T HE DANGERS OF NON - ACCOUNTABILITY Susan Gallagher, RN PhD Celebration Institute, Inc [email protected] [email protected]

THE DANGERS OF NON-ACCOUNTABILITYSusan Gallagher, RN PhDCelebration Institute, [email protected]@celebrationinstitute.com

WHAT IS ACCOUNTABILITY IN THE HEALTHCARE SETTING?

PURPOSERecognize the dangers of non-

accountabilityHand washing – the most basicCarrot and stickUnderstand the threat of

organizational dysfunctionPutting it all together

DANGERS OF NON-ACCOUNTABILITY Annual cost exceeds $9 billion Annual rate of underreporting is 50 – 96% Exceeds the total rate of MVA, general and

commercial aviation crashes, suicide, falls, drowning and poisoning

Misunderstanding the “near miss”

Charney W. Epidemic of Medical Errors and Hospital-Acquired Infections: Systemic and Social Causes. CRC Press: Boca Raton. 2012

HAND WASHING – THE MOST BASIC

“I notice you always wash your hands after we play. Frankly I find that quite offensive.”


“ There are billions of germs, bacteria and microbes living on my body, and I still feel so alone!”


Employees MUST NOT wash their hands before returning to work.


“I use so much alcohol-based hand sanitizer, my hands had to join a 12-step program.”

“Wait, this one’s s a lawyer. We better wash our hands.”


It is not funny! Symptom of a bigger issue

Infection is the #1 reason for mortality among hospitalized infants

Antibiotics lend a false sense of security Gels do not control all infectious agents Annual rate of hospital-acquired infection – 1.7

million 99,000 deaths related to hospital-acquired

infections each year Hand-washing is the primary deterrent to

hospital-acquired infection


WE KNOW THE FACTS Viruses and bacteria can live from 20 minutes

to two hours or more on such surfaces as cafeteria tables, doorknobs and desks

Eighty percent of all infectious diseases are transmitted by touch

Ninety-five percent of the population say that they wash their hands after using a public toilet. However when 8,000 people were monitored across five large cities in the US, they found the actual number to be more like 67%

http://www.hardydiagnostics.com/articles/hand-washing.pdf

WE KNOW THE FACTS

One study demonstrated that hand washing guidelines were followed 25% of the time during times when the floor was overcrowded and understaffed. Compliance rose to 70% when the floor was properly staffed and not overcrowded with patients.


WE KNOW THE FACTS A poll of pediatric ICU physicians showed that

they claimed their rate of hand washing between patients was 73%, but when followed and observed, the hand washing rate was found to be less than 10%.

A recent study showed that 21% of the health care workers in ICU had varying counts of Staphylococcus aureus on their hands


HAND WASHING – THE MOST BASIC Hand-washing facilities that are adequate and

convenient Time enough to adequately hand wash, clean

the healthcare environment, and also bathe patients

Effective equipment such as quality gloves, gowns that fit, and soaps and towels that do not threaten skin integrity

Enough equipment to use for isolated patients Employer-based pens, stethoscopes, clothing

and shoe covers


HAND WASHING – THE MOST BASIC Adequate staffing in all departments,

including infection control, housekeeping , sterile processing, and direct care staff members

Effective cleaning with chemicals that are easy to use properly

Effective isolation practices Furnishings simple to clean Sick policies which are not punitive


NON-ACCOUNTABILITY IS KILLING PATIENTS

Fifty percent of all health complications are associated with hospital-acquired infections

Five percent of all admissions are effected One death every six minutes!


CARROT AND STICK The parable of the carrot and the stick Must refocus on sustaining meaningful long-

term momentum for accountability The role of teamwork What is a bully, and how does this impact

accountability?

Gallagher SM & Gallagher SM. The carrot and the stick: recognizing the danger in the debate. JSPHM. 2013;3(1).

Center for the American Nurses Association. Lateral Violence and Bullying Fact Sheet. Accessed May 12, 2012 at: http://www.centerforamericannurses.org/associations/9102/files/LATERALVIOLENCEBULLYINGFACTSHEET.pdf

BULLYING AND ACCOUNTABILITY Thirty-eight percent of healthcare workers

report incidents of one or more types of bullying

Forty-eight percent report verbal abuse Workers who experience bullying have

significantly lower levels of job satisfaction, increased job-induced stress, and a greater intent to leave a position

Fifty-three percent of student nurses report bullying behavior by a staff nurse

Additional adverse outcomes have included poor morale, decreased productivity, and increased errorsCenter for the American Nurses Association. Lateral Violence and Bullying Fact Sheet. Accessed May 12, 2012 at: http://www.centerforamericannurses.org/associations/9102/files/LATERALVIOLENCEBULLYINGFACTSHEET.pdf

WHEN THINGS GO WRONG

Recognizing the need for a Crucial Conversation• Opinions vary• Stakes are high• Emotions run strong

Understanding the autonomic nervous system Reactions of others Reaction of self Evolution through time – fight or flight!

Gallagher SM, Steadman A, Gallagher SM. Tackling tough conversations: recognizing societal bias as a barrier to crucial conversation. Bariatric Times. 2010;7(6):1, 24 – 28.

MAKING IT HAPPEN

Gallagher SM, Steadman A, Gallagher SM. Tackling tough topics: recognizing societal bias as a barrier to crucial conversation. Bariatric Times. 2010;7(6):1, 24 – 28.

THREAT OF ORGANIZATIONAL DYSFUNCTION

Constant state of change Imbalance in funding Frontline care team members not included in

decision-making Unclear guidelines Poor communication Fail to seek innovative solutions


PUTTING IT ALL TOGETHER Must have the following in place:

Influential leadership InnovationSupportive workplace

How is this accomplished?


PUTTING IT ALL TOGETHER – PRACTICAL IDEAS

Do team members feel their contributions are essential to the organization?

…involved in facility decisions, especially where his contribution makes a difference?

…consulted before making any decision impacting her position?

…helped in his own development initiatives as well as those designed by the organization?

…evaluations are based on accountability?


CONCLUSION

Documents

T HE DANGERS OF NON - ACCOUNTABILITY Susan Gallagher, RN PhD Celebration Institute, Inc [email protected] [email protected]