“Take 5”Changing the culture to improve safety for patients

and their families through communication

Blair Butler, MD, FRCSC

bbutler@cw.bc.ca

Disclosure

• Position– Clinical Assistant Professor OB/GYN– Medical Director of Birthing BC Women’s Hospital

• Research– Funded through BC Children’s Telethon Competition (non-

industry)• Post-Dates Ultrasound Study• $18,801• No perceived conflict

• Spouse– Employed by a private fertility centre– No perceived conflict

Context

Problem/Issue

Problem/Issue

Problem/Issue

Problem/Issue

COMMUNICATION

Intervention

• January 2012

• 3 (+) year program

• Increase knowledge and interprofessional/interdisciplinary communication

Intervention

• “Take 5”

– January 6, 2014

• Clinical scenarios:

1. Postpartum hemorrhage (N = 705, 10.9%):

• EBL > 500 mL for vaginal birth (N = 526, 12.2%)

• EBL > 1000 mL for Cesarean birth (N = 179, 8.3%)

2. Operative vaginal birth (N = 834, 12.9%)

3. Shoulder dystocia (N = 262, 4.06%)

Intervention

“Take 5”1. What went well?

2. What did we learn?

3. What would we do differently next time?

4. Did we have any system issues?

– Communication, equipment, processes, etc.

5. Who is going to follow-up to address problems?

– PSLS, Department Head, CNL, etc.

Intervention

Cultural Element

PreAvg Rating

PostAvg Rating

Empowering People 3.85 4.01

Learning 3.57 3.76

Open Communication 3.36 3.57

Patient Safety 3.50 3.76

Teamwork 3.34 3.58

Valuing Individuals 3.49 3.66

Measurements

© 2011 Salus Global Corporation. MOREOB is a registered trademark of Salus Global Corporation. All Rights Reserved

Element DescriptionPercent Often True or

Always True (4 or 5) (%) % Improvement

Pre Post

TeamworkMultidisciplinary meetings about patient care are a normal part of our practice.

28.40 39.34 10.94

Open Communication There is a feeling of openness and trust in our unit. 31.60 40.98 9.38

Open Communication Information is shared across disciplines on a regular basis. 36.40 45.90 9.50

TeamworkWhen things do not go well with a patient, we meet as a multidisciplinary group to discuss the issues involved.

22.80 49.18 26.38

Open CommunicationThere is open discussion of the results of patient care reviews so that all members of our unit learn from the experiences of others.

30.40 49.18 18.78

Open CommunicationWe are able to communicate our points of view without fear of reprisal.

38.00 50.82 12.82

TeamworkI am included in interprofessional meetings regarding patient care and safety.

37.20 50.82 13.62

Empowering PeopleI feel free to question the decisions or actions of others,

regardless of their level of authority.48.00 58.00 10.00

Empowering People

I am comfortable intervening if I see someone about to do something that might threaten patient safety, regardless of their level of authority.

67.00 67.00 0.00

Open CommunicationIf I don't understand something, I feel free to ask questions.

73.60 83.61 10.01

Measurements

© 2011 Salus Global Corporation. MOREOB is a registered trademark of Salus Global Corporation. All Rights Reserved

Future

• How “Take 5” will be incorporated into BC Women’s Hospital

• Adverse event:

Continuum Patient Worker

Case Review Take 5

CPSER Check In

CISM

Challenges and Lessons Learned

• Main function was non-threatening, team based communication with a patient focus

– Identification of system issues were a bonus

• Sometimes difficult to maintain patient as primary focus

• Section 51

• Keeping it brief

• “I’m too busy”

Challenges and Lessons Learned

• Words of advice:

“Recruit those that are respected, supportive, and influential.”

Questions?

Special Thank You:• Debbie Johannesen• Dr. Dorothy Shaw• MOREOB Co-Chair Lisa LaFleur• Multiprofessional MOREOB Core Team