by Bryan D. Bohman
A SAFE Outlet for Docs
Does that ring a bell for you? It certainly does for me. I have said or thought something along those lines many times during my own career at SHC. And over the past few years, I’ve frequently heard from colleagues who have long-standing concerns or suggestions but are unsure where to go with them. There’s no doubt that our clinicians are really good at identifying problems and suggesting, or at least hypothesizing, solutions. But then what?
Sometimes it’s possible to devise a fix right then and there, but unfortunately that’s the rare exception. More often it requires figuring out who “owns” the process in question, getting that manager to recognize the problem (and a potential solution), and then hoping that somehow the solution will promptly materialize. Unfortunately, the success rate is low, busy managers sometimes can see those who make suggestions as complainers, and it doesn’t take too many fruitless attempts before a busy, sane physician decides to just keep her thoughts to herself.
Is this any way to run a hospital? Is this any way to promote engagement, pride of ownership, and safety culture in our Medical Staff? Surely not, and that’s why many of us have been working toward an alternative, which we’re excited to finally be ready to implement. The Stanford Alert For Events (SAFE) reporting system is designed to provide a quick and easy way for physicians to report patient safety incidents and concerns. But not just safety issues; if you have an idea or suggestion about how SHC can do anything better, SAFE is a way to be heard.
By collecting physicians’ reports and suggestions and getting them to the managers responsible for the processes at issue, SAFE can help bridge the gap between the hands-on, in-the-trenches knowledge of our clinicians and the management expertise of our administrators. This combination is invariably essential to design, implement and sustain real improvements in our complex care processes.
SAFE will replace the PSN (Patient Safety Net) incident reporting system and is not aimed solely at physicians; it will also be used extensively by our nursing colleagues. You may be familiar with the PSN, but then again, maybe not, because out of 8,241 total PSN reports in 2010, only 74 came from our medical staff! Those numbers illustrate a couple of major problems common to incident reporting systems generally: (1) too many reports; and (2) not enough from physicians.
Too many reports? With over 8,000 a year, it can be really hard to see the forest for the trees. A tremendous amount of resources are expended to investigate and respond to so many incidents, yet it’s quite a challenge to detect — let alone rectify — systems problems when dealing with a large seemingly random series of one-off events. The SAFE system addresses that challenge by enabling us to categorize and manipulate our reporting data in a way that helps to identify patterns.
Too few reports from doctors? The current system represents a real barrier for physicians. It can take 10 to 15 minutes to make a report, and the reporting algorithm is not set up for making suggestions or reporting concerns that aren’t linked to a specific patient care incident. SAFE, in contrast, is “doc-friendly” in a way that solves both those problems:
Physicians may access the system and complete a SAFE report in just a few minutes in three ways depending on personal preference:
First, via Hot Line, (650) 497-8788, or 7-8788 from a hospital phone. You may call that number at any time to leave a message specifying your concern or suggestion.
Most importantly, our input will be taken seriously. Far from being labeled as chronic complainers, SAFE users will be thanked for our reports and suggestions. We will be contacted (if contact information is given) in a timely manner and told what is being done with the information provided. Obviously not every suggestion can be acted on, but each will at a minimum be considered by someone in a position to intelligently evaluate it.
In addition, the quality department personnel who manage SAFE will be aggregating and collating input, from physicians and others to help root out systems issues, prioritize quality improvement initiatives, and generally improve the efficiency and responsiveness of our clinical operations at SHC. They will be guided by the Quality Steering Committee and will report back periodically to the entire Medical Staff on the fruits of this activity.
SAFE is not intended to replace other methods of addressing safety and operational concerns. Clearly it is not a one-size-fits-all solution. Performance improvement initiatives initiated independently of incident reports will of course continue. In fact, many of our increasingly engaged physicians are already involved in such projects.
And let’s be clear that we do not wish to discourage local solutions to local challenges. Filing a SAFE report should not be seen as an alternative to a conversation with the appropriate unit manager, for example. But if it’s not clear who is responsible for a particular concern, or if that manager seems unresponsive, or if the problem might be considered a general rather than a strictly local issue, SAFE is an appropriate avenue.
SAFE should not be used as a way to avoid direct collegial conversations about interpersonal issues with coworkers and/or local managers. But it is an important alternative if, for whatever reason, one is otherwise unable to address unprofessional or disruptive behavior in a colleague.
On the other hand, please do use SAFE as an alternative to repetitive negative comments to colleagues. The teamwork so essential to optimal patient care suffers greatly whenever our colleagues are denigrated, subjected to public criticism, or are the target of “venting” about problems they may not be in a position to solve. It’s far better to discuss your concern with a manager or yell at the answering machine on the SAFE hotline. A SAFE report, unlike a sarcastic comment, might actually lead to a solution — and won’t expose you to criticism for disruptive behavior of your own.
Recent survey results reveal that we have a serious challenge in establishing a high level culture of safety at SHC. SAFE is potentially an extremely valuable tool in responding to that challenge. With wide use, it can help us improve safety, quality and effectiveness, promote clinician engagement and improve the clinical quality of life for our Medical Staff. But of course it won’t do anything of the sort if we don’t take advantage of it. Please make a mental note right now to use SAFE the next time you have a safety concern or operational suggestion that fits its purpose.
