2017 MOREOB Patient Safety Award Winner
Moving house is recognized as being a significantly stressful event in the life of a human being. There are often weeks of preparation and packing, and then physically moving everything from one location to another. Then comes the “getting settled” and falling into a routine, which often takes weeks and more moving within the new home.
On September 10, 2017 the Campbell River Hospital moved. There were years (rather than weeks) of preparations, then months of packing. Layered within this was moving from a building that was showing its age, to a state of the art facility with all new layout, equipment and many new processes. All this would be enough change and disruption to deal with as staff – but we needed to move the patients as well!
As the craziness came to a peak around the 8th of September, one of the senior physician leaders was grilling all the departments on preparations and readiness for the move. His comment: “Through all of this Maternity has always kept its’ s*** together.”
The maternity department was able to “keep it together” because of MOREOB.
The Campbell River Hospital is located on the east coast of Vancouver Island in a small city of 35,000 residents. It also serves communities of northern Vancouver Island and surrounding islands such as Quadra and Cortes. There are approximately 400 births per year.
We started our MOREOB journey in early 2016 and in less than 2 years we have seen a sea change within the maternity department. The structure of MOREOB means that physician and midwife providers are accustomed to working closely with nurses and other staff as we do simulations, drills and reviews. MOREOB provided valuable tools such as FMEA, simulations and Take-5 debriefs as we made our transitions plans, and it was obvious that this multidisciplinary approach made the hospital transition easier and safer for both patients and staff.
We started our Milestone 4 in the late spring of 2017. The new hospital building was essentially complete and installation of equipment was ongoing. Each team member in every department was expected to undergo training within the new facility. The MOREOB Core team set up Milestone 4 with focus on Failure Mode and Effect Analysis (FMEA) and 5 different scenario / process simulations in our new building (with our new equipment) in anticipating potential safety issues in our environment and new processes before the move.
Using the FMEA lens allowed us to evaluate new processes with a critical eye that we might not have had otherwise. We were able to identify potential weaknesses in processes, with the view to change or mitigate any safety issue before it arose.
In August we held 3 simulation days with five simulation scenarios each day. Nurses, OBs, midwives, family doctors as well as the pediatricians were expected to participate together. We had almost 100% participation and the learning that came out of the drills was both reassuring and enlightening. We did a bit of “search and find” to learn where equipment was kept. We ran drills on emergency C-Sections, vaginal delivery, PPH, induction of labor, transfer of patient from the ER to maternity (imminent birth or trauma) and an NRP drill leading to the nursery. Practicing moving a patient on a new bed, out of a new room and down a new corridor to a new OR was exciting (but the kind of exciting that makes you nauseated.) We used the Take 5 debrief tool throughout the simulation days and many small changes were made in anticipation of moving day.
September 10th at 5:30 am the new hospital opened with the ER and Maternity opening first. Our first laboring patient came through the doors not long after this and the first epidural was placed at about 8:30, just after the post-partum patients and their babies moved over from the old hospital. The first baby was born around 10:30 and the second baby around supper time. At 2:30 in the morning the first emergency C-Section (and first ever surgery) took place. Although the first day was stressful, our preparedness allowed us to focus on our patients and all deliveries had positive and safe outcomes!!!
Each of these first were incredibly exciting, but also felt natural as we had rehearsed for precisely these situations ahead of time. When the team members knew where to go, where equipment was, and how to help each other, it was because they had all trained together in the weeks leading up to the move. The move was deemed a success based on the safe patient care, staff feedback at team meetings and great patient feedback. We feel that the unique Milestone plan that was created to prepare our team for a safe transition to a new hospital was extremely valuable in ensuring safe care during and after the move. We likely would not have had such positive outcomes if it wasn’t for the structure provided over the preceding year by MOREOB.
On the third day in our “new home” a situation arose which demonstrated one of the significant learnings from MOREOB – the elimination of hierarchy. A nurse attending a laboring woman found a presenting part other than a head on vaginal exam, and when she was unable to get the primary care provider immediately by phone she called the OB on call directly. The patient was very quickly safely delivered with both providers in attendance. The nurse commented that she initially felt incredibly stressed when the call would not go through to the PCP “but then I remembered that MOREOB says there is no hierarchy in an emergency, so I made the call to OB without worrying about the consequences.” This is just one of many examples of our culture shift since MOREOB.
Further evidence of change in our department is reflected in our recent mid-Culture Assessment Survey which demonstrated an increase in all 6 elements of the safety culture. Our highest scores were in the elements of empowering people and valuing individuals and teamwork – and teamwork is what it took to thrive in the midst of all this change.
Senior leadership within Island Health has been supportive of our efforts to bring our multi-disciplinary team together for learning, including ensuring there were funds to compensate physicians and midwives for part of the time spent in the FMEA process. There is also a recognition that the entire health authority is on the MOREOB journey. Each site (from large tertiary referral centre to small rural site) is participating, but the Milestones are personalized to meet unique needs. Having the opportunity to meet periodically as a region and hearing the experiences in other sites has been invaluable encouragement.
The move to the new Campbell River Hospital was completed safely and the transition is ongoing. MOREOB has provided the tools and structure to increase patient safety by enhancing staff competence, confidence and satisfaction (utilizing evidence-based care and a team approach.) We look forward to 2018 and our next Milestone learnings.
“There are far better things ahead than any we leave behind.” CS Lewis
Respectfully Submitted by Dr Jennifer Kask MD, CCFP, FCFP