The Safety Playbook: A Healthcare Leader's Guide to Building a High-Reliability Organization
- 2h 47m
- John Byrnes, Susan Teman
- Health Administration Press
- 2018
Each year, more than 200,000 patients die as a result of medical errors—the third leading cause of death in the United States.
Although the numbers are staggering and the challenges great, this national healthcare crisis is solvable—and fixing it has become a personal mission for John Byrnes, MD, and Susan Teman, RN.
Byrnes and Teman have a proven track record in helping hospitals and health systems transform into high-reliability organizations that aim to deliver error-free care at an affordable cost. In The Safety Playbook: A Healthcare Leader’s Guide to Building a High-Reliability Organization, they lay out their process for building a safety program that can eradicate preventable medical errors.
Written in a clear, conversational style, the book applies to all types of healthcare organizations and speaks to leaders across the spectrum—from board members and C-suite executives to clinical leaders; managers; and staff of quality, safety, and risk management departments. Readers of The Safety Playbook will:
- Review the current rate of medical errors and explore proven solutions, including high reliability
- Discover how transparency about errors and their causes makes a successful safety program possible
- Learn how developing internal safety experts saves time and money
- Examine safety tools and practices used effectively in high-reliability industries
- Understand why communication is the top cause of medical errors and how to improve it
- Explore guidelines used in other healthcare organizations that create a culture of safety
- Study a sample project plan and timeline for implementing a safety program
Filled with compelling case studies and practical tools and strategies, this groundbreaking book can be a catalyst for transforming an organization’s culture, delivering safer care to patients, and ultimately saving lives.
The American College of Healthcare Executives and the Institute for Healthcare Improvement/National Patient Safety Foundation's Lucian Leape Institute (IHI/NPSF LLI) have partnered to collaborate with some of the most progressive healthcare organizations and globally renowned experts in leadership, safety, and culture to develop Leading a Culture of Safety: A Blueprint for Success. This document is an evidence-based, practical resource with tools and proven strategies to help senior leaders in healthcare create a culture of safety—an essential foundation for achieving zero harm.
With both high-level strategies and practical tactics, the guide can be used to help determine the current state of an organization’s journey, inform dialogue with its board and leadership team, and help its leaders set priorities. Whether an organization is just beginning the journey to a culture of safety or is working to sustain its safety culture, Leading a Culture of Safety can serve as a useful guide for directing efforts and evaluating an organization’s success along this journey.
About the Author
John Byrnes, MD, is a nationally recognized expert in healthcare quality and safety. He has more than 20 years of experience leading, designing, and implementing quality and safety programs throughout the United States and Europe. During his recent 11-year tenure as chief quality officer at Spectrum Health, Grand Rapids, Michigan, the organization received more than 100 quality awards, was ranked three times as one of the nation’s top 15 health systems, and received multiple top-50 and top-100 hospital designations.
Dr. Byrnes is a popular speaker at regional and national conferences, including the annual meetings of the Healthcare Financial Management Association (HFMA) and the American College of Healthcare Executives. He is a member of the national faculty for the American Association for Physician Leadership (AAPL), serves on its board’s Faculty Advisory Council, and teaches at the AAPL Institutes. He recently completed his term on the national Board of Directors for HFMA and has served on board quality committees for large hospital systems, multispecialty medical groups, integrated healthcare systems, and health plans. Dr. Byrnes is clinical associate professor at Michigan State University’s College of Human Medicine.
Susan Teman, RN, CPPS, has 30 years of experience in healthcare leadership, quality, patient safety, and risk management. Currently, she is program manager for simulation at Helen DeVos Children’s Hospital (HDVCH)/Spectrum Health in Grand Rapids, Michigan. In this position, she is in charge of the management of the simulation program; the simulation laboratory; the associated technology, development, and implementation of the business plan for simulation; and the coordination of training programs among users by working with department leadership to establish high-level priorities and maximize the use of human factors integration principles. She led the safety culture transformation at HDVCH, which was subsequently recognized by the Lucian Leape Institute of the National Patient Safety Foundation and the Michigan Hospital Association. This work has been outlined in numerous publications.
Ms. Teman is a national speaker on patient safety for the Children’s Hospital Association and for Solutions for Patient Safety.
In this Book
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Foreword
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Foreword
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Preface
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A Call to Action—The US Patient Safety Crisis
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Transformation to a Safety Culture
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Proof That This Formula Works—Results from Around the United States
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The Need for High Reliability
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Integrating Patient and Employee Safety
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A Culture of Full Transparency and No-Fault Reporting
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Safety Metrics
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Lessons-Learned Programs, Safety Alerts, and Intranet Dissemination
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New Safety Roles—From the Board to the Front Line
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Unit-Based Safety Experts
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Getting Physicians on Board—Six Steps to Physician Engagement
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The Safety Specialist and Other Key Staff
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Root Cause, Apparent Cause, and Common Cause Analysis
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Error Prevention Behaviors—Making It Stick
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Situational Awareness, Shift Planning, Daily Check-ins, and Safety Huddles
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Brief and Debrief Huddles for Surgical Care
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Simulation—The Low-Tech, Low-Cost Version
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Checklists
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Human Factors Engineering
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Care Bundles
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Shift Planning and Workload Management
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Emotional Safety for Employees
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Swarming—An Alternative to Root Cause Analysis
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No-Interruption Zones, or the Sterile Cockpit
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Intimidation—A Deadly Factor
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Standardizing and Structuring Communication
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Situation, Background, Assessment, and Recommendation Technique
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Tools for Acquiring the Skill of Assertiveness
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First Names Only
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Red Rules
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Just Culture—Akin to a Whack-a-Mole Game
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Training—A Corporate Responsibility
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The Bottle-to-Throttle Rule
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Getting Started—A Sample Project Plan and Timeline
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The Power of the CEO
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The Cost Impact of Poor Patient Safety
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What to Adopt from The Quality Playbook
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References
