Bridging the Gap: Safety Forums for Executive Teams and Frontline Staff

Background: Early detection of potential harm and improved communication and teamwork at all levels is critical to providing safe care. Current adverse event detection methods often fail to capture as many as 90% of adverse and near-miss occurrences for timely intervention or prevention. Multiple organizations have implemented executive rounding processes to improve relationships between frontline staff, physicians, and senior leaders and increase reporting or recognition of potential safety events. Exposure to frontline teams enables leaders to demonstrate their commitment to building a culture of quality and safety and increase transparency. Case: A recent increase in the number of patients emergently transferred to the intensive care unit led to a series of conversations with frontline staff and physicians to understand potential failures leading to the change. Themes from the focus groups revealed a failure to recognize deterioration or reluctance to escalate concerns to appropriate personnel. The purpose of our project was to design and implement an innovative process in which frontline staff and physicians had regular interaction with the executive team to discuss and resolve existing and potential patient safety concerns. Our intervention included attendance of senior leadership representatives at 12 regularly scheduled meetings designated as safety forums instead of random walk rounds. Team members present during the forums included frontline physicians, nursing staff, attending physicians, nursing leadership, and supporting services. Each forum served as a plan-do-study-act cycle that enabled our team to modify the format for maximum effectiveness. Conclusion: Twelve safety forums were held during the pilot period, and more than 200 frontline staff and physicians were affected. The executive team was able to interact with the groups and create a safe environment to discuss safety concerns. In total, more than 100 issues were identified and resolved or referred to appropriate personnel for follow-up. Resolution and action plans were presented to the groups at subsequent meetings. Multiple safety concerns and process issues were collected, and rich discussion within the group enabled the senior leaders to better understand barriers and process issues interfering with optimal patient care delivery. © 2014 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses