101 - Building a Culture of Situational Awareness and Safety Across Hospital Clinical Operations

Health Care Problem
The delivery of safe, efficient and reliable care is directly dependent on the culture, systems, structures and leadership across all levels of the organization. Hospital leaders with the help of external consultants from Healthcare Performance Improvement (HPI) noted that leadership of both nursing and hospital-wide morning huddles focused on speed rather than quality of information and prioritization of safety and quality issues. Another finding was that local-unit huddles varied in duration, content and participation. Lastly, the institutional huddle had focused more on non-clinical operations, rather than identifying and escalating clinical concerns.These findings outlined above stressed the need to improve standardized identification and communication around patients at risk for clinical deterioration, which would provide enhanced Situational Awareness (SA) and proactive, anticipatory local planning/guidance for these patients. These improved systems would provide a heightened level of awareness hospital-wide. We also integrated a restructured approach to situational awareness and high reliability behaviors

Educational Strategy
Our team developed and implemented two sets of Physician/ Nursing Leadership dyads: Physician Operations Lead/ Nursing Operations Lead (POL and NOL) and Physician Supervisor for Patient Flow/ Nursing Supervisor for Patient Flow (PSPF and NSPF) in order to coordinate patient allocation to staff/location resources and ensure that operational, quality, and safety issues are identified and addressed. The team revitalized institutional huddles and implemented Situational Awareness category definitions within the EMR to incorporate a systemic approach for identifying patients at risk for clinical deterioration. More than 20 PDSA cycles were carried out to restructure and formalize the Main Hospital Operations Briefing in order to promote the spread of situational awareness, including but not limited to assigned seating with place cards, scripting for report-outs, representation of support services and staff recognition.

Patient-Level Outcome(s) Measured
Despite the marked increase in the frequency of days spent over 94% daily peak occupancy at the Main Hospital over the last fiscal year, 90% of the 36 leaders polled in a recent Hospital Safety Strategy session overwhelmingly agreed that Situational Awareness has improved and allows them to do their jobs in a better, safer, and more efficient manner. This data supports the benefits of unit-based huddles and other established methods that not only connect individual clinicians to their teams, but also local units to the broader organization. Our model, which strives for the ideal of a high reliability health system, has been exceptionally advantageous during High Census and Flu Season. These systems have served to create lines of sight that improve individual and institutional ability to anticipate risk, mitigate that risk and break through silos. Potential next steps include enforcing compliance with Unit Huddle occurrence within suggested parameters and a clear assessment of utilization for the Watcher tab in Epic SA module.

Eric W. Branning

Enterprise Improvement Advisor, Office of Safety and Medical Operations
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania

Eric W. Branning is currently an Enterprise Improvement Advisor. He has 4 years of healthcare experience which includes change management, internal healthcare consulting, process re-engineering, quality improvement, and systems implementation. Eric is Lean Six Sigma Green Belt certified and a MBA candidate at Temple University's Fox School of Business in Philadelphia, PA. He has a BA and MA from Rutgers, the State University of New Jersey in Psychology.

Edward J. Hopkins is currently an Enterprise Improvement Analyst II. He has 4 years of healthcare experience which includes change management, internal healthcare consulting, process re-engineering, quality improvement, and systems implementation. Ed is Lean Six Sigma Green Belt certified from Rutgers, the State University of New Jersey. He has a BS in Biology from Muhlenberg College in Allentown, PA.

Edward J. Hopkins

Enterprise Improvement Analyst II, Office of Safety and Medicial Operations
Children's Hopsital of Philadelphia

Edward J. Hopkins is currently an Enterprise Improvement Analyst II. He has 4 years of healthcare experience which includes change management, internal healthcare consulting, process re-engineering, quality improvement, and systems implementation. Ed is Lean Six Sigma Green Belt certified from Rutgers, the State University of New Jersey. He has a BS in Biology from Muhlenberg College in Allentown, PA.