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Culture Change Key To Safety, Quality Improvements

Janice Simmons, for HealthLeaders Media, July 22, 2010

Medical checklists are proving to be popular items in hospitals to help promote patient safety and stop medical errors. But at many hospitals, the active ingredient to transform a simple checklist into an effective tool is often missing: an energized work culture that empowers everyone who takes care of patients to speak up.

Peter Pronovost, MD, PhD, who first brought the checklist's potential in the healthcare environment to light nearly a decade ago, is first to admit that checklists will not change anything until the current medical culture changes.

In an interview in this month's HealthLeaders, Pronovost, a professor and medical director for Johns Hopkins' Center for Innovation in Quality Patient Care in Baltimore, says many of these cultures still can "contain a certain degree of arrogance, autonomy, and even fear." To change this, everyone must "evolve to a point where everyone on a medical staff can speak up and look out for the patient," he says

One group likely to agree with Pronovost is the 20-bed pediatric intensive care unit (PICU) at the Steven and Alexandra Cohen Children?s Medical New York in New Hyde Park. Earlier this month, the PICU became the first in New York State to go an entire year without a central-line infection. Key to making that goal was getting everyone on the unit—including 90 nurses and 11 fulltime faculty members—to communicate better with each other.

"Part of what we did is we changed our culture of the way that the ICU works," says Peter Silver, MD, chief of critical care medicine at the medical center. The idea was to move individuals from their "silos"—isolated groups of physicians and nurses who maintained little communication with each other.

And, it meant moving from the often patriarchal or hierarchical type relationship where what a physicians says is absolute gospel—with very little room for communication, Silver says. "We tore down all those walls."

The PICU staff actually had some concurrent assistance from its parent company, the North Shore-Long Island Jewish Health System, which began requiring all employees to participate in TeamSTEPPS—a program from the Agency for Healthcare Research and Quality and the Defense Department designed to improve communication skills among healthcare professionals when it comes to patient safety issues.

With TeamSTEPPS, the point was emphasized that "everybody on the medical team has a voice and everybody has...an obligation to use that voice to speak up in order to what is right for the patient," Silver says.

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