Program Overview

Figure 1

10 Functions Essential to In Safe Hands

Clinical Teams are ‘microsystems’ that are bound by a common purpose (providing care to a group of patients) and a place of work, and have identifiable functions (see below). In Safe Hands identifies these functions and enables and supports the clinical teams to identify the standards, tools, skills and resources required to perform these functions.

Many of the standards, tools, skills and resources needed are already available, provided by excellent programs such as Essentials of Care, the Clinical Leadership Program and Take the Lead. In Safe Hands brings these and many other solutions together under one uniting banner. Many of these solutions are already in place in units and facilities across NSW or are in the process of implementation. These solutions have been developed and designed, in response to information derived from the NSW Patient Safety and Clinical Quality Program and based on advice from clinicians, Directors of Clinical Governance and managers. These solutions also draw upon the international evidence of works. More recently, recommendations from the Garling Commission of Inquiry and initiatives being led by the Ministry of Health (espffice), the Clinical Excellence Commission, the Agency for Clinical Innovation, and the Clinical Education and Training Institute have enhanced the array of solutions available.

1. Leadership and Governance: Without good leadership and governance, teams are less effective.

• M/NUM role redefined to emphasise their role in the clinical coordination of care
• Interdisciplinary leadership (nursing, medical & allied health) to ensure optimal decision-making
• Clarity of delegated authority between unit leaders to avoid ambiguity

2. Team Structure and Dynamics: Teams and unit leaders require structures for decision-making and consultation, and the roles of individuals need to be clear.

• Ward rounds are the essential decision-making structures of clinical teams
• Uniforms to help patients understand team member roles
• Name badges to identify team members and help patients understand their roles
• Ward notices that identify the leaders to let patients know who they can turn to for help

3. Care Planning, Coordination and Delivery: An essential function of the team is to plan for and coordinate care of their patients.

• Care planning with objectives, so the patient and the team know what the goals of care are
• Care coordination by identified members of the team, particularly the NUM

4. Standard Protocols and Procedures: Standardisation of core procedures at the ward or unit level ensures greater efficiency and effectiveness.

• Handover checklists to ensure essential information from shift to shift
• Standard observation charts to ensure the most important vital signs are recorded and trends can be identified

5. Patient Safety and Quality Systems: These systems ensure that lessons are learned and acted upon.

• Incident reporting and review leads to risk identification and continuous improvement
• Risk register to support risk management
• Prioritisation to ensure the most important issues are dealt with first

6. Patient Experience: Teams must focus specifically on managing patient experiences and establishing procedures for doing this.

• Asking, listening and responding to patient needs and concerns
• Complaints management early and in person to minimise loss of confidence

7. Education, Training and Supervision All members of the team need to be appropriately educated and trained for the roles that they perform.

• Core skills training (e.g. DETECT) to ensure all members of the team can perform their essential roles

8. Workforce Management: Effective workforce management means having the optimal balance of people with the right knowledge and skills in the right places at the right time, within the available resources.

• Rostering for seniority to ensure leadership and clinical skills are available at all times
• Skill Balance to ensure appropriate skills are available for managing the patient group in the care of the team

9. Support Services and Equipment: These are essential for the delivery of good care and systems in place to manage them are required to ensure that they support clinical teams effectively.

• Supplies management to ensure availability to meet clinical needs
• Prioritisation of equipment to meet needs

10. Information Management: Good care depends on good decisions, which depends on having the right information at the right time as a foundation for these decisions.

• EMR to ensure ready access to patient information
• Decision support to ensure clinical decisions are supported by the best available information and evidence

In Safe Hands Forum

The In Safe Hands Forum was held on 7th September 2011. Presenters included international speakers Mary Salisbury and Jason Stein. Mary Salisbury, President of the Cedar Institute, Inc. N. Kingstown, Rhode Island, USA. Mary shares with us the journey and actions crucial to developing and ensuring high performing, highly reliable teams.

Dr Jason Stein, Associate Vice-chair for Quality in the Department of Medicine and Associate Director for Quality and Research for the Division of Hospital Medicine at Emory Hospital, Atlanta. Jason shares with us his experience of establishing Standardised Interdisciplinary Bedside Rounds and the major impact these have had on patient outcomes.

The two international speakers were joined by several other presenters, including: Julie Johnson Clinical Teams as Microsystems, Christy Pirone Making Teams Works, Debra Thoms Essentials of Care in NSW, Steven Boyages Education for Teams, Richard Tewson Coaching for Teams and Nicole Manning Excellence Programme who shared their experience and understanding of how to implement effective clinical teams.

The forum was well attended and much appreciated by those who attended (based on the evaluations), and generated much interest in implementation after the event.

To view the presentations please click on the link

Contact