Improvement Stories

Patient Safety Awareness Week: At MGH, It’s the Week that lasts all year…



As part of the 2015 Patient Safety Awareness Week (PSAW) celebrations, the Edward P. Lawrence Center for Quality and Safety hosted a Quality and Safety Forum on March 12 featuring a presentation entitled, “Overcoming Barriers to Effective Communication”.

The theme for PSAW 2015 was Speak Up for Safety. With that theme in mind, two MGH Anesthesiologists led an interactive presentation that encouraged staff and patients to speak up to improve communication and avoid errors. During the presentation, the physicians simulated patient care encounters with Erin Quinney, from the MGHfC Patient-Family Advisory Council. 

The physician presenters were May Pian-Smith, MD from the Department of Anesthesia, Critical Care and Pain Medicine. May serves as the Quality Chair and Director of Simulation, and is an Associate Professor of Anesthesia. Rebecca Minehart, MD is also from the Department of Anesthesia, Critical Care and Pain Medicine. Rebecca is an Assistant Professor in Anesthesia, serves as the Assistant Director of the Anesthesia Residency program, and is the Director of the Obstetric Anesthesia Fellowship program at Massachusetts General Hospital.

Dr Minehart led the presentation describing the obstacles to speaking up. She explained how fear can prevent people from speaking up. Rebecca engaged audience members to electronically text replies that she gathered into her presentation. She shared two language methods to guide people to speak up. The first is referred to as the CUS method, which stands for Concern, Uncomfortable, and Safety.  The use of this method is encouraged at United Airlines. The second method is also from the airline industry. This is called the Two-Challenge Rule. Airline pilots and staff can use this method to improve safety by ensuring that communication is both shared and received by both employees. 

Dr May Pian-Smith presented an Adult Learning Theory. She shared how she uses simulation in a laboratory setting to train young Anesthesiologists to speak up under controlled circumstances. The physicians are pushed to not only perform, but to clearly communicate their concerns during the encounters. May and Erin Quinney then role played a number of scenarios for the audience to help them to understand how communication can be misconstrued between providers & patients/families in a clinical situation. The audience was engaged throughout this hour-long presentation. 

In addition to this keynote presentation, the CQS sponsored a Patient Safety Stars awards breakfast in which over 50 staff was honored. These MGH Patient Safety Stars are nominated by their colleagues as people who offer examples every day of how to go above and beyond to assure patient safety. The theme of “Speaking Up” was evident in the narratives that described the staff’s outstanding efforts. 

The Department of Pathology created 50 English and Spanish posters that they distributed to phlebotomy areas throughout MGH blood draw areas. These posters encourage patients to speak up for patient safety and can be viewed by clicking here. Interpreter Services also created table top posters that were distributed to the area health centers encouraging patients to request an Interpreter as one way of Speaking Up for Safety. Informational tables were available in the White lobby for two days and generated large crowds of visitors, patients, and staff. You can view these posters by clicking here or the Spanish version of posters by clicking here.

This was another successful PSAW in supporting MGH patients and staff to learn the importance of Speaking Up for Safety.

To learn more about the choosing of Patient Safety Stars and the other celebrations during Patient Safety Awareness Week in 2015, we invite you to read the MGH Hotline  article from March 13, 2015.











































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































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