 Hi everybody, this is Donna Prosser with the Patient Safety Movement Foundation here to bring you another COVID-19 update. We're really excited today to be joined by Dr. Anthony Staines. Dr. Staines is joining us from the Vaugh Hospital Federation where he is the Director of Patient Safety and Quality Improvement. Today we're going to be talking about how we can better leverage the skills of our patient safety and quality improvement experts. Welcome Anthony, thanks for joining us today. Thank you for having me. I wonder if you'll tell us a little bit about your background and how you got involved in quality and safety. It's a pleasure. My background I've been a hospital CEO for about 10 years in Switzerland and I've had the opportunity to lead quality improvement programs in the hospitals I've worked for and I sort of fell in love with quality improvement and patient safety. And after about 10 years I had an opportunity to go back to studies and to do a PhD and I chose as the topic of my dissertation Quality Improvement and Patient Safety for for healthcare and now it's about 12 years that I've been in quality and safety in the healthcare field. That's wonderful. Well I know that you have been talking to a lot of patient safety and quality improvement experts around the world. This COVID pandemic has certainly shown a light on the cracks that we have in our healthcare systems. Tell me what you're hearing from these professionals across the world during this pandemic. Well at the very beginning of the pandemic crisis you know in the patient safety improvement program that I've run I work with 12 hospitals in the region of Vo in Switzerland and in each of these hospitals there is a quality and safety officer and I run meetings and this was a virtual meeting because it was at the beginning of the pandemic and I had prepared to see how can quality and safety help in a time of pandemic and I must say that I found rather little in the literature about how quality and safety can help and then I had these about 10 people on the on the video conference and they were saying well what can we do actually and I felt that I was a bit lacking experience and ideas about what can be the contribution in a time of pandemic and I asked them what was their situation and I realized that about about half of them had been sent home and their CEOs had told them well we're hibernating your quality improvement program or your patient safety program and your non-essential staff so please go home not to complicate the problem but not that we get more people infected please go home and we'll see later what you can do and so they were full of questions and about the other half of the people I had on the line were saying well we have anesthesia skills or we have intensive care skills so we've been asked to join the intensive care team and help out which is absolutely fine but still the result of all that was that half of the people were sent home with their program hibernated and the other half were doing clinical work and no one was left doing actually quality and safety work and that really got me thinking thinking well if I am a believer that quality and safety people have skills that are useful in such situations then what can I suggest to them and so that led me as I could find not much in the literature it led me to reach out to colleagues to authors people that I admire people like Don Burwick like Charles Wilson, Charles Vincent, Renea Mulverty, Jeffrey Braceway, Peter Lachman etc and say can you help me out and brainstorm with me on what can what are the skills that can be used and brought forward by quality and safety improvement people in a time like this that's the story oh that's great patient safety and quality improvement is often considered to be more of a long-term process not a short-term solution so tell us about the suggestions that you have come up with this group of folks across the world what can safety and quality people do right now in hospitals well first of all I will say I completely agree with you that it's more of a long-term program which is the reason why almost no no one had experience and which also means that my idea is really not to blame anyone for things that had not been done because I didn't have many ideas of what quality improvement and patient safety should do in such a crisis so it was just the idea to brainstorm so the group of colleagues came up with with five I will call them primary drivers for quality and safety the first idea is to strengthen the system for instance to start by assessing readiness of your healthcare facility you know there are for instance checklists WHO has a checklist to offer but there are other checklists to assess readiness another idea is to gather evidence at the beginning of the pandemic everyone wants to know what kind of disease is that how does it operate what are the characteristics etc and so helping gathering evidence is is something that quality and safety officers do all the time for their improvement programs and that they can contribute to also setting up just-in-time training for instance training on how to put on personal protective equipment or how to take off personal protective equipment another idea to strengthen the system would be promoting staff safety by staff safety I mean both psychological safety being able to express their fears their their worries and things like that and also physical safety and frankly from what I've seen I'm not sure we've done the best we could in terms of promoting staff safety in the time of the crisis and I think we have quite a bit to learn from from that and also organizing like peer support you know for instance when there is an adverse event in the hospital there can be healthcare professionals that traumatized by the adverse event we call them second victims and it's quite a good idea quite efficient to have peer support in such cases but in a time of pandemic I think you need similar peer support because there are also colleagues that are traumatized for instance for having seen a patient die in intensive care or having seen a colleague that is infected by covid and they that is going through a very time all this is quite threatening for the staff and so peer support I think is very important so that would be the first idea the second idea would be to engage with citizen with patients and their families for the co-production of of solutions for prevention for isolation for treatment for recovery so helping the organization to leverage partnership with patients or to set up partnerships with patients I think could be very very useful I was impressed for instance with what was done in Quebec in Canada who has a long-standing tradition of involving patient partners and so what they did is they mobilized their patient partners pre-existing to see does any one of you have experience of having gone through isolation during a pandemic and what can you advise us to do to help out patients and to co-produce solutions for the this time of pandemic for our patients so I think also their quality and safety improvement has skills to build and to leverage partnership with patients the the third idea of course it and is probably one that has been the most used is to work on improving care through actions such as the separation of flows the flash workshops for instance on teamwork teamwork is so important in the time of pandemic teamwork helps foster resilience and so reminders flash workshops on what you absolutely need to know and this cannot be a one-day education it can be 15 minutes here and 15 minutes there just in time training for instance and also the development of clinical decision support then of course there's the the essence of patient safety which is reducing harm by proactively managing risk and then there I'm talking of risks for patients with COVID but also risks for patients not with COVID which are also at risk if you focalize all of the attention on the COVID patients for instance it could be updating infection control guidelines but doing that with human factors people so that you make your guidelines digestible I don't know if it's the right word in English it's how we would say it's in in in French because I've heard so many people saying look there was a time where we got like three new guidelines per day in terms of infection control and these were five pages guideline and it was absolutely impossible for us to keep up so we just put them aside and then the best we could relying on our professional knowledge etc and so here I think for quality and safety people being the interface between infection control that has the knowledge of what should be done and human factors people that have the knowledge of how it should be wrapped up that have the knowledge of the social marketing that is that is needed to make it easily accessible that knowledge to the professionals I think this would be wonderful also like just-in-time audits of the relevant standards for instance in my region we have a hospital it's called the the Balkan du Jura healthcare network they managed during the first week of the pandemic there were very few patients then but the pandemic was there already they managed to do a just-in-time hand hygiene audit and to spread the results within the hospitals and that has been very very helpful also for instance helping prevent pandemic associated pressure injuries for instance pressure injuries linked to the prone position or pressure injuries linked to personal protective equipment that would be also a possibility so that was the fourth idea and the fifth idea is to work on the learning system so it's boosting and leveraging the learning system to capture improvement opportunities to adjust very rapidly to develop resilience and that is so important in such a case because of the lack of knowledge we have about the disease at the very beginning so as we don't know how it's going to to unfold we have to capture all of the opportunities the adverse events the errors the perception of the staff the complaints of the staff etc all of this has to be captured but unfortunately everybody is is running after time and it's very difficult to take time to go into the information system to feed in errors and adverse events so for instance to give you an example of a system that I admire I had contacts with the Nightingale Hospital in London which is the surge hospital that was opened in the conference centre in excel in London with about 3000 extra beds intensive care beds and they had quite a challenge because they were set up in two weeks two weeks before they didn't exist and two weeks after the decision they were operational to welcome their first patients and they were functioning with staff coming from all around London and even wider away people that did not know one another that did not know the procedures of this new hospital so what they decided to do is to invest in the learning system and the the position that they created was called hospital bedside learning coordinators bedside learning coordinators and the role of these people was to listen to the so they were in each of the wards and they were listening to their colleagues and so all of the colleagues who noticed an error an adverse event a risk a learning opportunity we're telling that to the um learning bedside learning coordinator and these bedside learning coordinators were gathering every evening with the hospital management with the quality and safety improvement department doing a debrief of the day and adjusting the system according to what had happened in the ward and the next day they were going back to their colleagues with the solutions saying we've decided we want to change this and change that and that's the new way of operating that's the new standard operating procedures and they were not coming with piles of papers they were coming with a condensed version of what had been decided the night before and so it was sort of working like a lung you know the whole hospital gathering from the bedside to the the the upper management in the evening back in the morning to the to the bedside and back in the evening etc and every day that movement was going on and I thought that's exactly what we need and there's so much to learn not just for a crisis but I guess for every day so I hope this can help I'm not saying that uh I would not have had all of these ideas at the very beginning and when the the safety officers asked me what ideas I had I had just very few amongst these but these these are a few ideas that were brainstormed with the group of colleagues as a foundation for the paper that you see wonderful well we're going to be sure to share that paper with all of our network along with this video and I really appreciate all of your all of your suggestions these are fabulous and I agree with you this is probably not something that is just in a pandemic this may be the new normal for quality and safety professionals moving forward and I think it teaches us that there definitely is a role for quality and safety improvement people during a crisis during a pandemic it also shows that in order for that to happen it would be good for the quality safety officer to be included in the uh in the system that runs the crisis uh in the command center I don't know how you call it doesn't really matter but if we forget to include the quality and safety officer there then it it diminishes the probability that quality and safety will be able to help because quality and safety will be sort of hibernated and will not have access to the needs of the structure and not see how it can help in such a time of crisis excellent point well thank you so much for joining us today I really appreciate all of your information and we are going to share this with our network and uh and we'll share the the link to your paper as well wonderful thank you very much for your time thank you as well have a great day thank you