denise Kivell, Director of Nursing.

“I can tell what kind of care my daughter is going to get within 15 steps of walking on to a ward.”

Providing a safe care environment for our patients and whaanau is one of the most fundamental things all of us strive for on a daily basis. Understanding what factors affects safety, and how this shows itself in the care environment, is complex. We measure and track key safety indicators, review adverse events and identify learning which could help prevent future events. However in the busy world of healthcare we don’t always know what we don’t know. The Director of Nursing (Chair of the Patient & Whaanau centred care Board), along with the Patient Safety Team and Ko Awatea are testing a new way of understanding ‘how safe we are’ through safety walk rounds; with a difference.  I’m joined by Denise Kivell, Director of Nursing to tell us more.

A few years ago a group of patients and families were talking with staff about the care they had received. A mother in one of the groups, who often had to take her daughter on to a hospital ward, said: “I can tell what kind of care my daughter is going to get within 15 steps of walking on to a ward.” This comment sparked the development of a toolkit that supports small teams, including consumers to describe how a ward or other clinical area feels within 15 steps of the entrance. This concept is the first of three themes of our Safety Walk Rounds.  I’m sure some of you have walked into an area before and made a quick judgement about whether safety is being taken seriously? Prompts might include isolation signs being up to date, or the corridor being uncluttered for rehabilitating patients. The purpose of the 15 Steps Challenge is to help healthcare staff, patients and others work together to identify improvements that can enhance the patient’s experience by understanding their first impressions more clearly, as well as a method for creating positive improvements and communication around the quality of care.

The second theme is focused on capturing the staff experience and understanding how it feels to work on a particular ward/unit. A series of questions has been designed to get staff talking about patient safety and initiatives on their ward.  The questions include: What do you think are the biggest risks? What does safety mean to you? Do you enjoy coming to work? And one of the most enlightening questions: Would you recommend this ward/unit to care for your family member (AKA the granny test)? Each question is followed by ‘why’ to further explore some of the important points. Together these result in a great deal of information that can’t easily be measured or collected as pure data, but are absolutely invaluable to be able to answer the critical question for care providers: ‘How safe are we?’

The third and final piece of the jigsaw comes from someone who sees, hears, experiences and notices far more than we often realise: the patient. The conversation with patients follows a series of questions designed to tease out their experience, observations and comments around their stay. As with talking to staff, the “why” question is absolutely invaluable.

This approach has been tested and adapted through visits to seven inpatient wards at Middlemore Hospital to date. The team plans to roll out the approach to all inpatient areas and other care environments. Each visit is planned and communicated to the ward/unit in advance. The visiting team consists of six people, who within the space of an hour gather information on the three themes of environment, staff and patients. The visiting team changes each time, with representation from nurse directors, quality improvement, professional leads, nurse educators, patient advisors, executive directors and clinical leads.  Information is fed back to the ward with 24 hours, with key highlights for celebrating and sharing with other wards, plus opportunities for improvement that the services can work on.

Feedback from the wards to date has been great with patients and staff saying they appreciate the opportunity for frank discussion. The visiting team have enjoyed learning and appreciated the time being safeguarded for these all-important conversations.

If you would like the Safety walk rounds to come to your area, please get in touch with Jacqui Wynne-Jones at Jacqui.wynnejones@middlemore.co.nz or 021689957.

Denise and Geraint

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Author: Geraint Martin

Geraint Martin was appointed Chief Executive Officer of Counties Manukau DHB in December 2006. It is one of the largest District Health Boards in New Zealand and services a population of half a million. He has significant experience over 30 years in national policy & in managing both primary and secondary care . Previously, he was Director of Health and Social Care Strategy at the Welsh Government .He authored a radical 10 year strategy of reform, including the successful “Saving 1000 lives” Campaign.Until 2004, he was CEO at Kettering General Hospital & had held senior positions in London & Birmingham.He has worked closely with clinicians in improving clinical standards,patient safety,chronic disease management & managing acute care to reduce hospital demand.In NZ, He has promoted clinical quality and leadership as central to improving patientcare. This has led to a significant increases in productivity and access, whilst maintaining financial balance. CMH has completed in 2014 a $500 m capital redevelopment programme, the largest in New Zealand. A central part of this is the establishment of Ko Awatea,the Centre for Innovation and Research which will underpin CMH as one of the the leading health systems in Australasia.In 2008, he chaired the Ministerial Review of Emergency Care in New Zealand, and in 2013 was an member of the Expert Advisory Panel on Health Sector Performance. Geraint has an MSc in Health Policy from Birmingham University .His post-graduate work has focused on health economics and Corporate Strategy . He is adjunct Professor of Healthcare Management at AUT and Victoria University, Wellington Elected in 2006 as a Companion of the Institute of Healthcare Management, previously he was an Associate Fellow at Birmingham University.He is is Chair of the Auckland Philharmonia Orchestra, a member of the Institute of Directors, on the Board of the NZ Institute of Health Management & previously the Board of The NZ Health Quality and Safety Commission.

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