Inspire, Engage, Motivate, and Empower Patient Safety and Reliability in all of Healthcare
- What Is HIIP
HIIP is a project devoted to identifying the cultural and institutional resistance to patient safety and quality initiatives, applying innovative approaches and solutions that will help to overcome these barriers, in order to make positive long lasting changes in healthcare organizations. Blending conceptual, pedagogical, and communication methods that have been successful outside of healthcare with clever, compelling, engaging, and entertaining multi/social media strategies, HIIP will help transform cultural and workplace dynamics so that highly reliable, safety cultures will become the norm throughout the healthcare system.
- Our Mission
Our mission is to help healthcare institutions – whether they are individual healthcare facilities or academic training programs –implement the principles of safety and high quality and reliability so that they become routine habits of practice.
To do this, the HIIP team targets two interconnected issues – the content of the messages and initiatives that promote patient safety and quality and the way these messages and initiatives are communicated –particularly to the various levels of stakeholders and healthcare providers. Utilizing research and methods developed by a variety of safety and quality researchers both inside and outside healthcare, we identify the aspects of healthcare culture that have made transformation so difficult. Mobilizing and synergizing the skill of videographers, public health campaign designers, playwrights, journalists, and patient safety experts, HIIP uses engaging and entertaining media from print to audio and video to inspire, engage, motivate and empower those who work in healthcare to make patient safety and the reliability of care a non-compromising passion in their everyday work. HIIP thus recognizes and celebrates the tremendous efforts of providers, health systems, and improvement organizations that have saved countless lives and reduced healthcare cost and seeks to amplify these efforts by addressing the implementation gaps that have made progress in healthcare safety and reliability so slow.
HIIP seeks to transform those lessons of patient safety and quality, which may be dry and didactical, into messages that will motivate and inspire people to change their behavior, priorities, and practices. From the most senior physician or executive down to the housekeeper or security guard –HIIP’s materials and messages will help change their attitude towards patient safety from ‘told to do’ to ‘want to do’, from ‘start tomorrow’ to ‘start today’, from ‘yes but’ to ‘yes now’, from ‘change is hard’ to ‘change is better’, from ‘go it alone’ to ‘go together’.
Our strategies seek to catalyze the commitment of individuals and organizations to produce a safer more reliable healthcare system.
- The Problem
In 1999, the US Institute of Medicine in its report ‘To Err Is Human’ publicized the fact that almost 100,000 people die from medical mistakes every year. Across the globe, other prestigious organizations in other countries reported similar statistics on the costs and consequences of preventable medical errors. These reports and many others launched a patient safety movement that has attained great public attention and prominence. Over the past decade- and- a- half, enormous energy, huge sums of money, and a great deal of time has been devoted to reverse the epidemic of preventable patient deaths and injuries. In pockets, there has been some remarkable success in making healthcare safer and more reliable. Unfortunately, such efforts have not resulted in an equally impressive improvement in patient safety (1). “Until there is a more coordinated effort to implement those strategies proven beneficial, I think that progress in patient safety will be very slow”. In 2013, for example, The Journal of Patient Safety estimated in 2013 that 210,000 to 440,000 people die every year from avoidable medical mistakes. This is equivalent to crashing three 747 jumbo jets everyday. And it makes preventable loss of life from medical mistakes the third leading cause of death in America – after heart disease and cancer. Almost everyone in healthcare now recognizes the dimensions of the problem and agrees that safety is a priority. However, all too often agreement does not lead to action and the commitment to patient is undermined by a series of yes buts – it’s too expensive, it takes too much time, I tried but it didn’t make any difference ….
This problem has been exacerbated by the fact that powerful examples of positive culture change in healthcare are not always promoted in a way that reaches—and engages — the majority of those who work on the frontlines of care. Patient safety successes tend to be written up in scientific journals that are not read by the vast majority of those who work in healthcare. Best practices tend to be taught in academic environments – through a series of PowerPoint lectures and academic workshops. While science is, of course, foundational to patient safety, the current approach to disseminating the message of patient safety and reliability assumes that statistics and reason alone will produce the passion and will at the frontline to overcome individual, social, and organizational barriers. This produces a focus on the mechanics of what to do rather than an equally important focus on how to do it. If there is not enough effort devoted to helping people figure out how promising models developed in other healthcare settings or even industries can be adapted to their own cultural and organizational context, enthusiastic safety and reliability advocates may be unable to engage others and sometimes even the best of intentions and programs do not lead to sustainable change.
The key questions HIIP addresses are thus: Are the programs that are designed to deliver healthcare safety and reliability adequate to the long-term goal of transforming healthcare culture? Will they improve the experience of care and , health of both individuals and populations as well as reduce the cost of healthcare (Triple Aim)? Are safety and reliability messages delivered in a way that engages those who work in healthcare so that they habitually practice safely, reliably and deliver high quality services? Are the messages and practices currently adopted encouraging higher level administrators – CFOs, CEOS, CNOs and COOs — to make choices that provide – over the long term — the allocation of time, resources and necessary empowerment of their staff to change the contemporary healthcare culture in a way that makes patients safe and staff feel heard and respected?
- The Audience
Our primary audience is those who work in healthcare –whether high level administrators, clinicians, professional trainees or housekeepers and other healthcare workers. We target this broad audience because a culture of safety and reliability depends on the attitudes, practices, choices, and actions that those who work in healthcare – at every level – make and utilize everyday. As we said above, the majority of those who work in healthcare recognize that the industry is neither safe nor reliable. Many believe that change is necessary. They do not, however, always believe that it is possible. Even the most enthusiastic safety and reliability advocates often feel stymied, frustrated, overwhelmed, and even burnt-out when it comes to creating a culture of safety and high reliability. Like others in healthcare, they feel inundated with exhortations to do everything from washing their hands, to learning new methods to insert central lines. From above, they are told to change their behavior, to work collaboratively, and to learn to deal with and resolve conflicts; while from below, the environment they are working in may continue to reinforce traditional, undesirable behaviors.
In order to change either their culture or behavior, they may be asked to attend a few lectures or workshops but may not get enough on the job sustained training, skill building and time to practice what is preached. Similarly, healthcare workers may be told what to do but are rarely engaged in developing solutions to safety and quality problems. Many may thus feel that there is a disturbing disconnect between those who run healthcare institutions and those who deliver front line care. As a result, they feel that the take home message about patient safety is that: It’s their fault patients are injured or die; critical patient safety initiatives are just another flavor of the month box-checking exercise that has to be endured rather than from which they actually learn and grow in their lives or practice.
Not surprisingly, too many well-intentioned healthcare professionals and healthcare workers feel burned out and disengaged when it comes to patient safety initiatives and actions. “We just don’t have time to wash our hands,” a surgical resident in orthopedics explains. “If I pursued every incident of a resident not following the proper protocol about patient identifiers, I would spend my whole day in the nurse manager’s office,” a nurse exclaims. “What can I do, there is just no support from upper level management when it comes to patient safety,” a social worker declares. “How many times can I stick my neck out?”
“Not again,” one surgeon exclaimed when told he had to go to another lecture by an airline pilot about safety in that industry. “I hate this touchy feely stuff,” an internist protested safety workshops. “I am inundated,” a nurse manager commented about what she called the latest flavor of the month initiative in her hospital. Like the kind of alarm fatigue that discourages front-line staff from attending to real emergencies and taking potential positive action, initiative fatigue has become a serious patient safety problem in and of itself and prevents more progress in moving toward patient safety and reliability.
What this audience — whether of physicians, nurses, housekeepers, or high level administrators – longs for is a message that instills hope rather than shame and blame and that inspires a sense of possibility and creativity rather than defensiveness. Even those who are staunch patient safety/reliability advocates are hungry for examples that inspire them to continue their efforts in spite of what may seem to be insurmountable odds and to adapt promising models to their own settings and cultures. Their message is summed up in what one patient safety champion told us of current patient safety discourse – “stop nagging and motivate.”
- The HIIP Method
Motivate and engage are the operational terms here. Research has clearly documented that culture change does not happen because people read studies, are convinced by the statistics, or are admonished about the dangers of their actions either to themselves or by others. We know that people change behavior – both on an institutional and individual level – because they have been moved by stories; inspired by real-life, relevant and attainable models of what is now known as positive deviance; motivated by the sudden epiphany created by an effectively presented message or concept; or convinced that change does not mean loss but rather a concrete benefit to them and an improvement in their individual practice or workplace environment. If you want someone to put on a condom before having sex, you don’t ask him to read an article from JAMA and summarize the study’s findings and limitations. You convince him that it’s actually cool, as well as beneficial, to have safe sex. Why do we believe that doing the equivalent with patient safety will produce results in the mass of healthcare workers and professionals?
Learning from the lessons of everything from successful campaigns to encourage safe sex in Brazil to Air New Zealand/Delta/Virgin’s campaigns to get weary travelers to watch their safety videos, and our own work with out-of –the- box – methods, that include plays, books, and videos and audio podcasts, HIIP proposes very different strategies to complement those currently used in patient safety. We will build on the insights and successes of public health, public safety, advertising and political campaigns to encourage people to change their behaviors and culture to make it safer and more reliable.
Our goal is to use several different methods to send out compelling messages and inspirational examples so that those who work in healthcare come to view patient safety and reliability not as something associated with shame and blame – or with the threat of discipline or punishment – but as an integral and even easy to accomplish part of their mission to care for the sick.
Method One – Inspiring MiniDocs
Ten to 15 minute mini-documentaries that highlight examples of institutions that have taken successful action to change culture in critical areas that impact patient safety. These mini-documentaries will use the most advanced production techniques to tell an engaging story of the “little engines that could.” Selecting critical areas of culture change, we will highlight institutions that mobilized the energy and activity of front-line staff and high-level administration to transform the hierarchical institutional cultures that encroaches on patient safety, teamwork, and staff satisfaction, joy and meaning at work. These mini-docs focus on the “how” as well as the “what” and will always contain a discussion of how these local models can be adapted to different healthcare settings and cultures. All of these documentaries will be distributed free via Youtube/social media with the goal of helping them go viral throughout healthcare.
- Creating a Culture of Respect
- Creating a Just Culture in which People Can Report Mistakes Without Fear of Punishment
- Teaching Teamwork through Simulation
- Coaching the Huddle
- How to Receive – as well as give — Feedback
- Learning from the Safety Practices in Other Industries
Method Two – PSAs that make you think
Sixty to 90 second PSAs that utilize the techniques of public health and public service advertising to create clever, yes sometimes even funny, messages that take on a particular patient safety problem – cleverly depicting the problem and then equally cleverly showing how it can be reversed. Topics for PSAs include:
- Stop Saying I’m Sorry to the Doctor
- Put Your Buts Behind You When It Comes to Patient Safety
- Hierarchy as a Curable Malady
Method Three – Animating ideas
Physician Michael Evans has helped to promote the use of white board animation in healthcare through his clever white board animation entitled the 23 and a 1/ 2 hour day which he posted on YouTube. So far this animation has gone so viral that it received over 4 million hits on YouTube. We propose to do somewhat shorter white board animations to make an argument about critical patient safety issues that would otherwise sound to preachy and teachey. Candidates for the use of white board animation would include:
- The Business Case for Patient Safety
- The Lessons of High Reliability Industries
- What Does It Mean to Play on a Team
- What Does It Mean to Teach Teamwork in Your Institution
- What is that System Thinking Thing They’re Always Telling us About
Method Four – Inspiring Prints
Posters and Bookmarks that utilize compelling graphics to make safety behavior cool. Public health campaigns have mastered the cool ad to change behavior. Suzanne Gordon has used posters –which have been distributed in the thousands — to encourage nurses to speak up and value their work. HIIP has created a poster that encourages people to work collaborative entitled Co Is Cool that is already in demand. We have also produced a Put Your Buts Behind You When It Comes to Patient Safety that is being used in different healthcare institutions and organizations. We will work to create other posters and materials that can be used to accompany our HIIP campaign.
Method Five – HIIPcasts
Suzanne Gordon has begun to use her journalistic interviewing skills to do podcasts with people who are putting innovation into practice to create safer, more reliable care. These 15 to 30 minute podcasts will be posted on our HIIP website and promoted among patient safety advocates so that they can then be promoted with students.