Ah – a new year. A new decade. People around the world celebrate such affairs with fireworks, noisemakers, champagne and resolutions they’ll never keep. In America, we revel with all those things and ... the ’Granddaddy of them all‘... The Rose Bowl. The Rose Bowl is an annual college football face-off between two champion teams held in Pasadena, California. The event is huge, complicated, prestigious and widely anticipated. This musing on Rose Bowl activities and how they might highlight safety concepts ‘kicks off’ my 2020 Letter from America series.
A renowned part of the franchise is the Tournament of the Roses parade. The 2020 parade theme was the ’Power of Hope‘. Volunteers, sponsors and organisations collaborate to produce a 5.5 mile spectacle involving over 40 floats, numerous marching bands and millions of flowers for viewer enjoyment. Collaboration is key to achieve medication safety too. In a recent study published in the Quality Management in Healthcare journal, a community health organisation’s successful method of frontline staff committee engagement generated process changes that culminated in reduced medication errors and increased near misses. Continuous quality improvement initiatives supported by these committees included technical handling and administration of medication, medication reconciliation, and enhancements to standardised treatment protocols.
Following the pomp and beauty of the parade comes the gridiron... the grit... the sweat... the teamwork. College teams are selected based on their performance during the year. Their individual and team competencies are what get them to Pasadena and give their fans hope for a win. Competencies are important for developing reliability no matter what field you play on. The Society to Improve Diagnosis in Medicine (SIDM) has identified key competencies that should be considered for inclusion in health professions education programmes to improve the quality and safety of diagnosis in clinical practice. They fill a noticeable gap in health professional education by embedding reasoning and partnering skill development into healthcare curricula. The SIDM approach emphasises individual, team and system level skills to hone clinician diagnostic abilities and orientation to diagnosis as a team.
In football and in healthcare, teams follow processes and plans but should be empowered to adapt when the situation calls for it. For example, TeamStepps is a US-government developed team training programme originally designed to enhance communication in acute care. A recent pilot study tested its application in mental health teams in schools to reduce staff burnout and turnover. This unique health environment adapted the TeamStepps method to improve organisational culture and provide support for the wide array of practitioners that provide care in schools. The success of the initiative improved team-based care delivery at the organisation.
Football holds for the teams, management and consumers the potential not only for spectacular performance but for mistakes that can result in injury. Fatigue and distractions can often be a factor in football injury on the pitch; so too can these factors result in injury in healthcare. The Pennsylvania Patient Safety Authority (PSA) released a 4-year analysis of newborn falls in the hospital following birth. Parental fatigue was a primary contributory factor that emerged from the investigation. The PSA describes educational tactics to help parents understand the potential risks for infant drops and encourages them to ask for nursing assistance in feeding if they feel overly tired to keep their babies safe.
Keeping track of disruptive behaviour is a relatively new effort for healthcare. Until recently, there was no way to raise a flag to indicate poor behaviour that can distract from team cohesion, coordination and communication. In a recent study, a large US health system devised a tool to evaluate disruptive behaviour among its ranks, measure its effect on teamwork, burnout and patient safety, and use that data to define improvement targets. In the sample, researchers found disruptive behaviour to exist in approximately 98% of work settings. The upside of this discouraging figure is that the tool effectively tracked disruptive behaviours so they can be addressed. There is hope for improvement – once a problem can be measured work can commence to fix it.
While not a strategy, hope motivates, as presented by Sidney Dekker in his movie: Safety Differently. Hope situates the future in possibility, instils learning from what goes array and sustains efforts to stay true to goals. Let’s keep hope alive as we work to score touchdowns for safety in 2020.