FEATURE


they identify issues to address at the next huddle.


“The OR has been doing huddles since we opened in 2007,” Holder says. “This concept was new to the other departments. Much to my sur- prise, they have done incredibly well. The huddles have become the founda- tions to our safety.” Also


critical to safety culture


improvement efforts at her ASC is the use of quality improvement (QI) stud- ies, Holder says. Topics addressed over the past few years include surgi- cal timeout and the use of the safe sur- gery checklist, immediate-use steam sterilization, Occupational Safety and Health Administration (OSHA) stan- dards and handoff communication. “Thanks to the huddles, staff is


always talking and brainstorming about opportunities for improvement,” she says. “I am never at a loss for QI study topics.”


Merrill says she made it a mission to


make sure her ASC’s staff is prepared to respond as effectively as possible to any crisis scenario. “That is becoming so much more a part of our job when you consider the new emergency pre- paredness regulations. These are criti- cal when you see what is happening with active shooters and other types of attacks in health care facilities.” To help with crisis preparation


efforts, Merrill taps into external resources. “We had a state trooper come in. He talked about scenarios that could happen, many of which we never thought about. That type of insight is invaluable.”


She has done the same for fire preparedness. “The fire department comes by for education and we put out an actual fire every October, which is National Fire Prevention Month. We even did an exercise where staff were challenged to close their eyes and try to find their way around the center. This helps simulate the experience of a smoky environment.”


Yoder says ASCs eager to improve


their safety culture will be best served by taking steps to remove barriers that might stand in the way of staff partic- ipation. “Leaders must make sure not to tolerate any bullying and harassing behaviors. Make sure your ASC has an open environment where staff feel free to voice concerns. If a staff member speaks up, hear them out and research their concern. Let them understand that you want them to be honest and come forward when there are ques- tions or concerns.” Yoder recommends ASCs con- sider using the Agency for Health- care Research and Quality’s Ambu- latory Surgery Center Survey on Patient Safety Culture—available at www.ahrq.gov/professionals/quality- patient-safety/patientsafetyculture/ asc/index.html—to assess staff opin- ion about the culture of patient safety. “That tool helps staff think about and answer questions concerning where they work, how they feel when they are


at work and how they perceive patients are being treated,” she says. “Try to get all of your staff and physician partners to fill it out. Valuable information can come from the survey.” Do not overlook the importance of


When you embrace the importance of a safety culture, I think much of the work required comes naturally.”


— Debra Yoder, RN Surgical Management Professionals


physician involvement in safety efforts, Merrill says. “I have pushed our physi- cians to become even more involved and engaged. Everyone looks to them for leadership. We have a picture of one of our doctors putting out a fire during an exercise. He was shocked about the weight of a fire extinguisher. Doctors need be fully trained and ready to go, just like staff.”


Reaping the Rewards A commitment to improving safety culture can deliver significant benefits, Yoder says. “When you create a safe environment, staff flourish and grow. Happy employees typically translate to happy surgeons and happy patients. When you embrace the importance of a safety culture, I think much of the work required comes naturally.” Merrill believes the efforts under-


taken at Endoscopy Center of Niag- ara are having a positive impact that extends beyond the walls of the ASC. “Through our exercises, we are pro- viding staff with a better appreciation of awareness and knowing your sur- roundings. Safety culture should be a way of living and not just contained to the center.”


The improvement efforts under-


taken at Andrews Institute ASC have paid off, Holder says. In August 2017, the ASC conducted its annual safety culture survey. The employee rating was more than 95 percent—an A+ to Holder. “That was my personal goal,” she


says. “We have seen improvements in team building, morale and effective- ness of identifying and handling safety issues and a decrease in incidents. The employees feel they have a voice and they use it. That helps everyone.”


ASC FOCUS APRIL 2018 |www.ascfocus.org 19


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