Achieving excellence through cultural transformation

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This is both an exciting and a challenging time in healthcare. There are a myriad of challenges facing hospital administrators – an aging population; a growing number of people with complex chronic diseases; operational financial pressures; and accountable care initiatives that focus on the delivery of patient-centred safe, high quality healthcare. There has never been a greater need for innovation in developing solutions that bring value through clinically effective, cost effective care.  At Southlake Regional Health Centre, our approach to creating sustainable change is focussed on shifting the culture across the entire organization.

The word culture can be interpreted in many different ways. At Southlake, it is The Southlake Way – the way we interact with each other; the way we think; the approach we take to problem solving; and our commitment to living our core values, every day. The Southlake Way is our commitment to the importance of organizational culture and falls under the leadership of our Director of Culture and Communication.

Our evolving culture has enabled us to work towards creating value in healthcare without compromising quality outcomes. We are relentless in our commitment to build an environment that expects and embraces high performance, celebrates tradition while welcoming innovation, and focuses on safety and quality.

Our physical transformation over the past decade has been dramatic. Now, our focus has shifted from building our infrastructure to using it to build upon our culture as a high-reliability organization where safe, high-quality healthcare is pivotal to exceeding the expectations of our patients. Our evolving culture is represented in our Vision – Shockingly Excellent Experiences, a proclamation that Southlake is creating a culture that thrives on delivering safety & quality, innovation, patient-centred care, and providing excellence to everyone we interact with – patients, team members and partners.

Safety & Quality

As healthcare professionals, we come to work each day with a set of beliefs and priorities that are formed by our individual life experiences. When I joined Southlake two years ago, I brought with me a heightened sense of the importance of safety and quality acquired from working in the aerospace sector, coupled with an understanding of the importance of core values, in building trust and developing culture. Delivering excellence in healthcare in an environment that respects safety is something patients and staff expect yet it takes a dedicated daily commitment to achieve.

As an emergency physician and later as an astronaut, I have spent my career working in zero fault-tolerant environments, where errors can have significant consequences. However, it was not until I became an astronaut that I learned of the importance of human factors, risk mitigation and culture in achieving peak performance in these environments. A zero fault-tolerant culture differs from a zero fault-tolerant environment in that there is an understanding that as humans, we are fallible. Yet in healthcare there is the expectation that we will perform without fault. In order to deliver safety and excellence in healthcare, we must reconcile human fallibility with the need to eliminate errors by embracing a system of checks and balances; to use error-trapping to create a zero fault-tolerant culture.

Error-trapping every day in every department and at every step is instrumental in developing a zero fault-tolerant culture. The space program accomplishes seemingly impossible objectives by embracing the credo Fail Ops Fail Safe meaning that the first error or anomaly will result in a situation where normal operations are not compromised. A subsequent second error will not impact safety. In fact it would take three sequential errors or anomalies before safety could be compromised. This error-trapping is achieved by building redundancies into the system – not unnecessary procedures, but rather additional processes to ensure errors do not impact operations. In healthcare there are many potential single point failures where an error or technology failure can immediately impact patient safety. If we have the ability to provide care with redundancy built in, we build a higher expectation for safe outcomes.

Southlake recently implemented Quality Huddle Boards for department-specific error-trapping. Whether it is the medicine unit, emergency department or administrative offices, they provide every member of the team with the ability to identify, discuss and address quality and safety concerns while immediately generating solutions.

The Rapid Response Team, part of the Safer Healthcare Now initiative, is another example of a process that empowers staff to ensure that safe, quality healthcare is at the forefront. If a patient’s physiological state is called into question by any team member at any time, this team rapidly assembles to proactively intervene and determine next steps.

Innovation

Another key way in which our Southlake culture supports our Vision is through innovation to push the envelope and find better solutions for our patients. Justine, a 35-year-old wife and mother, spent Christmas day with her family last year feeling ‘safe’ about her health for the first time in a long time. She became the first person in North America to receive an MRI-friendly implantable cardioverter defibrillator. Southlake’s Heart Rhythm team searched around the world to seek out a solution for this young mother with complex medical conditions. As healthcare professionals, it is both part of our culture, but it is also something we don’t take for granted. These transformative moments are the opportunities that we all strive for.

Patient-Centred Care

To focus our efforts to evolve and develop our culture, Southlake recently created a new five-year strategic plan. While we are working to take a number of bold steps in healthcare safety and innovation, one of my favourite commitments within this plan is that we will treat patients like family. Isn’t that a nice thought – to treat patients with the same care and respect we would treat those closest to us? Whether this is a cultural shift, or simply formalizing what most of us already subscribe to, this philosophy of patient-centred care is truly impactful.

I am very passionate about our institutional commitment to hand-hygiene as it crosses all of our cultural initiatives, safety & quality, innovation, and patient-centred care. This is an aspect of patient-centred care that literally places success in the hands of every single person who interacts with patients. Just a couple of years ago, Southlake had an overall score of 60% for hand-hygiene compliance. Now, we are continuously over 90%. How did we achieve these remarkable results? We made it part of our culture. We communicated why it was important and, even took it one step further by going ‘Bare Below the Elbows’, asking members of the Southlake team to roll up their sleeves and take off their jewelry while on patient care units.

We have included patients in our hand-hygiene efforts by placing sanitizer dispensers at the foot of beds in our Medicine Unit. That way, patients see that we are actively seeking to protect their wellbeing by cleaning our hands and they can encourage family members to comply as well. We have made it a part of our culture to seek and share solutions.

Our culture is woven into every interaction, whether with patients, between members of our team or with our partners.  It means walking the talk and making commitments. At Southlake, we are very proud of The Southlake Way. We have defined this as a culture that characterizes the qualities of compassion, innovation, excellence, and the ability to create opportunities out of seemingly impossible challenges.

When I came to Southlake I had learned about the transformative power of culture from my varied work and life experiences. What I have learned in this dynamic healthcare environment is that culture is something that evolves every day in very meaningful ways to ensure sustainable high quality care. I am thrilled to be part of the journey.