Safety Briefings as a Vehicle for Sustained Safety Improvement Martin DeBono Alison Lovatt Jackie Hallam July 2015

THE CHFT STORY Newly merged Trust. Bringing 2 teams together. Employ methods of improved communication to increase safety. 2

CHFT Maternity Driver Diagram – 2 year programme June 2009 - 2011 Process Measure Aims Interventions Outcome Measure 95% Accurate completion of AN care pathway stating appropriate lead professional. 95% Accurate measurement of obese women & SFD babies. Reduce: avoidable stillbirths & perinatal deaths avoidable neonatal harm avoidable maternal harm Improve: Culture Survey scores. Women’s perception of our services Clinical care: AN care record/customised growth chart 34wk USS for women with BMI>35 Shared care for women with H/O infertility EFM care bundle/intra partum documentation 2nd stage of labour care bundle Strategy for management of CS at full dilatation VTE risk assessment on women admitted & appropriate prophylaxis Back to basics in newborn care Making hospitals work project 30% Reduction in stillbirths & perinatal deaths 30% Reduction in avoidable term admissions to NNU Reduce blood loss >2litres by 30% Reduce Emergency LSCS at full dilatation by 30% Increase non-intervention normal births by 20% 80% or above score in Cultural Survey in all areas 95% of women’s perception scores will be 4 or 5 95% compliance with EFM and 2nd stage of labour care bundles. 1:1 care in labour in 95% cases. 95% compliance with VTE RA Communication: SBAR for transfers of level of care. Multi professional safety briefings & debriefs in: 1) theatre 2) LDRP, 3) in patient areas 95% compliance with transfer of care policy. 95% usage of SBAR for transfers 95% compliance with theatre safety measures. 95 % compliance with safety briefs & debriefs on in-patient areas.95%compliance LSCS women who have VBAC debriefing Education: Updates on alternative labour &birth positions. Improvement methodology training. Regular open invitation staff updates. Monthly MDT training 95% of all staff trained to awareness level in improvement. 75% staff uptake to updates. 95% staff attending MDT training Leadership: Programme of leadership walkrounds. Quarterly management/staff interface meetings. Effective sickness/absence/poor performance management. 80% staff have positive perception of management. Sickness/absence reduced to 3% 3

LDRP Theatre Time intensive to implement initially Consultant led Ownership Value to staff Too busy? Checklist changes Time intensive to implement. Consultant led. Checklist underwent many changes. Required ownership. Provide value to staff

? Version 13. Anecdotally staff report much more effective communication

Long term SUCCESS! Regular MDT discussion All members invited to contribute SOM of the day Checklist is working document 5 years later SUCCESS? Have we improved safety?

2007 – 2010 Stillbirth Data

Stillbirths - CHFT The number of stillbirths at Calderdale and Huddersfield Foundation Trust January – June 2014 n = 18 January to June 2015 n = 9

Clinician’s perspective Team building Extended to twice daily Clinical incident discussion ST training at safety briefing Message of the week Roles and responsibilities

Review value and purpose?

Alison Lovatt – Clinical Network Director Safety Huddles as part of a systematic approach to reducing harm and improving team culture Alison Lovatt – Clinical Network Director

Patient Safety Huddles Ali C to use her experience to explain what a safety huddle is

What is a safety huddle in Healthcare? Daily forum for staff to discuss and focus on safety Clinically led Multi-professional On time and brief (5-10 minutes) Reliable ‘what might stop us keeping our patients safe?’ Ideally followed by debrief at end of day/shift

What does a safety huddle cover? Design by frontline team members Varies in different areas Need to discuss Plan for the patients Might cover Who is at risk of falling? Who are we worried about? E.g. high NEWS Who is at risk of pressure damage? Who is planning to go home today?

The perfect recipe! Designed and agreed by frontline team Embraced by leaders Multi-professional team involvement ‘Fear free’ and inclusive A team that feel empowered Briefings are held in the spirit of learning and improvement

Safety Culture Requirements of leaders to encourage culture of safety across organisations Psychological safety No hesitation to voice concerns Organisational fairness Accountability for being capable, conscientious and not engaging in unsafe behaviour but NOT accountable for system failures A learning system Leaders hear concerns from staff and promote improvement to increase safety

Assessment of Safety Culture Displayed survey was developed by University of Texas Validated measuring tool designed to address Safety Leadership Policies and procedures Staffing Communication Reporting An intervention in itself Stimulates thought about safety issues, and staff interactions

Case Study - Setting the Scene Large Tertiary level Teaching Hospital 4 Acute medical and elderly admission wards Aims Improve ward-level patient safety culture Reduce in-patient falls Interventions Introduction of patient safety huddles Assessment of staff safety culture Weekly meetings with staff members ‘The big discussion’ Star signage for patients at risk of falls

Case Study - Results

Changes in Question Scores between Cultural Surveys

The Future Plans Staff now experienced in methods of improvement Main interventions discussed but multiple small changes resulted in large impact Continual improvement Identifying alternative goals eg. Improving efficiency of patient discharge process ‘Scaling up’ Methods in use now amongst 10 frontline teams Plans to increase to organisational level in 3 acute healthcare trusts incorporating 129 wards

The Safety Huddle intervention …. …igniting a spirit of learning Making measurement visible Addressing Teamwork and Safety Culture Celebrating success Ali C to continue to explain that the way we implement Safety Huddle is not just as a vehicle for increasing team-working and communication But also igniting a spirit of learning through (1) measurement for improvement (2) measuring and addressing safety culture and (3) celebrating success “Excellent achievement given the history of falls on this ward” Clinical Director, Calderdale & Huddersfield NHS FT