Creating a Culture of Safety, Research Paper Example

Summary of the Problem

The health care industry provides a service to clients that remedy the results of perilous acts, random misfortunes or violations of safety protocol which result in harm or injury. Throughout the process of providing health care service to the clients there are many opportunities for potential further injury or accidents to occur. In order to ensure that the safety of the patients comes first a management action plan will need to be implemented and followed to provide the upper level support for change as well as the guidance and establishment of goals and objectives for safety.

Safety must remain paramount in the healthcare organization. Patients come into the facility to improve their health and well-being and do not expect to traverse a gamete of unsafe conditions. The teams must be prepared to prevent safety issues as well as fully address the potential opportunities for safety incidents should they occur. The management action plan will address the problems, potential solutions, people involved and the strategic goals and objectives to fulfill the needs of the patients to remain safe and abate further injury or health risk while receiving treatment.

The management action plan must focus on short term objectives as well as a strategic roadmap to show a beacon on the planning horizon to ensure the path the team is following remains true to the intent and focus of safety first. The success of this management action plan falls under the purview of the management team as well as the collaborative efforts of all the different parties involved. The collaboration teams and their responsibilities will be covered later in the plan.

The main objective of the management action plan is to align the strategic intent of safety throughout the organization and the goals and objectives of the business in regard to the health and wellness of the patients. This will also define the mechanisms for prevention of safety issues as well as the reactionary responses necessary in case of a safety incident occurring at the health care facility. The management plan will integrate multiple facets of the operational entities to obtain their goals. These fall into the categories of project planning, function/operational management, innovation and ingenuity of the teams and diligence and work ethic.

Project planning is the ability to build and follow a project’s scope, schedule and cost to ensure the missions, goals and objectives are met. The functional and operational management provides the day-to-day guidance and control to the staff members’ responsibility for any interactions the patients have with the facility. The innovation and ingenuity of the teams is enhanced by leadership allowing the team members to adapt and respond to safety issues as they arise based on a structured and established response mechanism but also provides the leniency and foresight to allow a human reaction by the trained staff members. And as all good action plans the team must have a strong work ethic to be able to identify potential safety issues and address them promptly while also providing top notch healthcare to the patients.

Within the scope of the current business operations plan and the financial resource limitation faced by all healthcare providers the management action plan will provide the insight and guidance to provide a best practices framework to mitigate the risks associated with running a healthcare facility. The risks will be mitigated by driving out non-standard responses to safety issues, providing the opportunities for communication both up and down the chain of command and allowing ideas and process improvement ideas to be submitted and responded to by leadership.

Area of Opportunity

Throughout the review of current practices and research of the safety plan in place there are multiple areas for improvement based on improving current practices and establishing standard operating procedures for identifying a potential area for a safety issue or concern, responding to a safety violation or hazard and implementing a post-incident reporting procedure. The current practices treat each safety violation in a reactionary response. To further complicate an already arduous procedure, each safety violation or incident is handled without guidance or protocol.

For example, when a water pipe leaks into the hallway from the janitorial room a safety issue arises due to the floor becoming slippery in a heavily traveled area. Patients utilize the hallway to go from one area of the hospital to the other. Under current situations when a an employee of the healthcare facility finds the safety issue there is not a current protocol template or procedure to follow that provides the member with the guidance and steps to mitigate the issue, report it to the correct parties and mitigate potential risk to the clients due to a totally preventable offense from occurring.

It is important to establish a standard to for reporting and acting on safety issues presently so that no further preventable safety concerns or issues will occur in the future. With each day that passes there are numerous safety concerns occurring throughout the healthcare facility and industry. Preventing the problems now eliminates the hazards and ramifications of patients or visitors hurting themselves and requiring further medical treatment.

Another reason for implementing the action plan for safety now rather than at a future date is not only the physical and mental safety of the visitors and patients but also mitigates the financial burden of the healthcare facility by removing the potential for litigation and payments due to negligence or lack of safety in their facility. By placing the safety of the patients and visitors first and building a framework around the safety and business objectives this allows all members of the healthcare facility to have the tools and methods to do their job in a safe and structured format. This allows the business to provide the quality healthcare they promise in a safe and secure environment while negating the potential and costly impacts of a safety issue.

If this does not occur now the safety issues will occur and patients will fall prey to the looming safety issues that are posed throughout the facility. Patients and visitors will get hurt which will require further medical treatment taking time and efforts away from other triaged patients awaiting healthcare. The time spent by the healthcare provides fumbling through non-standard work processes to remedy the situation will degrade the quality of work afforded to the clients. Also, with pain and suffering caused by the hospital’s negligence comes financial responsibility of the hospital to compensate the impacted party for the injuries or mental anguished afforded by the safety violation’s occurrence. The consequences of not implementing a proper framework for safety violation reporting, mitigation and remediation includes but is not limited to financial responsibility, decreased quality of work and employee efforts diverted from the primary objectives of the business.

In order to create a successful safety program and eliminate the potential for mishaps in health care institutions there needs to be a cultural acceptance of the initiative. Creating a culture of adoption for new techniques and new processes will help facilitate the adoption of change. Leadership has the ultimate responsibility for creating the environment for a health care policy that upholds a high standard of safety performance and performance. Thousands of medical errors have the opportunity to occur every day and the policy for proactive measures and standardized procedures to quickly and efficiently mitigate medical errors rely on the culture and environment developed by leadership. It is paramount that leadership addresses the problems at their root in order to eliminate the potential for safety concerns. If the culture of safety is not developed and implemented by leadership, consistent and repeated errors will occur resulting in exponential tragedy and loss incurred by the patients and staff. The unnecessary harm could be prevented if safety was given the attention and focus needed and precautionary measures were valued as opposed to reactionary Band-Aid actions.

The solution to creating a safety conscience environment is to raise safety concerns whenever possible and promote safety in daily activities until it is fully integrated into the everyday work of the faculty. Without the focus necessary to create a safety conscience work environment, safety will never become part of the culture and successful implementation of the safety program will not occur.

Goals and Objectives

In order to get where we are going there must be clear and definitive goals and objectives. By setting measurable goals and objectives this allows the resources of the business to be allocated and assigned to address specific areas of concern within the business. Safety goals are sometimes too vague and do not provide the definitive structure or driving force to achieve change in an organization. A couple examples of this type of goal would be “to comply with all safety rules” or “provide a safe work environment”. The goals are vague and are not measurable unless they are all or nothing. They either do or do not meet the objective. The purpose of providing an avenue of distinct goals and objectives is to establish a baseline on the safety objectives and from the data gathered implement future project’s based on continual improvement.

The goal of the safety management action plan is to improvement safety throughout the organization by implementing continuous process improvement projects based on measurable metrics in the areas of process control and post-implementation reports and lessons learned. The metrics in which the goals are measured in the following areas: Total Injuries, Injuries resulting from negligence, injuries in areas without standard operating procedures, injuries in areas with standard operating procedures, injuries to visitors, injuries to clients, injuries to staff, safety issues reported, safety issues reported after incident, safety issues reported before incident, who the safety issue was reported by and actions taken in all safety issues. In conjunction with all of the metric based reporting listed above there will also be reporting based on areas of concern for safety issues and whether or not standard operating procedures are written and communicated throughout the organization.

The outcome of the management action plan implementation will result in safety concerns to come to the forefront of management’s issues list as well as metrics and statistics on areas of concern so that management can allocate resources and effort to alleviate or mitigate the largest areas first to achieve the greatest return on investment possible and knock out the low hanging fruit and big hits.

The assessment of the management action plan will be measured through a burn down chart showing the outstanding issues, resolved issues and timeline remaining to mitigate all outstanding issues. This will allow a visual by all members with vested concern in solving the problem to see and understand where the issues remain while also ensuring complacency does not take hold and put the safety projects on standby or a hiatus from management’s view.

Constraints are present with any project and each area of the project should be compared to the constraints. The areas of scope, cost and schedule come into play and each play upon each other in different fashions. Within the management action plan there are certain objectives that leadership wants the organization to achieve. Within these objectives, management wants them to be achieved by a certain point in time. Within these objectives, with their foreseen scope and potential timeframe, there is a cost associated with doing the work to meet the time and scope concerns. If the scope grows larger so does the cost and timeline. If the timeline is shortened cost can increase or the scope can decrease to meet certain objectives. It is like a triangle with each point representing cost, schedule and scope. As one point moves there is a correlation between the other two. All of these three constraints encapsulate quality of a project. The quality of safety and the ability to ensure a safe environment are imperative to the overall success of the safety management action plan.

The primary objective of the management action plan is to establish the means for management to provide the operational guidance to the men and women on the front lines of the healthcare business to mitigate safety issues and promote proactive thinking in safety. It is also imperative to focus the resources necessary within the timeframe needed to provide the safest environment possible given the limited resources of the business. The most realistic constraints on implementing the management action plan rests in the limited resources of time and money. The business must take away key resources from current projects or sustainment efforts in order to ensure the successful implementation of the plan. The constraints on time must be addressed by leadership to ensure the correct prioritization is placed on the safety projects resulting from the management plan. With management’s backing and support the operational and tactical implementation will have the traction needed to be implemented. The same type of management support is needed to carve out the appropriate funds necessary for the projects. The projects will require an initial investment as well as possibly a sustainment fund to maintain success.

Idea Generation and Actions

The scope of safety extends to every person that steps foot into healthcare facility. The end state of the management plan is a safe and secure environment to provide healthcare opportunities for the patients without causing undue and extraneous stress or injury. The end state has a definitive and measurable goal based on metrics and measurements of safety and demographics but how the objectives are achieved are still under consideration. The best way to garner support and buy-in from the operational level to leadership formulating the strategic vision of the company is to have them all involved in developing the plan, formulating the ideas and implementing the execution plan on their ideas. Brainstorming and putting together ideas to solve complex problems allows the team members to be part of the solution and instills a sense of ownership and pride in the efforts. The voice of the customer is necessary in understanding their needs and opportunities for improvement. Since the goal of the management action plan is to address the high impact items and then implement continual service improvement projects to continually improve and instill safety into every aspect of the organization.

Before the brainstorming session begins we need to target the audience to garner the feedback. There are different perspectives from different roles and responsibilities held in the organization as well as the voice of the patients and visitors on what is perceived and realized in the realm of safety. The problems in safety exist because we see safety violations, accidents and other mishaps occurring due to the preventable or negligence of the facility or the residents of the facility.

Finding the root cause of the issues will eliminate the redundant and wasteful tendencies of projects aimed at firefighting issues. Firefighting eliminates the results of problems and never really dives into why the results are occurring. By focusing in on the root cause of the problem the scarce resources available for the project are utilized in the best possible manner for the long term results instead of short term mediation. Performing a root-cause analysis is predicated by the operational belief that fixing the problems, behaviors, actions or the lack thereof is the best way to utilize limited resources. In order to discover the areas that need projects to increase the safety a brainstorming session among organizational and client stakeholders a brainstorming session to gather ideas needs to occur.

To address the safety concerns we need to understand the perspectives of the stakeholders. The patients need to have a safe and clean area prior to and after the treatment. They also expect to have standard operating procedures for each task and service provided by the physicians and staff. Reducing the opportunities for a safety issue allows patients to alleviate the issue prior to a negative experience. Leadership wants the overall operation to run smooth with little or no investment into products or services that do not return a profit to the business. The positive benefits of safety projects do not specifically return an inflow of revenue but the negative implications could be devastating to the business as a whole. Leadership must understand the full ramifications of safety issues and the benefits far outweigh the cost to run the projects. The agenda for leadership is to target the high risk areas with the least amount of cost associated with them.

Physicians and nurses as well as other staff running the healthcare facility also must focus on safety but their time and effort associated with projects not directly associated the care of patients is taking away from their primary job function. The projects that would fall under the preference of the physicians would include those with the least time commitment so they can focus on patients.

Through the brainstorming process multiple areas of safety are brought up by each department. The areas of safety concerns were populated together and resulted in the different areas of Patient safety, Worker Safety, Prevention and Service Improvement. The ideas were establishing standard operating procedures for operating, patient in-processing and triage, and out-processing patients. As the project list is drawn together from ideas around each department they must be prioritized.

Prioritization
The list of actions that need to occur with each area in need of improvement will require the initial as-is process to be documented. This will establish the baseline needed for the team to come up with the areas in the process that could benefit from the focus of resources in order to result in a safer and repeatable process for all members of the healthcare facility to follow.

The steps for each one of the projects for improved safety include:

• Develop the Foundation and Scope Definition
• Define Key Stakeholders and Customers
• Develop the Process Map
• Estimate the Schedule and Cost
• Apply process improvement techniques such as Six Sigma or Lean Management
• Measure with metrics and create control systems
• Review, test and rework for continual process improvement

The prioritized list includes those that have the highest rates of safety issues. The standard operating procedures for client coming into the healthcare facility have the most frequent areas of safety concerns based mostly on the unfamiliarity of the clients to the processes and layout of the facility. The least concern but still on the radar for improvement is the out-processing of the clients after they receive treatment.

Management Action Plan

Develop the Foundation and Scope Definition

1. Define the problem

1. Who is impacted
2. Who is Accountable
3. Who owns the problem
4. Depth of Problem
5. Breadth of Problem
6. Impact Analysis

1. a) What departments are impacted
2. Define the Scope

1. Where does the solution end
2. When are the requirements finalized
3. Voice the scope to leadership
4. Where does the problem begin
5. What solutions are involved
6. What areas of responsibility are involved

III. Define Key Stakeholders and Customers

1. Responsible
2. Accountable
3. Consulted
4. Informed

1. a) Voice of the Customer
2. Develop the Process Map
3. a) Develop High level process

b)Focus on the area of concern

• Develop detail process maps
• Develop inputs
• Develop outputs
• Document key interaction points between systems and departments

1. Estimate the Schedule and Cost

1. Estimate the time to complete

1. a) Schedule for each stage in the project lifecycle
2. Estimate the cost associated with each portion of the project
3. a) Detailed Cost estimate for each function
4. Apply process improvement techniques such as Six Sigma or Lean Management

1. Develop 6 sigma methodology
2. Apply concepts through process improvement

1. Measure with metrics and create control systems

1. Develop key metrics
2. Develop ways to ensure accountability

VII. Review, test and rework for continual process improvement

1. Process improvement requires accountability and rework
2. Review the changes after implementation
3. Define success and review key metrics

VIII. Post-Implementation Review

1. Review project for success
2. Review lessons learned
3. Document successes and failures for future projects

Accountability

For each step in the continual process improvement project there must be a single focal point for accountability within a department or assigned to a specific individual. The assignment of accountability ensures that a devoted party in the organization has the overall responsibility and control over the success and implementation of the project. For each step there is assigned department or individual along with other areas that need to be responsible for actions on the step, accountable for the implementation, consulted on the process or informed of the progress. This project encompasses the development of the standard operating procedures for the in-processing of patients into the healthcare facility.

Develop the Foundation and Scope Definition

The accountable function for the project foundation and scope definition is the functional organization that will implement the project. This area would own the entire process and own the implementation as well as the key deliverables and metrics that will measure the success of the project. The accountable party would be the staff leadership of the reception area.

Define Key Stakeholders and Customers

Defining the key stakeholders and customers also falls under the purview of the same team that is implementing the project. The basis for the project relies not only the scope definition but also the key stakeholders and the customers because the project will benefit the parties by either providing a more safe healthcare environment or it will mitigate potential financial risks. The accountable party would be the staff leadership of the reception area.

Develop the Process Map

The organization that was selected to implement the project has ownership of the development of the process map. The process map should be designed and implemented by the subject matter experts which in this case are staff leadership of the reception area.

Estimate the Schedule and Cost

Cost estimates need to be done by experienced professionals and the financial management team where the expertise lies. The inputs into the process would be obtained throughout the organization but the final cost/benefit analysis and cost of the project is the responsibility of the finance team. The project management office is responsible for the schedule and maintaining the project management methodologies throughout the process.

Apply process improvement techniques such as Six Sigma or Lean Management

The implementation of the lean management and six sigma methodology would fall under the project management office where the methodology expertise resides. The accountable organization is the PMO manager.

Measure with metrics and create control systems

The actual measurement of the metrics could be held by the organization that implements the project or a non-partisan entity within the organization. The metrics team management is accountable for the proper collection and representation of the metrics needed by leadership to make informed business decisions.

Review, test and rework for continual process improvement

The project management office leadership is responsible for monitoring and controlling the project as well as identifying potential future projects for continual process improvement to enhance the opportunities for safety.

Conclusion
The management action plan establishes the baseline functionality of the project as well as the key areas to initially focus on to improve safety. The key function of the action plan is to set forth an opportunity to identify areas for improvement and implement projects that enhance the organization, in this case for safety reasons. To understand and measure success the measurement of improvements will need to occur continuously as well as relying on the PMO to monitor and control the implemented projects to negate remission of any gains and positive changes made.

Project management methodology, continual service improvement, monitoring and controlling the project and addressing the root causes of the safety concerns in the healthcare facility will ensure success and provide the framework for future projects for continued success.

References

Highsmith, J. A., & Highsmith, J. (2010). Agile project management, creating innovative products. Addison-Wesley Professional.

Monk, E., & Wagner, B. (2009). Concepts in enterprise resource planning. (3 ed.). Boston, MA: Course Technology Cengage Learning.

Prencipe, A., Davies, A., & Hobday, M. (2007). The business of systems integration. Oxford University Press, USA.

Project Management Institute. (2008). A guide to the project management body of knowledge. Project Management Inst.