Red Rules - First Do No Harm!

Hospitals are complex organizations. One one hand, its nothing short of amazing that we can orchestrate dozens of departments to work in concert with each other to provide care to literally hundreds of patients each day with relative ease. On the other hand, it takes hundreds of policies, procedures, and protocols to make sure that each that each patient gets the right care at the right time and in the right manner. Given that these are mainly human processes, there is obviously a high potential for things to go astray despite everyone's best efforts. At best, this can create a service delay or dissatisfaction, but at worst, the results can be catastrophic. Therefore, we must have a way to both navigate and differentiate the multitudes of rules that we depend upon to make our organization run.

With that thought in mind and in recognition of National Time-Out Day, today we officially kick-off our first organizational "Red Rule." Our first Red Rule addresses pre-procedural time-outs within the hospital. While not a new concept, this is one policy and practice that when done right has been proven to save lives in hospitals across the country and one that we feel is of utmost importance to the hospital and our patients.

Below is a copy of a communication I recently sent out to our team at the hospital. I would be interested in hearing how others are dealing with this same issue or thoughts on how we can continue to improve.

"As many of you are aware, our organization, led by Chief Medical Officer Dr. Lynn Simon, has embarked on a goal of achieving “Zero Harm” to patients by 2013. While this is an aggressive goal, it is a worthwhile one and one that we are focused on reaching. When patients trust us with their care, our objective should not only be to get them well and home soon, but to also have no harm done to them while they are in our care.

One way that we will be focusing on achieving this goal is through the creation of “Red Rules.” Red Rules are non-negotiable behaviors that are expected and supported throughout the organization. As such, the rules are not difficult but we must have complete compliance to be effective. Sanctions will be administered to any individual— including physicians and team members —who do not support and adhere to these behaviors. The purpose is not to be punitive, but rather to instill accountability in our team for practicing safe behaviors in helping our patients.

Our first Red Rule is to require all departments to conduct an “active time out” prior to the start of a procedure. We’ve found that previously, many departments had different definitions of what an “active time out” is so we have clarified by developing a consistent definition that will be used across the facility. The steps of an active time out are:

1. Announcement of the “time out.”
2. Verification: all other activity stops and the patient’s name, site/side and procedure are stated and confirmed.
3. Verbal confirmation: each person involved in the procedure in any way confirms.
4. Announcement of “time out completed.”

Part of being able to enforce Red Rules is having a culture to give team members the freedom to stop a procedure at any time if they feel that the process has not been appropriately followed or the patient’s safety is at risk. Let me take this moment to reassure each of you that you have my, and the rest of Administration’s, utmost support in this initiative. While it may not always be comfortable to have a confrontation of this sort with a fellow team member or physician, it is what is in the best need for the patients we serve and as a result, you need not fear being reprimanded if you are simply ensuring that a Red Rule or patient safety is being followed. In fact, I would argue that this is not only what is allowed of you, but what is expected.

Achieving our goal of Zero Harm by 2013 is going to be an aggressive target—but I am confident that through the Red Rules and our culture, we can absolutely achieve it! Please feel free to reach out to me at any time should you have concerns or suggestions about the adherence to Red Rules. Our patients are depending on you. Thank you for your support."

Red Rules - First Do No Harm!

Teaching and Leadership in Action

Most of you know that meetings are an everyday fact of my life. From meetings with our staff, physicians and community members to development initiatives, quality improvement and everything in between, all is fair game in my day-to-day life. Today, one of the people I had the pleasure of meeting with was Dr. Ed Halperin, Dean of the School of Medicine at the University of Louisville. Dr. Halperin and I meet fairly regularly to discuss any number of efforts that we are working in concert on between the medical school and our hospital. What made today special was how the meeting began...

As busy as our schedules get, we set up this meeting at his clinical office which I walked to on campus. When I got there I was greeted by his nurse who quickly brought me to the back to meet with Dr. Halperin. She brought me around to one of the exam rooms and I realized that he was still with a patient and I quickly stepped back so as not to intrude. However, Dr. Halperin had invited me in to meet this patient who had to travel all the way to Louisville from Alaska to seek her healthcare. This patient has a rare lymphoma of the eye that requires specialty radiation therapy not offered in her hometown. She went on to explain that there are other facilities in neighboring states that could care for her condition, but she could not afford to pay $86,000 in advance to begin her medical treatment which ultimately lead her to Louisville. A sad commentary on our healthcare system no doubt, but that can be the subject for another posting.

From there, Dr. Halperin completed his consultation with the patient and also took the time to educate the medical resident that was with him (and myself) about the intricacies of treating a patient with this disorder, and calming the fears of a patient who appears to be on the road to recovery as a result of his care. Without missing a beat, we then proceeded to another exam room to conduct our meeting. It was certainly an interesting venue in itself for a business meeting and a great environment to keep things in perspective!

In these tough economic times where everyone is being asked to get more accomplished in less time, it is refreshing to see a leader who is managing to juggle and keep his priorities in check. Not only is Dr. Halperin the Dean of a large public medical school, but he remains true to his roots as an educator, a physcian, and an advocate for patient care. The University is fortunate to have such a capable and balanced Dean who defines what it means to be both a teacher and a leader!

Teaching and Leadership in Action

For a Good Cause - "The Larosa Loop"

Saturday was a special day for our team members at Frazier Rehab. After months of planning, this year's "Larosa Loop" turned out to be one of the biggest yet with almost 400 participants in this family run, walk, and cycling event to honor the memory of the late Ethel Larosa-Klemens.

Dr. Larosa was a special physician who was certified both as a pediatrician and a physiatrist. There are not many physicians who have achieved this rare combination of specialties and we are still searching for someone who can attempt to fill the big shoes that she has left behind. Dr. Larosa was a champion for innovative pediatric rehabillitiation at the Frazier Rehab Institute and in her tenure, she helped rejuvenate and rehabilitate countless injured and physically limited children that were in her care. Unfortunately, at the early age of 37, Dr. Larosa lost her own battle with cancer in 2006, but her memory still lives on today. Today, we honor her legacy through this event that her family helped create with the Jewish Hospital & St. Mary's HealthCare Foundation. The event sponsors an endowment to provide scholarships to female medical students pursuing a degree in pediatrics or physiatry.

I had the pleasure to talk with Dr. Larosa's husband, Dr. Jim Klemens, as well as Dr. Larosa's mother and brother. Each shared with me personal stories of their memory of Ethel and it was obvious to see how much she is missed. Her husband Jim told me how they would trade stories when they both came home from work, and how he could never compete with her as she would tell him uplifting stories about how she helped a child learn how to walk again after being in an accident or similar situation. For all this event is a labour of love, but one they are proud to keep moving forward.

I am glad that I had the chance to share in this event and meet such wonderful people that are dedicated to the future of our children in need of rehabiliation. While we will miss Dr. Larosa, we can be comforted in the fact of how many children she had helped in her lifetime and how many more we will be able to help going forward in her memory.

For a Good Cause - "The Larosa Loop"