Dr. Kate O’Neill: Just like we did in the airline industry and goal is ZeroPatientHarm.

I would like to introduce Dr. Kate O’Neill. She has over 25 years’ experience in the healthcare industry and is VP of Practice, Education and Transformation at iCareQuality.us. Over the past 6 years she has served as a Subject Matter Clinical Expert collaborating with engineers and informatics teams with program innovation, project development, and system implementation at the patient safety labs in Philadelphia and Toronto. As a healthcare leader, Dr. ONeill works with key industry stakeholders to develop evidence-based solutions to improve provider engagement with focus on reducing ALL CAUSE HARM. Dr. ONeill also has deep expertise in frontline clinical practice with over 20 years in emergency medicine where she was awarded textbook of the year for Pediatric Triage Guidelines; served as ER Staff Development Educator; and developed the first clinical ladder program to measure skills, competencies and nursing performance. She served as the Senior Nursing Editor for PEMSoft and the journal Pediatric Emergency Care. Kate received a US patent for designing a medical device bite block for cervical spine radiography; and in 2009, she received the Bayaida Business Award at Drexel University for new technology development. Additionally, while at Drexel, she collaborated with nursing faculty and led the simulation team to develop an online platform for evidence-based practice to measure competencies in the student practice setting. Kate has other advanced skills and capabilities including hospital compliance, patient safety, risk management, quality improvement, LEAN and health information technology (HIT).

Actually Dr. O’ Neill knows Bulgaria very well, as she came here during the 90s, to help University Hospital “Pirogov”to establish the Pediatric ER. Today Dr. O’Neill and I “brought”  the Patient Safety Awareness Week from USA to Bulgaria.

Do you find any progress in patient safety since “To Err is human”​ was published?

Yes and No

Leadership and public awareness have grown in the US and globally such as Patient Safety week this week, IHI and NPSF, HIIN and other national awareness campaigns. However, the information about patient safety science and best practices are NOT getting infused down to frontline staff where there are gap in care, knowledge and competency that are associated with medical errors and adverse events.

Over the past 6 years you have served as a Subject Matter Clinical Expert collaborating with engineers and informatics teams with program innovation, project development, and system implementation at the patient safety labs in Philadelphia and Toronto. Tell us more about your work and how do you improve patient safety?

Our two patient safety labs in PHL and YYZ have been working on high-reliability organization (HRO) metrics and measuring “PROVIDER VALUE AT THE POINT OF CARE.”  We are working on a “proxy measure for real-time Quality of care” leveraging mobile technology on the frontline. We have several successful pilots with very promising early data and will be featured as an AHRQ Impact case for CAUTI Prevention. As such, 2 key areas enterprise-wide are the focus of our work and work together synergistically:

1. Frontline Life Long Learners- Building a learning organization is key from the bottom grass roots level/ non punitive where staff engagement is essential for ongoing learning and building informed knowledge workers at every level. .
2. Leadership Culture of Safety – Building a High Reliability Organization as part of the Strategic Plan at Leadership Level who is committed to #ZeroPatientHarm.

How important is communication for patient safety? What should we do to improve communication between patients and doctors, as well as communication between the medical staff?

Real-time information is essential, real-time dashboards, real-time communication, real-time handoff/transitions, with real-time dashboards to track our progress.

Think air traffic control.  Paper and faxing is old news and out dated.  We need integrated communication systems in place for seamless transmission of clinical information at our fingertips to reduce errors and improve efficiency of patient care.

How does technology help improving patient safety?

Technology can be both a blessing and a cure.  We need smart phones to be SMART and not use them as DUMB phones where staff cannot use them in the clinical setting. Think Siri or Alexa with artificial intelligence. How many times during the day do you use “Google” search engine or YouTube videos to view HOW to do something?  We need to trust in HIT experts and frontline care teams to  use technology in the workplace that is safely protected within their technology platform to delivery key information “when and where” we need it the most – at the bedside.

Technology, when used properly, with testing and safeguards in place, can improve care efficacy and treatment effectiveness and reduce redundancy and improve clinical workflow.

However, technology challenges remain without dated systems, escalating costs, security breaches, EHR silos,  inability to share information with other providers, legacy systems,  information is locked down, care and tests are repeated, which drives up costs and slows down essential care delivery.  Staff have technology overload in the workplace with concerns over data validity and data governance to really portray the “truth” about the care that was actually delivered.

Can you give us examples of good practices, implemented/or experienced by you/your team? Do you think we can implement them in Bulgaria?

Absolutely. Technology is universal and the same methodology applies in the US, Canada or even Bulgaria.  The goal is to bring best practices to the bedside so the clinical teams of doctors and nurses can consume essential information, JUST IN TIME – at the bedside.  Think micro learning moments and tasty videos online we can watch and learn quickly in micro learning moments. As we know, there are plenty of best practices published by AHRQ and other organizations – we just need to use a technology to enable staff to implement these EBP solutions. So Jason Uppal, myself and the engineering team in Toronto built a mobile healthcare platform to bring best practices to the bedside and measure provider engagement at the unit level to reduce harm.

We used this same mobile platform for my doctoral work at a hospital in North Jersey, where they had a problem with rising CAUTI rates.  So we installed the Mobile Toolkit at the hospital for frontline staff to access at POC to address gaps in care and staff knowledge. This innovative approach supported nursing engagement, CAUTI best practices, just in time learning and gamification. Staff accrued reward points for learning and implementing best practices in the ICU and med/surgical settings. Staff had 20% increase in learning, 264 % increase in FOLEY FREE DEVICE DAYS, and exponential increase in frontline engagement. Staff had daily dashboards to track their learning performance and was rewarded for their active engagement activities with coffee, pizza and small gift cards for “doing the right thing.” Similar to frequent flyer miles, staff can track their daily education knowledge and best practice competency points and build a learning organization culture organically. Our system uses gamification as part of action oriented learning platform to make learning rewarding and meaningful to drive staff engagement and reduce patient harm.

 What is the future of patient safety? What are the new challenges?

In 2005, the Patient Safety Quality Improvement Act  (PSQIA)  established a voluntary reporting system designed to enhance the data available to assess and resolve patient safety and health care quality issues.  However, the intent of this law has not been fully embraced by healthcare organizations and risk management here in the US.  In fact, this law continues to be challenged by courts across US whereby making it difficult to disclose or learn from adverse events to help support a learning organization culture. So our system was designed to build a learning organization culture and support staff and drive improved outcomes as part of an intrinsic culture bottom up instead of top down.

The future is clear and simple:  Just like we did in the airline industry and goal is #ZeroPatientHarm.

1. We must believe in building an HRO that starts with the top C -executives who are committed to zero failures. We must overcome fear with hospital accountability and transparency in care delivery. That starts with data and wanting to KNOW the truth about the bench strength and gaps in your frontline care teams.

Like Deming said.. Best efforts will not substitute for knowledge. Therefore data is king.

So in closing, I would to say that hospitals need to start somewhere to measure meaningful information. You don’t have to be a Magnet organization or a world renowned academic university hospital. Just start with simple technology tools in your pocket. Start by measuring staff engagement, go upstream and measure staff knowledge and provider competency with best practices.  Get a proxy measure for quality every day, just do not report outcomes for the sake of tracking something. Action oriented learning is key.  Start your learning organization and HRO journey today. My favorite quote is by St Francis of Assisi who said.

“Start by doing what’s necessary; then do what’s possible; and suddenly you are doing the impossible”