Download - National EMS Culture of Safety
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National EMS Culture of Safety Sept 2010 – Sept 2013
NEMSAC UPDATE
August 29, 2012
Sabina Braithwaite, MD, MPH, NREMTP
Wichita-Sedgwick County EMS System Chair, Culture of Safety Strategy Steering Committee
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Project Background • Funded by the National Highway Traffic
Safety Administration (NHTSA) Office of EMS and EMS for Children
• Stimulate the growth of a “Culture of Safety” within the EMS community through development of a Strategy document – Where are we? – Where do we want to be?
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Project Overview • Steering Committee Meeting • National EMS Culture of Safety Conference
– 18 Member Steering Committee – 21 Member Group of National EMS Organizations – Additional invited groups/media
• First Draft Delivered to NHTSA • NEMSAC Update • Steering Committee Review • Second Draft Due • Draft Available for Public Comment
APRL 2011
JUNE 2011
AUGUST 2011 SEPT 2011
DEC 2011
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Project Overview
• Third Draft Due • NEMSAC Update • National Review Meeting • Fourth Draft Due • NEMSAC Review Draft Presented • Collect NEMSAC Comments • National EMS “Culture of Safety” Strategy
Document • Dissemination of Strategy
MARCH2012
JUNE 2012
AUGUST2012
SEPT 2013
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National Stakeholder Meeting • EMS identified as high-risk industry • Affects patients, responders and the public
– Violence – Vehicle Operations – Medication errors – Infectious diseases – Lifting and moving patients
• Lack of EMS injury data system • Limited sources of data
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Considerations • Balance between patient – responder – community
safety • Capitalize on concern for the patient • Recognition that this is a long process but has
intermediate “wins” • Disparate nature of EMS • Respect for unique circumstances and environments
of EMS
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Considerations • Limited resources • Incorporate lessons from other fields • Evidence-based within reason • Balance between cultural and practical • Build on existing foundations • Seek to be emulated
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Creating a Culture of Safety Are we headed in the right direction?
•Vision / Strategy •Operational tools
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Right balance – EMS Personnel, Patient and Safety of the public? Purpose: One of the challenges Culture of Safety is creating a pervasive culture – one that touches the personnel, the patient and the public. Safety of the Community vs. Public
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EMS Culture and Safety
How do we use the vision / strategy document to seed change in culture? Vision far into the future
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What are we trying to create? •Environment of empowerment •Environment of knowledge •Environment of openness •Environment of inclusiveness at every level •Environment of quality
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Suggested elements: •Just Culture •Coordinated Support & Resources •National responder and patient safety data systems •Education initiatives •Reporting and investigation tools
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Just Culture • Human error:
– individual should have done something other than what he or she did, and
– the action(s) inadvertently caused (or could have caused) an undesirable outcome
• Negligent conduct: – falls below the standard reasonable level of skill expected
• Reckless conduct: – greater culpability than negligence because it is conscious,
unjustified, and done in spite of understanding of the likelihood of harm
• Intentional/willful violations: – know the negative result of the action but do it anyway.
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Just Culture • Separate behaviors from outcomes
– Base the response to unsafe acts on the behavior itself and the risk it presents,
– Not on the outcome
• Console human error. • Coach at-risk behavior. • Punish reckless behavior. • …independent of outcome.
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Coordinated Support and Resources • Unified message • Providing visibility to support culture • “One-stop shopping” for tools • Collaborating • Sharing research
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National Data System • Linkage • Unified taxonomy • Anonymous reporting
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Education Initiatives • Education of leaders • Build clinical judgment • New employee onboarding • Integration and practice of safety in
education
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Standards • Evidence based approach • Development of standards
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NATIONAL REVIEW MEETING Washington DC-June 19, 2012
• 60 attended General Session -Steering Committee, -Invited organizations -Federal Partners -Writers, Public and ACEP Staff • Steering Committee met the following day
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NATIONAL REVIEW MEETING Highlights and Direction
• Better Define Target Audience • Directness and Brevity • Just Culture as a concept vs. a single
philosophy • Reorganize content • Include Actionable items
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NATIONAL REVIEW MEETING Highlights and Direction
• Survey Organizations to see what they are doing now
• Survey for Suggestions in Moving Forward • Re-evaluate definition of EMS or remove • Taxonomy
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Next Steps
• Draft 4 for NEMSAC review – November 20, 2012
• Final Draft to NHTSA – May 15, 2013 • Public release of EMS Culture of Safety
Strategy—fall 2013
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Steps to Adoption • Dissemination • Implementation • Integration • Culture Change
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For more information on the project please contact: • Sabina Braithwaite, MD, MPH, FACEP Culture of Safety Steering Committee Chair American College of Emergency Physicians [email protected] • Pat Elmes, EMT-P (Ret.) EMS and Disaster Preparedness Manager American College of Emergency Physicians [email protected]
• Rick Murray, EMT-P EMS and Disaster Preparedness Director American College of Emergency Physicians [email protected] www.emscultureofsafety.org