Establishing a Culture of Patient Safety: Improving Communication, Building Relationships, and Using Quality Tools

By Judith Ann Pauley and Joseph F. Pauley

The purpose of this book is to provide a road map to help healthcare professionals establish a “culture of patient safety” in their facilities and practices, provide high quality healthcare, and increase patient and staff satisfaction by improving communication among staff members and between medical staff and patients. It achieves this by describing what each of six types of people will do in distress, by providing strategies that will allow healthcare professionals to deal more effectively with staff members and patients in distress, and by showing healthcare professionals how to keep themselves out of distress by getting their motivational needs met positively every day.

The concepts described in this book are scientifically based and have withstood more than 40 years of scrutiny and scientific inquiry. They were first used as a clinical model to help patients help themselves, and indeed are still used clinically. The originator of the concepts, Dr. Taibi Kahler, is an internationally recognized clinical psychologist who was awarded the 1977 Eric Berne Memorial Scientific Award for the clinical application of a discovery he made in 1971. That discovery enabled clinicians to shorten significantly the treatment time of patients by reducing their resistance as a result of miscommunication between their doctors and themselves.

• Language: English
• Publisher: ASQ Quality Press
• Release date: Apr 7, 2011
• ISBN: 9780873895125

Book preview

Establishing a Culture of Patient Safety

Improving Communication, Building Relationships, and Using Quality Tools

Judith Ann Pauley and Joseph F. Pauley

ASQ Quality Press

Milwaukee, Wisconsin

American Society for Quality, Quality Press, Milwaukee 53203

© 2012 by Judith Ann Pauley and Joseph F. Pauley

All rights reserved.

Library of Congress Cataloging-in-Publication Data

Pauley, Judith A.

Establishing a culture of patient safety : improving communication, building

relationships, and using quality tools / Judith Ann Pauley and Joseph F. Pauley.

p. cm.

Includes bibliographical references and index.

ISBN 978-0-87389-819-5 (alk. paper)

1. Hospitals—Administration. 2. Medical errors—Prevention. 3. Communication

in medicine. 4. Physician and patient. 5. Medical care—Safety measures. I. Pauley,

Joseph F. II. Title.

[DNLM: 1. Hospital Administration. 2. Medical Errors—prevention & control.

3. Comprehensive Health Care—methods. 4. Models, Organizational. 5. Professional-

Patient Relations. 6. Safety Management. WX 153]

RA971.P38 2011

362.11068—dc23

2011017946

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Publisher: William A. Tony

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To

Major General (ret.) Gale S. Pollock, former Acting Surgeon General of the United States Army, for her friendship, for sharing her leadership skills with us, and for recognizing how the concepts of Process Communication can improve the healthcare provided to the army heroes wounded in battle defending our country and to their family members who have remained behind.

And to

Dr. Taibi Kahler, the clinical psychologist who made the discoveries on which the concepts of Process Communication are based, for his genius, for his friendship, and for improving our lives and the lives of all those we come in contact with every day.

And especially to

All the healthcare professionals who provide outstanding medical care to millions of patients every year, especially those who have dealt patiently with our idiosyncrasies and provided excellent medical care and advice to us throughout our lives.

Table of Contents

Foreword

Acknowledgments

Introduction

1 The Need to Improve Patient Safety

Three Examples

2 Who Are These People?

3 Interaction Styles

4 Perceptions

The Language of Perceptions

5 Channels of Communication

Establishing Contact

6 Motivational Needs

Motivating the Six Personality Types

Personality Phase

An Anesthetist’s Example

A Patient’s Example

7 Using the Concepts in Treating Patients

8 Distress

Workaholics

Persisters

Reactors

Dreamers

Rebels

Promoters

9 Healthcare Providers in Distress

Story One

Story Two

Story Three

Story Four

Story Five

Story Six

Story Seven

Story Eight

Story Nine

Story Ten

Story Eleven

Story Twelve

10 Getting Patients to Diet and Lead Healthy Lifestyles

11 Using the Concepts in Leading Improvement

Leading Improvement in a National Healthcare System

Leading Innovation in a Healthcare System Medical Education Department

Leading Improvement at a Medical Facility

Leading Improvement in a Family Clinic

Leading Improvement in a Healthcare System Education Institute

Leading Change to Develop a Team

Leading Change in a Women’s Hospital

Influencing Improvement in Safety Procedures in Biomedical Research Laboratories

Epilogue

Notes

Foreword

Human interaction can be complicated. It probably always has been. Even in the days when communities of our ancestors huddled together in caves for protection and for warmth, living together in proximity for extended periods, it was the same. As they negotiated or resolved to establish an agreed pecking order, and as they rationed out their (often scarce) resources, their skills in being able to relate effectively and constructively to one another were tested—and, indeed, the very survival of their community often depended on it. Not to mention the challenges of keeping their youngest ones safe, dealing with their impulsive and rebellious teenagers, and caring for their sick and elderly. All this required sophisticated social interaction. One would have to think that nothing has changed.

Well, almost nothing. The same bases for these intricacies of human behaviour remain. But what is different now is the environment in which they play out: It is much more complex and demanding. It places much greater stress on its inhabitants. The senses are bombarded with a greater range of stimuli that require rapid and specific responses. So in many ways, the range of skills required for effective daily functioning has become significantly more complex. It is not so much that the technology we use (whether it be cars or computers) has become more complicated, but more that the array of systems and processes with which we now have to comply has become increasingly complicated. Nowhere is this more evident than in the area of health services.

That is where this book comes in. It is true that the technology and techniques of medicine are advancing rapidly, concomitant with an ever-expanding knowledge base, and that this necessitates high levels of cognitive and technical expertise by those who provide medical care. Yet, this is not where the real challenge lies. Rather, it is that these advances also demand that all healthcare workers communicate effectively and work collaboratively, an absolute necessity if the complex processes that have been built up around healthcare provision are to function properly.

Why have these processes around the delivery of healthcare become so complex? Not surprisingly, there are several reasons. One obvious one is the explosion in knowledge and skills required within each specialty area. This has led to an increased level of specialization and delineation of the roles and responsibilities of each member of the workforce. In turn, this means that, more than ever before, health workers are dependent on those around them for support if they are to perform their work correctly.

But there is another reason, one that relates to patient safety. The public now expects good outcomes to be routine. Previously, complications were assumed mainly to be related to patient factors (e.g., old age, poor healing, comorbidity, or the patient not following the doctor’s instructions correctly) or to limitations in available technology. It was assumed that medical staff, being honest and having integrity, were infrequent contributors to poor outcomes. Now—and this book highlights the importance of this aspect—we realize that many, if not most, unexpected adverse events are due to human factors, specifically the actions and behaviour of those looking after the patients.

In short, medical error leads to adverse events, and adverse events lead to poor clinical outcomes. Understanding how medical error occurs is the first stage in reducing its incidence. This book reviews the evidence that certain types of human behaviour contribute to errors occurring. Moreover, it also shows the degree to which these types of behaviour are predictable. Fortunately, they can be recognized and dealt with, not only by health professionals reflecting on themselves but also by colleagues. Understanding the role of personality types and recognizing the effects of stress and distress allow a greater degree of collegiality and a more collaborative and supportive environment. The authors outline the tools available to achieve this. Put simply, once we have the tools that have been shown to improve behaviour (or eliminate those behaviours that contribute to mistakes), we will be on the road to providing a safer health system.

This book is a welcome addition to our libraries, as it applies the Process Communication Model® to the health sector. We already know that human factors—primarily behaviour affected by varying degrees of stress—contribute to medical errors. Here we have a tome that reminds us that perhaps the most productive way to minimize medical error is to study how well-intentioned and committed health specialists function and communicate. Additionally, it encourages us to adopt some very specific tools to influence this behaviour in a way that eliminates many of the human factors that contribute to the high incidence of medical error that plagues our health services.

Spencer W. Beasley, MB, ChB (Otago), MS (Melbourne), F.R.A.C.S.

Professor of Paediatric Surgery, Christchurch School of

Medicine and Health Sciences, University of Otago

Former Chair of the Board of Surgical Education and

Training, Royal Australasian College of Surgeons

_______________________________

The healthcare industry today faces many challenges. In spite of the fact that technology has enabled healthcare professionals to provide the highest quality of healthcare in history, raise the life expectancy of our population, and find cures for illness after illness, we still are challenged to improve patient safety and patient satisfaction. Our challenge is daunting: improve the quality of healthcare, and improve patient safety to a perfect level in a labor-intensive business model that will remain labor intensive and people dependent for the foreseeable future. This people-dependent business must ensure that employee engagement and satisfaction are also a constant focus. To accomplish these tasks, it is essential to improve communication among all members of the healthcare team (doctors, nurses, administrators, and patients) and to reduce their distress levels.

When working daily in situations dealing with patients who have suffered life-threatening heart attacks or strokes or who have been in accidents, stress is inevitable. The key is to be able to deal with stress in positive ways, thereby turning it into positive stress rather than negative stress (distress). This book provides a tool that can be applied to accomplish these goals.

In an effort to improve communication and reduce the distress in our hospital, the leadership was trained in the concepts of Process Communication. It worked. Tools that could be applied were applied. Leaders who struggled with one another and with certain relationships suddenly had a different lens to view not only their statements but also the reception of their statements. Listening improved. And we saw results. We saw improvement in employee engagement. These concepts enhanced our ability to deal positively with individual issues as well as hospital-wide management issues. This resulted in a 6% improvement in employee engagement in one year (2009) and has enabled us to move the entire organization to the next level.

I learned a lot about myself and about communication gaps that I unintentionally allowed; but, for the first time, I have a tool that I can use with my children, their teachers, my wife, my staff, patients in the hospital, and everyone with whom I interact. The concepts have enabled me to be a better manager because I now listen for clues to indicate how to interact successfully with the person in front of me at any given moment. In addition, senior leaders in the hospital now individualize the way they communicate with their employees on the issues facing them. They are able to respond to each person in the way that makes the most sense to each individual.

For example, those who perceive the world through their emotions want to know that their bosses care about them and are willing to listen to them and allow them to discuss their feelings. Those who perceive the world through thoughts don’t care about that. They come to meetings with their list of things they want to discuss, and they want to run through the list of topics. They want their managers to respond in the same way, and on time. Understanding this, the members of the leadership team are able to respond accordingly. As a result we are training the physician leaders, nursing leaders, and other staff members in the concepts in order to improve communication with our patients and enable us to work more effectively across the various business units. We believe this will improve our quality and service metrics and will have the ultimate result of benefiting us financially.

This book describes these concepts succinctly. It contains true stories that exemplify how healthcare professionals have used the concepts to improve patient safety by helping staff members get their motivational needs met daily. In this way they keep themselves out of distress, significantly reducing the number of preventable medical errors. The book also describes how healthcare providers can increase patient satisfaction by communicating with patients in their preferred mode and by helping patients get their motivational needs met during their hospital stay and in visits to clinics and doctors’ offices.

Healthcare professionals have known for years that people can avoid the onset of many of the leading causes of premature death—for example, heart attacks, stroke, and diabetes—if they lead healthy lifestyles, exercise, and lose weight. Nearly every healthcare professional has tried unsuccessfully to persuade his or her patients to adopt a healthy lifestyle and is frustrated by the fact that people refuse to do it. Chapter 10 contains specific strategies, individualized for each of the six personality types, that healthcare providers can use to accomplish this.

This book is a welcome addition to the medical literature because it outlines the concepts of a tool that provides the ultimate safety. Listen to what people say and how they say it. Respond not only with empathy but with words and phrases that resonate with your listener.

Hugh Tappan

CEO, Wesley Medical Center

Wichita, Kansas

Acknowledgments

We are deeply indebted to all those who have contributed to this book. We especially want to thank Dr. Taibi Kahler, whose genius resulted in many of the discoveries that led to the concepts described in this book. The power of the concepts of Dr. Kahler’s Process Communication Model® has enabled executives to lead their organizations more profitably; managers to operate their organizations more effectively; healthcare professionals to reduce human error, thereby improving patient safety and both patient and staff satisfaction; and educators to individualize the way they teach so that they reach and motivate every student, thereby reducing disruptive behaviors in the classroom and improving student academic achievement. In addition, Dr. Kahler’s Process Therapy Model™ has enabled psychiatrists and psychologists to reduce significantly the treatment time of their patients and speed up their recovery.

For more than 40 years, Dr. Kahler’s discoveries have enriched the lives of people in all walks of life. We have enjoyed our association with him for more than 25 years. He has changed our lives, and his Process Communication Model® has enabled us to be more effective leaders in every organization we have headed. More important, the concepts of Process Communication have enabled us to improve the lives of all those with whom we interact every day and have enabled us to impact significantly professionals, leaders, teachers, students, and educators throughout the country.

We also are indebted to the many people who shared stories with us detailing the ways they have used the concepts. We especially want to thank the doctors, nurses, and other healthcare professionals who described how they use the concepts to treat patients, to reduce conflict and promote teamwork within their facilities, and to improve patient safety and patient and staff satisfaction. We also want to thank the patients who shared their stories—both positive and negative—with us. Some of those who provided stories are named in the book.