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CPSI Share                                                    
6/10/2019 7:00 AM

Alex Munter is the President and CEO of the Children’s Hospital of Eastern Ontario (CHEO). CHEO has implemented Safety First, an organizational commitment to reduce harm for children, youth and staff – including medical staff – with a goal of zero serious safety events.

What can you tell us about CHEO’s goal of zero harm?

About three years ago, we introduced the Safety First program at CHEO and decided on a goal of zero serious safety incidents. As we talked about outcomes that matter for families, what better outcome could matter than preventing harm? We signed up with a collaborative, Solutions for Patient Safety, that started in Ohio with five children’s hospitals there. The collaborative has spread across the United States and internationally. CHEO was the first Canadian paediatric hospital to join the collaborative. This collective of children’s hospitals is dedicated to the goal of zero harm and tracks the metric of “zero safety events”. When there is a gap between performance and generally accepted performance standards, and there is harm to patients, that’s called a serious safety event.

This past year, we went 348 days without a serious safety event. That was a first for our organization. It tells us that we can get to 365 days and go a full year without a serious safety event.

How is CHEO using zero harm to instill a culture of patient safety?

At CHEO, we track patient harm and harm to staff and physicians. We don’t make a distinction between patient safety and occupational health and safety. If you want to create a culture of safety, that means preventing harm to everyone – to patients, visitors, volunteers, and staff, and to physicians as well. Our rallying cry is safety first and our target is zero serious safety events.

We use lean methodologies to drive quality improvement and safety throughout the organization. It is how we identify and resolve issues, and ultimately make care better. Last year, our CHEO Works program resulted in 2,385 improvements. That’s one improvement every four or five hours for 365 days a year. The improvements are not all safety related, but relate to either added value for the patient or increasing the efficiency of operations. All the improvements are based on the ethic that you are the experts on the work and on the people who do the work.

When I do an employee orientation session, I always tell folks that they have two jobs at CHEO. The first is whatever we hired you to do. The second is to improve whatever it is we hired you to do because you’ll know where things could be better on your unit, with your team, and in your work.

Our lean methodologies are the vehicle by which people identify improvement opportunities and carry them through. When you put improvement culture and safety culture together, you get the basic ingredients of a high-reliability organization – preoccupation with failure, looking for opportunities to

improve, recognizing the expertise resides in the staff clinicians doing the work, and empowering them to be able to make things better. That’s how it all comes together.

Looking at the three pillars of enabling, enacting and learning, how has CHEO implemented the Patient Safety Culture Bundle?

Safety can’t be directed from the Boardroom: it can only be empowered and supported from the Boardroom. We have lots of activities to really reinforce patient safety in all kinds of ways.

We require all of our executives to spend time on the front line every month. We take turns chairing a Daily Brief, a virtual teleconference huddle of organizational leaders that happens 365 days a year. We take 15 minutes at the start of the day going through and identifying any risk to quality, safety and operations. This situational awareness of recent, ongoing or anticipated events that impact the quality of our patient care and the safety of our patients, staff and organization allows us to quickly establish leadership priority, alignment and accountability for resolving issues.

In terms of learning activities, we celebrate big safety catches, and do a lot of brown bag lunch sessions with 30-minute presentations from subject matter experts. We do Safety First Friday sessions to reinforce the message and provide tools to empower folks to be an agent for the Safety First agenda. We are building capacity and providing training in Lean methodologies with Yellow and White belt certifications. In June we will launch training throughout the organization around error prevention. It’s about skills to optimize safety behaviours, but more importantly it is also about effective communication.

If you look at the Patient Safety Culture Bundle, there is no silver bullet. It illustrates that there’s not a switch to flick and it’s not just one thing to do. It really requires a concerted effort across the organization and a mobilization of our people.

What advice would you offer to others when it comes to advancing patient safety?

Put safety first. When it comes to patient safety, the work is never done. There is always so much more to do. I always want us to go faster and further, but realize that slow and steady wins the race. We talk about safety every single day during a safety brief. We talk about how many days it has been since the last serious safety event. You can start to see safety seeping into every conversation. Once you inject patient safety into your staff culture, it is prevalent in every conversation and it changes the conversation about other topics as well.

Where can we learn more about Safety First? 

Visit our Safety First webpage at