Back in December, I announced a new focus of our BIDMC SPIRIT program, one directed to solving the problem of employee injuries. I had noticed that we had hundreds of injuries per year, and it occurred to me that we might be able to reduce those using the same tools and approaches we have used so effectively elsewhere.We set up a reporting system, and we now have a post on our company intranet portal for all to see how many injuries have occurred and what the major categories are. You can see a sample above. We have also tried to adopt the root-cause problem solving methodology to the incidents.
I want to talk about one category here today because we are struggling a bit with how to solve it, and I seek the advice of others among you who may have already done so.
It's that last category above -- exposure to blood and fluids -- which you can see is a persistent problem. In theory, people should wear personal protective equipment (PPE) when there is a chance they will be exposed to blood and other bodily fluids that might fly through the air or otherwise reach them. But this often does not happen. There might be a variety of causes -- improper training, complacency, lack of proximity of equipment when needed, or even a lack of definition of when it is needed. We are currently reviewing all of these factors. If anyone out there has figured out how to ameliorate this problem in your hospital, will you please post your thoughts and suggestions?
9 comments:
As an administrative intern in a large health system I spent part of the day yesterday in the ER. I counted 4 times in 4 hours when a health care provider should have been using PPE and did not. As a former clinician and future administrator, it bothers me that people so blatantly passed up the opportunity to protect themselves when it is so easy to do. Keep up the great work Paul. I read your blog every day (most of the time not on the clock).
I think it all comes down to personal responsibility. If a health care provider knows that there is a possibility of exposure, then it is THEIR responsibility to wear PPE. I am a nurse and I know what a pain in the butt it can be to gown/glove/face mask (if needed), but it is for our safety. Like Nike says, just do it.
In process improvement and mistake proofing a system, it is key to make the right way, the easiest way. Not putting on PPE is still easier than putting it on. The question is how do you make it easier to do the right thing than to not do the right thing.
Telling employees they need to “just do it” has been tried, tested and has failed over and over again. If “just do it” worked, every hospital in the country would not have a problem with hand washing.
From afar, it appears to me, a major cause of the continuing problem is that the people who do the work have not signed on to the goal of achieving an incident free work place. If they had signed on, they would have, through observation and analysis, agreed when people should wear PPE, they would have solved the problem of PPE availability and they would be reminding each other to use the PPE. In a high performance organization, once a systems design has been agreed, individuals do not have the option of non compliance,
but in order to hold to this standard, everyone first needs to own the goal of an incident free work place. Once the work mates own the goal they will align their own behavior and that of the organization. Neither you nor others in the hierarchy will have to be the enforcer.
If I were you, based on what you have said in your blog, I would assemble the five individuals who were involved in the last five incidents and ask them to discuss how to proceed. They may not know it but they have the answer if they agree with the goal.
When I worked at a defense nuclear facility, PPE was a major concern. Don't forget that PPE has to be comfortable and, if worn all day, it helps it it's reasonably attractive (think safety glasses and shoes).
I come at this issue from the research lab setting but I think it crosses over all disciplines within the hospital, whether it be research, clinical, support staff, etc as the issue is the same (compliance with PPE use), just the situation and the particular PPE are different.
Paul O'Neill above really gets to the heart of the issue... you need 'buy in', which means allowing your staff to take ownership. The most important place to get this 'buy in' is at the mid-level manager, shift supervisor, team leader level. People with some authority and experience, but still getting their hands dirty, need to be the leaders both by listening to and implementing suggestions but more importantly by example. More than that, everyone needs to know that this is a focus and push for the institution for which public posting of data (as you are doing) really helps.
I also found that division level, team level meetings every so often can really hammer things home when examples of what it looks like when people do not take precautions are included (tailored to the group), from a health/well-being standpoint complete with pictures (a real attention getter), and then from a financial standpoint of what incidents cost the hospital and the things you'd rather be spending the money on.
The hardest thing to overcome is the sentiment: "I don't have time and because I know what I'm doing, I'll be careful and it'll be fine".
Good luck, keep us posted.
As an aside, a local tv outlet recently did a story (I'll use that term loosely) concerning doctor coats, scrubs, etc being worn outside of the hospital by personnel. I must say, that's one of my top 5 pet peeve safety issues. Has BIDMC done anything pertaining to this issue?
I know accessibility of PPE can make a big difference. I remember working in a hospital with large plexiglass "boxes" (for lack of a better word) mounted on the walls outside of every third room. The boxes held cover gowns, 3 sizes of gloves, and goggles. Gloves were also available in the patient rooms, but we were never more than a few steps away from a gown or goggles if needed.
In high risk areas-the ER, OR, etc... I would suggest finding a way to provide all direct caregivers with their own eye protection. They can wear it around their necks, making it readily available, and perhaps they can have fun with it--much like those who work in radiology often have personalized lead garments.
This issue, like many others in the hospital, requires a significant amount of management time to address a lack of compliance. I agree with many others that the "just do it" approach is much better in theory than in practice. My recommendation would be to "just do it or be subject to the progressive disciplinary process included in our HR policy". Granted, this saying is not as concise as the Nike one but I would hope it would encourage compliance. In my experience, I see such a variation in policy enforcement in hospitals that it is difficult to determine which policies the hosptial feels are important vs. which ones are optional. As a consultant, I realize that all hospitals say that all their policies are important but I can tell which ones they really think are important by their enforcement levels. Inconsistent application of policies leads to confusion and overall non-compliance. Take a week and strictly enforce the PPE policies of the hosptial without exception and the staff will realize that you are serious and compliance will hopefully increase. Next up --- drinks on the nursing stations and physician legibility.
The NY Dept of Health has an interesting chart for PPE in the pre-hospital environment, that seems to fit the hospital environment just as well.
http://www.health.state.ny.us/nysdoh/ems/policy/88-22.htm
Dan
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