Cleveland-based University Hospitals is working on its final step on the next wave of patient safety, Peter Pronovost, MD, PhD, chief quality and clinical transformation officer of University Hospitals, told Becker's.
In a 2016 piece Dr. Pronovost co-authored for the Harvard Business Review, there are three phases for improving patient safety. The first phase is improved training; the second is procedure standardization, such as checklists; and the third is high reliability organizing, which "recognizes that over-standardizing can also increase risks."
A hospital unit's culture can either propel or halt a domino effect of post-surgery complications, according to the article. Patient safety improves when clinicians can recognize where a problem is going wrong, collaborate with others to change course and rescue the patient. This is high reliability organizing, or relational coordination.
Eight years after penning the article, Dr. Pronovost told Becker's his organization is tackling relational coordination. This is when "there's a number of different roles that need to be involved in doing a task," he said.
"Sometimes it's ambiguous what role is [meant] to do what, and even at different times with different resources, it may switch who does it," Dr. Pronovost said. "Often they're all at the same level of the role. In other words, they don't necessarily report up into one leadership structure of someone who could coordinate it, but rather, they have to figure it out."
Recently, University Hospitals — which employs 32,000 people — realized a relational coordination issue with transportation. Transferring a patient from the intensive care unit to an Uber ride, for example, involves several people and steps. But, it wasn't clear who was responsible for making the calls and what number to call.
Local teams then dissected the confusion and clarified the responsibilities, the appropriate phone numbers and escalation procedure if a transport is delayed.
This initiative "only happens if you have this culture of love where people respect each other," Dr. Pronovost said, "and they see value in collaborating as they make sure every role that is involved has a voice in making it better."