Agenda

1. Implementing an Organizational Daily Check In Shirley Gibson, DNP, MSHA, RN, FACHEJen Murphy, MHA, CPPS

2. Agenda • Overview of VCU Medical Center • Daily Check In Basics • Evolutions of the Daily Check In at VCU Medical Center • Lessons Learned

3. VCU Health System 13000 Employees 1100 Licensed Beds VCU Health Epitomizes “Complex, High Risk”: • High Volume: 25,000 Surgical Cases 36,000 Inpatients 90,000 ED Patients 600,000+ Outpatients • Complex/High Risk Care: trauma/burn/transplant/etc. • AND thousands of students and trainees involved in care delivery • AND the safety net mission with the socio-economic issues that this brings A High Reliability “Seeking” Organization 5000 Learners 200+ Specialties High Reliability Organization: “An organization that has succeeded in avoiding catastrophes in an environment where adverse events can be expected due to risk factors and complexity”

4. VCU Medical Center • Academic medical center located in Richmond, Virginia • 865-licensed beds plus 40 bed NICU • Safety net hospital for Central Virginia • Only Level 1 Trauma Center in Central Virginia • Largest employer in Richmond

5. The VCUHS High Reliability Journey 2003 – 2007: Recognizing the Need to Change - Challenging the status quo - Demonstrating the ability to change • 2008 – 2012: • Transforming Culture: • Clear Vision and Goal • Led with Safety as a core value 2013 – 2016 Reliability principles to all domains of STEEEP 2017 – Becoming a High Reliability Seeking Organization • Launched Safety First Every Day • Science of safety 101 training >16,000 • Robust root cause analysis • Began tracking serious safety events • Safety Star recognitions >200 • Daily Check-in • Safety Coaches • Applying reliability principles to all domains of quality (STEEEP) • Vendor Alignment • Chief Safety Officer • Robust PI methods • Integration of learners • STAR Service • Vendor & Partner Alignment • Continue applying reliability principles to all domains of quality (STEEEP) • Increasing PI capability • Continue integration of learners • STAR Service • “War” declared on nosocomial infections • Improved CMS Core measure performance

6. Safety Vision and Goal • Safety Vision:To be America’s safest health system. • Safety Goal: • Zero events of preventable harm to • patients, team members, and visitors.

7. Daily Check In • Sunday-Saturday at 7:45am • Led by Associate Vice President for Support Services • Additional support provided by Nursing Director on Call or Administrator on Call • Hybrid roll-call format – in person and via conference call • Approximately 70+ participants. • Notes taken for follow up purposes only

8. Goals of Daily Check In • Improve leadership situational awareness • HRO principles of anticipation • Preoccupation with failure • Reluctance to simplify • Sensitivity to operations • Escalation of “sharp end” safety concerns • Identify high risk or unusual patients and/or situations • Anticipate problems and act to prevent

9. Daily Check In Basics • Consistent time of day, every day • Consistent facilitator(s) • 15 minutes or less • Look back and look ahead • Safety successes • No problem solving – establish accountable person • Key repeatable messages • Start every call with safety vision, goal, and common purpose • End every call with Days Since Last SSE

10. Look Back • Reported safety events • Including any new Serious Safety Events • Injuries to patients, team members, or visitors • Delays in assessment or treatment • Slips, trips and falls • Patient misidentifications • Unplanned downtimes/outages • Equipment (i.e. elevators, physical plant, Pyxis) • Information systems

11. Look Ahead • Census and acuity – anything unusual? • Patients with unusual conditions or needs (ex. pregnant psychiatric patient) • New procedures or equipment in the environment • New high-risk medications or drug shortages • Restraints, suicide precautions, security concerns • Issues contributing to work arounds • Testing being down/offline • Shortages • Deficiencies in equipment

12. Phase 1 – Pilot • Daily at 7:45am; appx. 6-8 participants • Led by Interim Vice President for Nursing Operations • Included Nursing Director On Call and Clinical Administrator • Report by exception Lessons Learned • Liked having set questions to ask • Difficulty getting participants to share issues • Tendency to problem solve during check in

13. Phase 2 – Educate & Evaluate • Conducted education at monthly management meeting • Provided a job aid and notepad to assist with implementation at unit/department level • Shared experiences and best practices • Conducted survey of leaders to evaluate effectiveness of Daily Check In implementation • 74% felt it had an impact on safety in their area • 84% felt it increased their awareness of safety successes

14. Phase 4 – Evolution • Addition of divisional Nurse Managers On Call • Revisions to DCI Job Aid • Expansion to include Support Services, Professional Services, and IS/IT • Added “Days Since Last SSE” • Addition of team member safety events • Change to roll call format • Moved “clean-up” areas to end of the roster • Continued to add participants as requested/appropriate • Introduction of Weekly Safety Topic

17. Lessons Learned • Be patient and persistent • Rapid cycle improvement • Daily nature of call makes it easy to make changes • Adapt, adopt, or abandon • Not all changes stuck (ex. “Fishbowl” questions) • Importance of 5:1 feedback • Lots of offline coaching initially to encourage reporting and help diminish punitive feelings • “Strive for progress, not perfection.”

18. Questions and Discussion

19. Contact Information Shirley Gibson, DNP, MSHA, RN, FACHEAssociate Vice President of Support Services VCU Health System shirley.gibson@vcuhealth.org Jenifer K. Murphy, MHA, CPPS Patient Safety Manager Department of Performance Improvement VCU Health System jenifer.murphy@vcuhealth.org