No matter if you are in an executive or a management role at an academic center or a private practice hospital, as a physician leader you want your medical staff to not only understand the principles and theories of the quality and safety movements, but also to put them into practice.

Though there may not yet be a burning national safety platform, for the best organizations the train has truly left the station. For leaders of health care organizations, it is not a question of if, but how to facilitate improvement in patient safety among medical staff. Changing people’s behavior is difficult and education alone is not enough.
In 1999, Children’s Hospitals and Clinics of Minnesota began a journey to improve patient safety. Our CEO at the time, Brock Nelson, had an epiphany that year that changed our organization and how we operate.

Nelson had been advised by our attorney not to disclose to a family that our pathologists made an error in a diagnosis. Nelson went against the advice and further decided that Children’s would always disclose the full truth. In addition, Children’s hired a world expert in patient safety–Julie Morath–as our chief operating officer. With these two key events, Children’s of Minnesota had begun the effort to change our culture.

We then developed a specific agenda that included readiness, accountability, infrastructure changes, empowerment of all employees and staff, high reliability training, and new safety technology.

Children’s medical staff not only concurred with the agenda but also took leadership roles in its development, through the vice president of medical affairs, the elected chief of staff, the chiefs of divisions, and by adding a new position, medical director of patient safety.

Over the past seven years, we have continually updated and revised our patient safety agenda to expand and enhance its effectiveness.

One recent enhancement is a relatively unusual commitment made by our medical staff: All members who are appointed (and at reappointment) will continue to have to meet traditional conditions such as maintaining their licenses, getting continuing medical education credits, showing competencies in their fields, and being good citizens.

In addition, each member must also pass a test that demonstrates understanding of safety and quality principles. At appointment, staff is now given a package of critical communication components to absorb, followed by a test of 10 questions. The medical leadership of Children’s of Minnesota took this step in order to raise the bar on safety. Medical staff members will not be appointed or reappointed without passing this test.

How we did it

In 2004, as Children’s vice president of medical affairs and chief medical officer, I recommended to the professional executive committee that we commit to an expectation of patient safety knowledge before allowing appointment to our medical staff.

The recommendation further stated that upon staff members’ application for reappointment every two years, Children’s would offer updated information and knowledge about patient safety, and members must renew their commitment by taking a test again.

The recommendation was supported by the leadership of the professional staff, including the chief of staff, division chiefs, community physicians and Children’s boards of directors.

With the guidance of our director of patient safety, Children’s created a package of critical communications that focused on nine areas of patient safety:

1. Stop the line policies

2. Chain of command

3. SBAR communications

4. “Do not use” abbreviations

5. Verbal order read backs

6. Rapid response teams

7. Medical accident reporting

8. Universal protocol

9. Disclosures

These recommendations were instituted in 2006. The new process began with all of Children’s employed physicians, followed by all of the private-practice (community) physicians and advance practice nurses who apply for appointment on a two-year cycle.

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The requirement can be fulfilled electronically or on paper. We have also created a CD-ROM with the information available for individuals to review the necessary communication skills.

Here’s a look at the test:

Children’s Professional Staff Patient Safety Training Questionnaire

Please circle the correct choice.

1. If someone invokes the “Stop-the-Line” rule:

A. All participants will immediately stop and respond to the request by re-assessing the patient’s safety.

B. Assistance by any means most expedient shall be sought.

C. Emergency interventions may be initiated without prior express physician order.

D. They are acting in a manner sanctioned and supported by Children’s professional staff.

E. All of the above.

2. The chain of command policy is a Children’s policy that describes how an employee or professional staff member is expected to escalate an issue of concern depending upon the patient’s acuity.

A. True

B. False

3. The obligation to provide disclosure does not require that harm has occurred.