Digging for Dinosaurs: Towards Better, Safer Care

February 29, 2024

Digging for Dinosaurs: Towards Better, Safer Care

Have you ever asked yourself, “Why do we do things this way?” Last fall, in conjunction with Canadian Patient Safety Week, teams from the Health Workforce Innovation Challenge were invited to reflect on this question through the Dinosaur Mini-Challenge. By “digging for dinosaurs” around their work practices, teams identified and worked to re-examine practices that no longer promote safety.

Quality and patient safety improvement doesn’t need to be a big project. In some cases, it can be a small change – like eliminating an unnecessary process. Considering the ongoing challenges to retaining and supporting the health workforce, the Dinosaur Mini-Challenge encouraged teams to question their practices in a light and fun manner. It also emphasized how everyone can contribute to patient safety and open communication across all levels in the health system leads to better, safer care.

Sometimes it’s about taking things away

At Gabriola Medical Clinic, one of their biggest workflow challenges was the redundancy of uploading Do Not Resuscitate (DNR) and Medical Orders for Scope of Treatment (MOST) forms to a shared database with the nearest hospital. These forms are essential for patient safety since they inform the emergency department at the nearest hospital about patients' wishes regarding resuscitation and end-of-life care. Getting these forms into the patient chart and then into the shared database was cumbersome (taking 16 steps) and time-consuming (four minutes per form).

When the team looked closely at their Electronic Medical Records (EMR) system, they found a more efficient approach of scanning and linking forms directly into their patients’ charts. This approach allowed them to download documents directly from their EMR to the shared database folder, eliminating four steps.

“The staff felt empowered that they could make a change, that their input mattered and best of all, the outstanding 37 documents were uploaded to the hospital within the week, a task that would have normally taken at least two weeks,” says Angela Pounds, Gabriola Chapter Coordinator at Gabriola Medical Clinic.

The team at Camrose Primary Care Network faced similar redundancies. With physician partners working outside of their EMR system, health providers often duplicated patient charts when sending updates to physicians. This affected the providers’ availability and delayed communication with physicians. The solution? Examining their EMR system and maximizing its features like the ability to prepopulate information with proper programming. This way, providers avoid duplicating their work and frees up their time.

Likewise, Kingston Health Sciences Centre uncovered an outdated practice with the workflow of their medical radiation technologists. Previously, staff transcribed daily tech assignments and weekly responsibilities onto whiteboards around the department. Until digital scheduling systems came along, this was a common practice. Now, this process duplicates the information readily available in these systems. The team plans to eliminate the duplicative practice and monitor the results through staff feedback collected through weekly huddles.

“The impact was evident as it sparked conversations about all sorts of processes around the department. It also resulted in the creation of an “ideas board” where staff can post QI [quality improvement] suggestions,” says Jeffrey Koob, Charge Technologist at Kingston Health Sciences Centre. “It has created another means of communication within the department and [has] given staff an eye for process improvement and increased overall engagement.”

While the changes at Gabriola Medical Clinic, Camrose Primary Care Network, and Kingston Heath Sciences Centre may seem small, they greatly reduce administrative burdens, increase staff morale and improve patient safety. By “digging for dinosaurs,” these organizations empowered staff to spot opportunities, even small ones, to improve their day-to-day workflow.

Everyone contributes to patient safety

How do we create a culture of continuous improvement toward better, safer care? One way is by cultivating open and transparent communication among staff across all levels.

At Island Health, the Psychiatric Emergency Services (PES) Mental Health Unit at the Royal Jubilee Hospital used the "huddle" format to promote non-hierarchical conversations with all members of the care team. The 15-minute weekly gathering of frontline staff surfaced "dinosaurs" by prompting staff to think about inefficiencies and redundancies in their work. They also scheduled the huddles mid-afternoon to enable the widest variety of staff to attend (such as mental health workers who start their shifts at 3 p.m.). By engaging in these huddles, the PES unit noticed "a palpable sense of satisfaction among staff" with staff feedback resulting in tangible improvements in their environment.

Holding space for honest conversations, however, does require organizations to address the discomfort of bringing up non-optimal practices in an open forum. Teams have done this by fostering a collaborative and inclusive atmosphere that flattens hierarchies or commits to constructive dialogues.

“Throughout the discussion, there was a deliberate emphasis on setting aside personal opinions and maintaining an objective stance,” says Laura Levesque, Executive Director at Essex County Nurse Practitioner-Led Clinic, about their approach to hosting the Dinosaur Mini-Challenge.

In both cases above, as well as others mentioned earlier, the openness and curiosity to engage with staff about their experiences led to insights (and tangible results) that could improve patient safety and staff experience. Even the smallest change can have a big impact.

“The exercise has further stimulated critical thinking among the staff, encouraging them to question and analyze the rationale behind established procedures,” says Laura Levesque. “This shift towards a more inquisitive mindset not only promotes a culture of continuous improvement but also lays the groundwork for innovation and efficiency.”

What’s next?

Are you and your colleagues trying — or wanting to try — new approaches to promote staff retention and support of your current health workforces? It’s not too late to join the Health Workforce Innovation Challenge and participate in upcoming challenges. Register anytime up until April 30, 2024.  The sooner teams join, the more award opportunities they will have. The challenge runs until July 2024 for all teams, regardless of when they registered.

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