Safety Sentries

Understanding people’s motivations and meeting their needs to make a hospital safer is an intricate process.

“I think it is important for hospitalists to understand how complicated and time-consuming system changes are,” she says. “You do not have that perspective as a clinician. You think that change can occur from a memo or from good intentions to do the right thing.”

She has learned to think about the bigger world outside the clinical portion of running a hospital.

“To be a change agent you really need to appreciate the hospital from the penthouse view, which is what this fellowship provides,” she says. “You need to have access to every meeting, every record, every clinician, and every senior executive to put the pieces of the puzzle together to understand how things change.”

The hospital is working to apply the Toyota method of employee involvement to the issue of how an obstetric patient progresses from triage in the emergency department (ED) to labor and delivery, and how much time passes before the triage the patient is discharged or admitted. Their focus first targeted convening the right group to discuss the issue and identify the details of the problem, then put a plan in place to track ED triage. They looked for ways to make that process more efficient, met again to determine how to implement a new version of that process, then tracked the difference. “All of this was a multihour ordeal,” she says.

It’s exhilarating, frustrating, and intriguing—and sometimes discouraging. “It’s very tedious making change, and I didn’t appreciate that before the fellowship,” she says.

Dr. Sivaprasad advises hospitalists that to be effective in patient safety efforts means being a problem solver, highly empathetic, sensitive to others, and above all, extremely patient. But results often emerge slowly.

“You must have several things brewing at once because if certain programs’ changes are taking time, you need to complete the loop on something else,” she advises.

The Ideal Candidate

Of the 20 fellows Dr. Shulkin has mentored, about half were older and more experienced than he was. Reflecting on the successful fellows and those who benefited less makes him think the distinction of experience and age is less important than the individual’s personality.

“What is important is the personality and motivation and self-directedness of the fellow,” says Dr. Shulkin. “This is a very autonomous fellowship. One of the pluses and minuses of working with senior executives is that they are very busy; they don’t have time the way traditional academic program directors or residency directors do to think, ‘Where are my fellows and what are they doing?’”

Those who will get the most out of this type of experience know how to be delicately assertive yet drive their own agendas.

To Drs. Shulkin and Bernard, a good patient safety leader is naturally curious about what makes healthcare organizations tick. The ideal candidate has an appreciation for hospital financing and the science behind physician behavior change, and the capacity to be a good listener. The trainee also needs to put aside his or her ego while transitioning from a physician in charge to stepping back into the student role to learn the new language and environment.

Where to Begin

The institution sponsoring the development of the patient safety officer is just as important as who that candidate is.