Physician education is constantly changing to keep pace with the changes in health care. Indeed, while residencies (post-medical school training) used to focus solely on direct patient care, working as part of an interprofessional team and understanding how the complexities of hospital systems can cause errors are now core competencies. To help residents and other health care providers view their work through a safety lens, a new initiative is taking place on many of HUP’s patient care units, teaching them to “find the potential for failure before harm reaches the patient,” said Neil Fishman, MD, chief medical officer for HUP.
The initiative is part of a Patient Safety Collaborative led by the Accreditation Council for Graduate Medical Education. HUP is one of nine hospitals chosen to participate. Across the hospital, an important component of the initiative is the “Patient Safety Huddle.” Its goals are not only to help residents better understand the importance of their role in HUP’s culture of safety, but also to establish an environment throughout the hospital in which they and others feel psychologically safe to voice concerns. “We want to integrate house staff into the fabric of patient safety work in the institution,” said hospitalist Jen Myers, MD, who is taking the lead on this initiative. “If new residents see how we talk about safety issues – open and transparent – they will be more inspired to engage with patient safety activities.” These efforts are aligned with patient safety culture efforts at HUP and throughout the Health System, she added.
The huddles comprise not only residents but also attendings, nurses, and other members of the health care team, as well as a member of HUP’s quality and safety team. “Listening to people at the front lines is a critical component,” Fishman said. “We want residents and fellows to learn that they can make a difference by speaking up when they see vulnerabilities in the system.”
In the huddles, the group discusses a recent safety event – identifying an error that reached a patient or a potential error that did not cause harm because it was caught just in time – and then investigates the reasons behind it and brainstorms some possible solutions. “Residents and new-to-practice nurses and advanced practice providers have a unique lens from the front line,” said Meg Yoho, MSN, director of Quality at HUP. “It’s fantastic to have a ‘naïve’ set of eyes look at a problem compared with those of us who look at it all the time but don’t see. They ask simple but powerful questions.”
All huddles are held on patient care units. “Residents are not talking about something in abstract, removed from the actual work they do,” said Jeffrey Berns, MD, associate dean for Graduate Medical Education. “Holding them directly in the environment in which they care for patients increases the effectiveness of these discussions. We want to engage them in thinking about how safety is related to what they do every day.”
Fishman hopes that these huddles will remain a permanent part of HUP’s practice after the initiative ends. Also, “we are looking for ways to disseminate the huddles throughout the Health System,” he said.
“Our hope is to transfer these huddles from the AGCME Collaborative to our every day way of working – discussing safety events, how they happen, and what we can change to ensure it doesn’t happen again,” Yoho said. “There’s a lot we can learn from one another.”