Humber River Hospital (HRH) serves a dynamic community in Northwest Toronto and houses the busiest emergency department in Ontario with an average of 390 visits per day. HRH is North America's first digital hospital, and is LEED Gold certified.
Under the leadership of President and CEO Barbara Collins, HRH leverages information, communication, and automated technologies to deliver highly reliable and quality care. The journey to becoming a high reliability hospital provided us, as co-chairs of the Corporate Patient and Family Advisory Committee, the opportunity to reflect on the presence of safety in our systems/process. HRH's approach to safety behaviours for error prevention is directly related to understanding how human factors can be embedded into hospital operations both from a provider and patient/family perspective.
Hall and Kari Versace, with Pepper)
Our learnings to date suggest that integrating patients and families into the design of safety systems is critical to fostering resilience. For example, HRH established Reinventing Patient Care Councils: unit-driven quality committees which include patients and families as frontline owners. This model creates investment between patients/families and hospital staff, focusing attention on diverse perspectives as well as mindfulness for safety. By co-creating "human-based" safety systems together, we are able to drive experience and empower the true end-users of healthcare: patients and families.
To better understand and improve the experience of patients and families, HRH's Maternal Child and Surgical Programs piloted a program to enhance positive experiences for paediatric patients going to the operating room (OR). Older children can use an electric-powered toy Tesla car to drive into the OR with their parent. While, younger children can choose to ride in a wheelchair, wagon, or on a toy, accompanied by their parent.
The Tesla was used with 375 paediatric surgical patients during the pilot. In a structured assessment conducted by Certified Child Life Specialists, the use of the Tesla reduced the patient's anxiety and stress, increased coping, and enhanced positive experiences on the way to the OR.
In another pilot study, a humanoid robot named Pepper was used to support coping, cooperation and resilience of paediatric patients in the operating room. The healthcare team used Pepper to normalize the hospital experience and make it fun; prepare and practice opportunities for induction; and role play with hospital equipment for comfort and familiarity. Pepper was used with 515 paediatric surgical patients and 115 times in the operating room during the pilot. It was found that the humanoid increased coping and enhanced the patient experience.
As the province of Ontario continually experiences increases in demand for hospital beds, HRH has implemented a Quality Command Centre that hardwires the presence of safety through anticipation and preparedness. The Quality Command Centre provides real-time situational awareness, supporting discussions, and keeping us mindful of safety.
This multi-phase improvement project aims to support current operational pressures and predictively identify safety triggers. Baseline measures illustrated an average of 387 daily emergency department visits, an average of 99 per cent medical bed occupancy, and 16.4 hours – the time to receive an inpatient bed from the emergency department (ED).
The HRH Quality Command Centre opened its doors in November 2017, and has completed Phase 1 of the project, focused on utilization. The results have reduced the ED to inpatient bed-ready transfer time by 15 per cent; reduced operating room holds by 30 per cent; and increased capacity by approximately 23 beds, for a cost savings of $6.5 million per year. The second phase, now in progress, is focused on quality and safety. The third phase, targeting home monitoring, will go live in 2019.
Our journey to high reliability also suggests that patients and families/support networks in themselves are effective emerging forms of disruptive innovation for healthcare. Thus, the investment in genuine collaboration with our patients, families, and ultimately our community is critical to foster resilience. In our experience, their integration into our service design and planning goes beyond creating just a role. Through total integration, we continuously nudge the presence and mindfulness for safety via human factors into our daily operations.
Kari Versace is the Co-Chair of Humber River Hospital's (HRH) Corporate Patient and Family Advisory Committee and a Leadership and Coaching Specialist with Bombardier. Trevor Hall is the Co-Chair of HRH's Corporate and Patient Family Advisory Committee, the Director of Quality and Patient Safety and is the co-lead, with University of Victoria's Elizabeth Borycki, of the Canadian Patient Safety Institute's Human Factors in Healthcare Network.