Southlake Academic Family Health Team’s “Doing It Better” Rounds A DFCM Learning Collaborative Congress: February 09, 2018

Patient Safety Leadership Team Dr. David Makary, Quality Improvement Director, Family Medicine Residency Program Dr. Gurpreet Mand, FMTU Faculty Dr. Monica Nijhawan, Site Director, Family Medicine Residency Program J.C. Kirk, Executive Director, Southlake Academic Family Health Team Identify that this team was “voluntold” as they were seen as important to achieving the leadership element from the IHI Framework Highlight the original titles when the group was formed Highlight, we hope this team will change and grow over time, however, goal was to have a team in place that was large enough to help facilitate success, but small enough to achieve deliverables in the first year of this initiative.

Our Beginning SAFHT collected and reviewed patient safety incidents arising from our FHT employed administrative staff and IHP Reviewed/actioned upon by SAFHT’s executive director and medical director While efforts had been made to ensure this was conducted within a safe and just culture, we recognized that a team approach was missing if the goal of patient safety improvement was to truly be disseminated across the entire organization.

Initial Goals Learn from other Academic Sites. Of special thanks: Sunnybrook Academic Family Health Team Toronto Western Family Health Team Build a sustainable project Recognize capacity limitations of leadership team and our organization Integrate patient safety into the culture of the organization, including our physicians and residents Use our main site (academic site) as the initiator Achieve an observable improvement in patient safety

Framework of our “Doing it Better” Rounds Developed a communication strategy and rounds documentation (Excel Tracker and Power Point Template) Goal: 1 hour rounds, 3 times per year All sites invited, participation facilitated by webinar links Guiding Principles: Safe and Just Culture Consistency and Fairness Team Approach Confidentiality Identify, this allowed us to focus on the following IHI framework elements: Psychological safety Teamwork and Communication Continuous Learning Improvement and Measurement (to some degree)

First “Doing it Better” Rounds September 2017 Case identified and presented by the leadership team Case included administrative staff, IHP, residents and physicians Rounds attended by academic site physicians, residents, IHP and administrative staff (employed by FHT) Successfully introduced rounds concept and completed: Case review Root cause analysis in small groups Identification of mitigation strategies

Results of First Rounds Successes: Participation from all teams (physicians, residents, IHP, admin) Completed in one hour Following the rounds, collaboratively developed a interim solution and a subsequent permanent solution to address the root causes identified Lessons: Barriers for webinar participation Communication strategy had missed some individuals Lack of participation from satellite sites No feedback on rounds or tracking for statistical analysis Success: Collaboration included the patient safety leadership team, admin and nursing leaders and consultation with IHP, physicians and admin. Highlight, that the case had been identified as a high likelihood of recurrence and severe impact if it reoccurred, so while not perfect, our interim solution mitigated the risks and we developed a more complex process to handle the issue if it were to arise again. Lessons: Webinar – include unable to hear discussion or see items written on white board Communication Startegy

2nd “Doing it Better” Rounds Strategies implemented to improve: Pre-rounds communication Offsite participation Feedback Reviewed past case – 93% of participants reported being “Very Aware” or “Somewhat Aware” of the permanent solution implemented Case put forward and presented by one of our residents 78% of participants indicated these rounds are “Very Important” to improving patient safety within SAFHT Include picture from 2nd rounds Highlight, that we struggled with what to include on the post Rounds survey (Improvement and Measurement element of IHI Framework).

Future Direction Continue Rounds Cases Identification Participation Increase participation Expand the Patient Safety Leadership Team Expand the scope to include a review all patient safety incidents in the organization Integration of “Doing it Better” Rounds with the Southlake Regional Health Centre Ensuring cases continue to be put forward, especially by physicians indicates our difficulty with psychological safety, accountability and teamwork on the IHI framework. If we ever wanted to pursue bullet 4, this would be a significant cultural shift, especially for non-FHT employees. Overcoming psychological safety and accountability on the IHI framework would be a challenge.