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Patient Safety in Action: Irwin Army Community Hospital Builds a Tiered Safety Briefing Structure

Civilian and military staff at Irwin Army Community Hospital are gathered in a room to briefly discuss quality and safety concerns across the organization. Mr. Jon Cranmer, head of facilities stands to give his update. Mr. Jon Cranmer (far right), head of facilities at Irwin Army Community Hospital at Fort Riley, Kan., gives his update at the hospital level (Tier 3) leadership safety briefing. These briefings are held every morning to maintain awareness across the organization.

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Daily safety leadership briefings are a leading practice in health care facilities. Every morning, these brief meetings allow senior leaders, department and unit leaders of the organization to establish shared situational awareness of safety or quality issues from the last 24 hours and discuss any anticipated concerns for the next 24 hours. 

These briefings also increase transparency and enable staff to resolve issues faster by collaborating to solve a problem or share lessons learned from one unit to another. That’s what staff at Irwin Army Community Hospital at Fort Riley have been experiencing since former commander Col. John Melton implemented the tiered leadership safety briefings almost ten months ago.   

“Our process is that we have a clinic/team level huddle (Tier 1) and then roll up the information to a service or department level (Tier 2) huddle,” explains Mr. Reynold Mosier, deputy to the commander for quality and safety. “In large areas, there may be several Tier 1 level huddles that feed into the Tier 2 level huddle.”

For example, the surgical clinics have a clinic-level huddle and then one of the leaders meet with the other leaders from the surgical section for a service-level huddle. The third tier, called the daily operations brief, is at the hospital level with each section represented.

The huddles take place every morning from 7:30 to 9:30 a.m., including weekends and holidays. Staff who cannot make it to the meeting, such as staff at outlying clinics, can participate in the daily operations brief via telephone conference. These briefings are recorded and uploaded to the hospital’s SharePoint site so managers and shift workers can listen as their time permits. In the past, leaders tried hosting all virtual huddles, but the staff like to collaborate face-to-face directly after the in-person meeting. 

“Our Tiered Huddle System was deliberately designed using the TeamSTEPPSTeam Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) is an evidence-based teamwork system designed to improve the quality, safety and efficiency of healthcare. TeamSTEPPS consists of a collection of instructions, materials and tools to help drive a successful teamwork initiative from the initial planning to implementation through to sustainment. The system is designed to improve patient safety using a three-phase approach: Phase I Assessment: Facility determines organizational readiness; Phase II Planning, Training & Implementation: Facility “decides what to do” and “makes it happen;” and Phase III Sustainment: Facility spreads the improvements in teamwork performance, clinical processes and outcomes resulting from the TeamSTEPPS initiative.TeamSTEPPS® concepts to facilitate intraorganizational communication and collaboration,” said Lt. Col. Donald Sexton, deputy commander for administration. “The system enables us to gather information from the frontline teams and share it with teams across the entire hospital. This allows us to quickly identify organizational risks, respond with a multidisciplinary approach, and provide timely feedback across the system.

“As we move toward high reliability health care, our hospital is trying to enhance employee engagement and communication at all levels,” Sexton said. “The approach we are taking enables team communication, mutual support, and a shared mental model to identify and respond to unanticipated events.”

The IACH leaders credit the daily briefings for decreasing downtime of services, improving staff morale and improving the quality and safety of care such as identifying infection control issues.

“We saw a trend of plumbing issues across the organization which could have led to an increased incidence of infection control concerns. With this knowledge, we set out to ensure every employee understood basic infection control prevention standards,” Mosier said. “Without our briefing process, I don’t think we would have been able to identify and respond to this risk in as timely of a manner.” 

The briefings are structured to focus on quality and safety, and synchronize operations across the organization; larger announcements of events happening a few days or a week away are reserved for other meetings. Each Monday, a quality or safety topic is introduced as a focus for the week. For example, in winter, cold weather safety and hazard reporting was discussed to reduce falls in the parking lot and prevent overall organization risk. 

IACH’s new commander, Col. Ted Brown, who came on board in January 2018, has learned a lot about his organization in a short timeframe because of the briefings. 

“I have experience with similar briefings, but none executed to this extent across the entire team,” Brown said. “Engaging the entire organization down to the frontline clinical worker and the immediate collaboration that occurs is one of the key strengths. This briefing process has flattened the organizational structure and empowered individuals; now everyone has a shared understanding of what is going on and can resolve issues much faster.”

Sustainment of these processes can be a challenge for military health care teams that experience staff turnover.

IACH leaders plan to mature the unit and hospital level huddle communication to maximize input from all staff. Part of this will be completed with executive leader engagement at the Tier 1 and 2 huddle levels, implementation of visual management boards, and continuous application and education of TeamSTEPPS.  

“I would encourage other MTFs to look at how they can adopt similar processes to make communication more efficient and productive,” Brown said. “Our goal is to enhance our Tier 1 huddle process and incorporate lean daily management principles to help synthesize the vital information that is shared in this huddle. As the new commander, I benefited greatly from daily engagement in the huddles, which facilitated a smoother and quicker transition than I have experienced previously.”

Col. Melton, who helped start the tiered leadership safety briefings, is now implementing it at a larger military treatment facility. IACH leaders are also presenting on their briefing structure at the American Hospital Association’s National TeamSTEPPS conference in June.

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