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

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

3. 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 ) 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

4. 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

5. ? Version 13. Anecdotally staff report much more effective communication

6. 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?

7. 2007 – 2010 Stillbirth Data

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

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

11. Review value and purpose?

12. 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

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

15. 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

16. 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?

17. 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

18. 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

19. 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

21. 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

22. Case Study - Results

23. Changes in Question Scores between Cultural Surveys

24. 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

25. 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