Staff education: Painting with broad strokes?
As is periodically the case, I will hear from friends who are bearing questions about this, that, or the other thing. In this particular instance, the question revolved around providing education to staff regarding the appropriate response to surgical fires. The question was prompted by a conversation with the surgical services director, who indicated that staff at the ambulatory surgery center (ASC) could use focused education regarding surgical fire response. The thought was to distribute posters outlining the appropriate response (RACE/PASS would definitely be in the mix), but a compliance consultant counselled against that approach as it might draw unnecessary attention to surgical fire response during a future survey. To my mind, I kind of understand the “not bringing attention to a potential issue” advice, but I would be more concerned about it from a patient safety perspective. If a department/service leader is coming to you to say that staff response is “squishy,” I don’t think I could walk away from it without trying to do something.
If it were me, I would feel comfortable targeting the ASC, but I would put the posters in the backstage areas (i.e., break rooms, staff restrooms, etc.). And I would still do some digging as to how it came to be that the folks responsible for managing surgical procedures with a reasonable potential for fires are uncertain as to what they are supposed to do. Are we conducting the mandated (by NFPA 99) annual review and associated education? How did their limited knowledge manifest itself? It wasn’t really clear how any evidence of a “less than” response had manifested itself. I’m thinking that if staff had “stumbled” during a fire drill, the obligation to take some sort of action/intervention would be much more notable. And if the vulnerability has the potential for being more widespread than just the ASC , then I suppose you would need to spread the wealth even more, probably in the form of focused fire drills in surgical procedure areas to ensure that you have some current data upon which to plan your pre-survey strategy. If it turns out to be more widespread, then I would be seriously concerned about the process for educating the surgical folks. The whole thing might be limited in scope, but the response needs to be measured and focused on the root cause of the gap, which is probably not clear enough from a conversation—real world performance data is key in identifying the heart of the issue. If you can’t say for certain what the problem is, you can’t say for certain that posters would be the solution. But I think it’s safe to say that surgical fire response and prevention is going to remain one the topics of conversation during regulatory survey activities, so a solid foundation of staff education is certainly warranted/desired.
But going back for a moment to the reticence on the consultant’s part to bring attention to this as an issue, you could certainly frame the “enhanced” education as a performance improvement initiative, again, starting with some data collection. I would want to look and see (and understand) the nature and magnitude of the issue and then plan accordingly. Anything else runs the risk of exacerbating the problem or missing the point entirely. It is important to figure out (which includes understanding) the problem before you can solve it. If the gap in knowledge was not knowing the steps, there’s a reason they didn’t, which leads to questions regarding the effectiveness of the fire safety education program. If the first reaction to a less-than response is to consider plastering the place with RACE/PASS posters, then that would seem to speak to a lesser level of confidence in the process than would bode well for survey. The QAPI process is supposed to be the use of data to identify improvement opportunities and then to strategize for how to make those improvements. Posters are one intervention, but you want to make sure that the response is actually aimed at the target—there’s too much going on with the management of healthcare resources, including time, and errant responses do not help establish an effective program.
About the Author: Steve MacArthur is a safety consultant with The Chartis Group. He brings more than 30 years of healthcare management and consulting experience to his work with hospitals, physician offices, and ambulatory care facilities across the country. He is the author of HCPro's Hospital Safety Director's Handbook and is an advisory board member for Accreditation and Quality Compliance Center. Contact Steve at stevemacsafetyspace@gmail.com.