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About lzipperer

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    Patient safety and knowledge sharing entrepreneur that helps experts "get things done!"
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    Zipperer Project Management
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  1. Content Article
    The COVID-19 pandemic is creating an updraft to do something. Clinical, political, geographical, humanitarian, economical and logistical forces present recognisable pressures that either inspire or dissuade action ... but not for all. Innovators are energised when they see an urgent need to dismantle the status quo. They are well equipped to capitalise on the momentum generated by emergent situations to respond in a way that is collaborative, effective and safe. It is from this whirlwind that the April Letter from America is penned. Innovators can be challenging to be around. They see the world differently and can ruffle feathers with ideas that don’t stay on the well-trodden path. But when there is no normalcy, free thinking presents opportunities, necessitates unique partnerships and motivates organisational willingness to recalibrate. It is the responsibility of leaders and peers to appropriately harness this energy to make the most of opportunities that innovators present as they directly interface with patients. The willingness to innovate to address the COVID-19 pandemic is inspiring. An impressive range of solutions have been devised to meet equipment and care service access challenges. Social media is a robust and widely accessible mechanism to stimulate conversations about these ideas. #MacGyverCare is one of several Twitter streams devoted to sharing unconventional solutions. MacGyver, hub members may know, is an American TV character known to improvise to get things done in difficult circumstances. Similar to the hub's own Coronavirus Share your Tips page, people are using #MacGyverCare for sharing ideas and innovative solutions to help those on the frontline manage the demands of the crisis. Examples include creative solutions to the personal protective equipment shortage across the country. While acting to devise a new “as needed” approach may not be something everyone working directly with patients can do, there are other avenues for supporting clinicians to help them provide safe care and find comfort, resilience and even joy in that commitment. People are coming together to ‘MacGyver’ with peers during the pandemic. For example, unique partnerships with libraries are cropping up provide access to the literature, open WiFi hotspots to provide children access to school programmes and even to produce PPE. Is that a MacGyverism? At Columbia University in New York, a Research and Learning Technologies librarian partnered with a cardiology fellow to modify a freely available pattern to create face shields. Using 3D printer skills, assembly line know-how and teamwork they brought together a team to produce and distribute the equipment to staff at New York Presbyterian Hospitals. The Columbia University library shared their process to spread the innovation and encourage the wide use of their concept. At an organisational level, agile information sharing is the bedrock of crisis management. Flexible, enterprise-wide and individualised communication strategies must be in place to respond to rapidly changing circumstances and keep those touched by the situation healthy and safe. The Johns Hopkins University in Baltimore are using peer support and crisis communication strategies to promote institutional resilience. Leadership commitment to resilience, information sharing to reduce anxiety and support network development all buttress system efforts to assure its workforce and community remain safe and healthy both during and after a crisis. The Hopkins process brings the skills of employee assistance, chaplaincy, workplace wellness and psychiatry to the fore in a multidisciplinary team-based approach to assure staff are well situated to provide safe care while staying safe themselves. In light of the shift of resources to patients with COVID-19, delivery of services to patients with non-COVID-19 conditions must also be redesigned. The University of Wisconsin has used an administrative restructuring approach, building on military and emergency management experiences to make adjustments in surgery workforce and expertise availability to address complex shifts in care processes in response to the COVID-19 pandemic. Adjustments were made to synchronise work cycles to assure clinical expertise was reliably available, develop a single clinical pool to staff from rather than coordinating assignments based on speciality or educational level, and form strike teams to engage highly experienced clinicians as needed. These tactics invigorated information transfer, provided role clarity as situations changed and strengthened process sustainability. Team leaders anchored their work by remaining focused on a declared mission and guiding principles to support that mission. While the uptake of new knowledge and science into healthcare practice is often shrouded under the oft-stated “17-year lag” , it is obvious through these and other examples that care innovations can be recognised, applied and improved upon quickly. Granted, it is important for innovators and the organisations they engage with to seek the advice and council of experts from the human factors, process improvement and safety domains to ensure their new ideas are developed and flow into daily work in the safest way possible. However, after this current crisis, let one of the lessons we learn from the COVID-19 pandemic be to make patient safety progress more rapidly through the use of innovative thinking, partnerships and organisation ingenuity.
  2. Content Article Comment
    An important source and concept for us to consider in these trying times.
  3. Content Article Comment
    Richard -- Congrats on your success in these challenging times. I hope to see more of your story on the hub!
  4. Content Article Comment
    Here is a link to the bias webinar I mention in the March webinar: https://register.gotowebinar.com/recording/5627630769960041484 you should be able to get at it just by filling out the form.
  5. Content Article
    Each year in March, Patient Safety Awareness Week (PSAW) serves as a spark for increasing safety. Initiated in 2002, the concept of PSAW was formed by New York State-based founder of the Pulse Center for Patient Safety Education and Advocacy, Ilene Corina. In 2003, Ilene then collaborated with the Society to Improve Diagnosis in Medicine founder Dr. Mark L. Graber and the National Patient Safety Foundation to establish the annual event. PSAW triggers the sharing of resources and experiences to initiate partnerships that propel patient safety work forward. Many in the field take advantage of the opportunity to build awareness of their inventiveness and motivate collective action toward enhancing patient safety. PSAW uses a wide range of communication methods to create energy and rejuvenate effort through the sharing of lessons learned and common goals. Buttons, posters, in-house newsletter articles, blogs, webinars, employee recognition awards, and poster presentations are all used to increase awareness. Earlier this month, The Institute for Healthcare Improvement (IHI) partnered with the Agency for Healthcare Research and Quality (AHRQ) to host a Twitter chat that surveyed the experiences of participants on transitions, challenges and successes. Programmes highlighted during the discussion include the bundled handoff method I-PASS developed by a team at Boston Children's Hospital and Harvard Medical School to enhance team communication. Twitter chat participants noted the importance of being able to adapt transitions tool to their environments. I-PASS leaders noted efforts to develop local champions to assist with the application of the bundle for use in the variety of situations patients and providers encounter throughout the care journey. The California Patient Safety Organization (CHPSO) hosted five free webinars during PSAW on a range of topics. One webinar focused on mitigating unconscious influences, or cognitive biases, that degrade relationships, decision making and care delivery. The speaker, Michelle van Ryn, President and Founder of the Institute for Equity & Inclusion Science, highlighted specific tactics, tools and educational programming to combat unconscious biases generated by gender and racial differences. She reviewed organisational conditions that facilitate biased interaction such as unsafe psychological culture and overwork. Dr van Ryn discussed valuable skill development tactics for increasing an individual’s management of their potential for implicit bias that focused on mindfulness, empathy, inclusion and partnership-building behaviours. Another high point of the week was the release of AHRQ’s Making Health Care Safer III report. This publication summarises the current evidence base on 47 patient safety practices targeting 17 areas of concern. For example, the chapter on sepsis discusses the evidence on manual or electronic screening tools for sepsis. The authors discuss the performance of currently used methods to determine patient susceptibility to sepsis to help ensure timely treatment initiation. While they concluded more evidence is required to determine outcome measures associated with screening methods, the authors shared links to examples of robust tools currently being used in US hospitals. Another focuses on infections due to multi-drug resistant organisms. One distinct practice review discusses hand hygiene, of particular relevance due to the COVID-19 outbreak. The authors discuss the persistent weakness in hand-hygiene practice due to workload, lack of education and easily accessible supplies. The World Health Organization’s My Five Moments for Hand Hygiene programme is highlighted in this evidence covered as an important approach for implementing hand hygiene completeness into frontline care. Thirdly, patient and family engagement is covered as a patient safety practice relevant across the spectrum of care delivery. The authors discuss difficulties in tracking the evidence on engagement as a distinct element of patient safety. They highlight several studies on the topic and share resources to encourage adoption of activities that encourage patient involvement in their care. hub members should refer to the search strategies in the report (included as an appendix in each chapter) designed to review each discussed best practice. Leaders can use these vetted search strategies to keep current on the emerging evidence related to the initiatives they are implementing in their own organisations, targeting the specific challenges they are confronting in their own improvement work. Connecting with experts and recognising their contribution to change can motivate action. By providing stimuli, Patient Safety Awareness Week re-energises those on the front-line of safety. It facilitates expert conversation, knowledge sharing and evidence identification to keep our patient safety efforts and our patient safety leaders moving forward.
  6. Content Article Comment
    This post reminded me of John Nance's book "Why Hospitals Should Fly: The Ultimate Flight Plan to Patient Safety and Quality Care". Worth a read in its entirely -- but here is a nice excerpt. https://abcnews.go.com/GMA/Books/story?id=7319785&page=1
  7. Content Article
    The US observance of ’Groundhog Day‘ is more than just the annual emergence of Punxsutawney Phil – the rodent soothsayer who ceremoniously predicts the timing of the arrival of Spring. It is the name of a popular film that represents how the repetition of unwanted experiences can contribute to scepticism, callousness and burnout for the primary character – weatherman Phil. However, he emerges from the darkness by applying what he learns over time to arrive at a new brighter day. Patient safety leaders are apt to feel like weatherman Phil. Repetitiveness – the feeling that something been done over and over again without change – can decrease engagement but it can also lead to experiential knowledge that can be applied to future efforts. Community engagement is paramount to patient safety success but it can be challenging if people feel like they wake to the same problem every day despite efforts to make a difference. The Boston-based Betsy Lehman Center has developed Including the Patient Voice: A Guide to Engaging the Public in Programmes and Policy Development. The Guide shares a six-element approach to involving members of the public as partners to reduce reoccurrence of poor care. Strategies focus on enabling community members to succeed as partners and contribute as experts to designing health services that are evidence based and accessible to all. This includes leadership-led mini-workshops for staff to inform their engagement programmes and patient correspondence reviews to identify the right consumers to invite as participants. Similarly lessons have been shared by MedStar Health, a large regional healthcare system that sought to engage patients and design strategies that engage patients and families in safety improvement. Organisational structures such as Patient and Family Advisory Councils (PFAC) served as the focal point of the shared learning effort. The system developed a network of courses that shared best practices to foster innovation and sustain realised improvements in event reporting, disclosure (the CANDOR Toolkit), after-incident support and sepsis reduction. The tactics used include board and leadership activation activities, a mentorship programme for new community leaders and public awareness campaigns. For example, the system launched a collaborative to share information to improve early detection of sepsis. Patients who had contracted sepsis along with PFAC members and in-house quality experts were brought together to design an educational video to reduce sepsis that highlighted symptom identification and response. The programme contributed to marked sepsis treatment improvement. The City of Philadelphia recently launched a prescription monitoring strategy to curtail the overprescribing of opioids in their region. Because this programme identifies by name the 10% of physician that overprescribe, these individuals can be offered targeted training and, if necessary, legal interventions to address their behaviour. Home-grown programmes can also be proactive to prevent overprescribing. One Boston-based family medicine clinic described their five-year change management effort to reduce opioid overuse. The authors reported their focus on developing “shared general principles”; communication mechanisms to connect clinicians with in-house addiction experts, patient registries, targeted training, certification opportunities and centralised leadership were all instrumental in embedding improved prescribing practices throughout the organisation. Consistent unremitting workload pressure perpetuates stress and fatigue. Its presence degrades staff relations, performance and the safety of care delivery. It’s a common problem that medical residents are burnt out: no news there. What conveys great promise are programmes like what the Virginia Mason Medical Center in Kirkland Washington has done to address burnout by implementing workflow changes and fostering a culture of “collegiality, respect and innovation”. The Center changed workflow by standardising clinical tasks, defining staff roles and carving out protected time for staff to recharge, self-educate and participate in improvement efforts. The Center has enhanced its culture and improved staff morale through leadership efforts to lower hierarchy, welcome and respond to feedback, and address inefficiencies that can discourage staff and derail efforts. Ninety percent of staff at Kirkland reported in a 2018 internal survey feeling content and engaged about their work. Medical residents can also find support through programmes like the ACGME Aware initiative. This set of tools targets strategies that junior doctors can use to build resilience and embrace their professional community through a mobile phone app to find support as they need it. Personal tactics to protect against burnout for more experienced healthcare professionals are also in demand. A news story in Medical Economics highlights what doctors and hospital administrators can do to minimise burnout, such as making time to socialise with peers and using the opportunity to share stories, rethinking their roles to bring joy back to medicine, and to listen. For 2020, Phil has told us that Spring is due to arrive early. Will the application of the successes reviewed in this month’s Letter reduce the recurrence of opioid overprescribing and staff burntout? We need more than a rodent to speculate on that for us. But given efforts by patient safety champions in the US and UK, improvements optimism is in the air.