Collaborative Anticipation; Helping Solve HealthCare Problems

April 30, 2012
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Next month, I expect to be home only three full days.  I quip that this is a marital protection strategy, now in its 28th year and give kudos to my family for supporting my passion to reach out to disgruntled doctors and hospital leaders, listen to their issues, and help them solve their problems through improved communication, engagement, and collaboration.

I call this process collaborative anticipation as I brainstorm ways that I can:

Next month, I expect to be home only three full days.  I quip that this is a marital protection strategy, now in its 28th year and give kudos to my family for supporting my passion to reach out to disgruntled doctors and hospital leaders, listen to their issues, and help them solve their problems through improved communication, engagement, and collaboration.

I call this process collaborative anticipation as I brainstorm ways that I can:

  • connect with people’s pain and aspirations
  • help them depersonalize their differences
  • make their time count
  • help them leave a lasting legacy

For example, I travel this week to Chicago to facilitate a 2-day discussion of quality and safety issues, which will give me the opportunity to learn from experts and share with them the insights in a chapter that I coauthored with Gary Yates and Carol Sale in Getting It Done on the pioneering work at Sentara to improve their safety culture. To deal with inadequate communication, inattention to detail, noncompliance with policy, and failure to recognize high-risk situations and use error-reduction techniques, they implemented four strategies to promote the practice of safe behaviors:

  • Expectation setting: developing behavior-based expectations (BBEs)linked to techniques for error prevention for all hospital staff, hospital leaders, and physicians
  • Operational focus: establishing “red rules” to focus employees’ attention on high-risk procedures that can result in patient harm if not followed exactly (e.g., positive identification prior to any action with a patient, site verification before surgery)
  • Effective tools: developing an enhanced root-cause and common-cause analysis process that was more timely and geared toward producing long-term, systems-oriented changes
  • Streamlined rules: adopting an approach for simplifying policies and procedures (e.g., identifying and standardizing key steps in a checklist)

Proof of their success lies in their results:

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Staff increased their use of expected communications behaviors (such as using repeat-backs and clarifying questions) by 42 percent. Ventilator-associated pneumonias were reduced by 92 percent (6.15 to 0.42 per 1000 ventilator days) from January 2002 through December 2009, and the device-associated bloodstream infection rate fell 93 percent (3.68 to 0.42 per 1000 central line days) from January 2002 through December 2009.

Additionally, symptomatic catheter-associated urinary tract infections within the critical care units fell 66 percent (1.86 to 0.60 per 1000 foley catheter days) from January 2007 through December 2009. Total compliance to proper hand hygiene increased to 96% by December 2009.

What seems unique about the Sentara experience is that Dr. Yates was not satisfied with healthcare-specific benchmarks, so he looked to industries like nuclear power and aviation to improve quality and safety.  What do you think?

  • What is unique to your situation that benchmarks do not address adequately
  • What can you learn by making “apples-oranges” comparisons with leaders in other industries
  • Where can you benefit from collaborative anticipation, disrupting your thinking and your routines in order to improve care for your community

As always, I welcome your input to improve healthcare collaboration.

Kenneth H. Cohn

© 2012, all rights reserved

Disclosure: I have not received any compensation for writing this content.

©2012 Healthcare Collaboration. All Rights Reserved.

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