Step 1) Commitment to Safety

Premise: There will not be consistent or sustainable improvements without 100% commitment of all providers and staff to safe patient care. This must be a top priority, higher than budgets, relationships, and personal needs. It must come from top leadership and include everyone. It must be an ongoing goal supported by actions.

Benefits:

I. Decreased patient injury and preventable death

II. Increased health and well-being of staff

III. Increased productivity of staff and quality of care provided, thus lower operational costs and higher revenues

IV. Return on investment (ROI) of two times the safety investment (western cultures)

IV. This allows standards of care to be used as benchmarks at point of care, not outcomes, to drive change and standardization.

Investment required:

I. Education and training:

a) Everyone will attend a safety course. This will take place at the hospital. Everyone includes the CEO of hospital, all administration, all staff and support(housekeeping), all providers and more.

i) The course will include education, implementation, staff practice (PBLs, small groups, and more)

ii) Topics will include communications, using a checklist,

b) There will be champion participants from each department, team leads (2), and a lead (1). Every one of these will come from the site.

c) These champions/Team leaders and lead will receive additional training before the launch of safety so they can participate in the first launch. Thes champions will be the first contact for department issues then escalate to lead as necessary. The leads will be expected to not only launch safety at other sites, but to train others at the site to lead to do the same.

** per Tanzanian experience, there is more success if the press is notified of the safety launch, a high-ranking officer participates, and a celebration follow

II. Time:

a) Department heads and administration: Planning meetings: Get recommendations for and appoint chief safety officer lead, lead jr, and safety officer in each department. introduction of outside team -prn, plan meeting times, budget, Procure safety course, lecturer, handouts, posters, and money. (1-2 hours)

b) Everyone: Launch (2 hours/lectures, 4 hours in 3 months/small groups), monthly updates (1/6-hour x 12), and yearly reinforcement (2 hours)

b) Chief safety officer lead, lead jr., and team leaders: monthly safety meetings (1 hour each/month), policy updates (6 hours total/year), presentation/preparation, new hire training, and posters (6 hours total/year)

III. Financial:

a) Course for everyone: Donation likely

b) Presentation needs: Access to a computer, Power point software, slide projector- (0 to 2 hours per month), on-site displays/posters/ pins/reminders/"good- job" rewards/ handouts $100/year)

c) Chief safety lead: 1/10 or 1/5 (one day per week) of a full-time employee (FTE) to start. This is a person trained in safety not a physician, nurse, or pharmacist, but one of these may take the position in the beginning if they have an interest and specialty training. While this may sound like an extravagant and expensive first step, it is needed. Safety is the driver for all improvements. Not getting this step right and claiming safety to being the driver of change is a culture of blame and unaccountability is bad.

d) Team leader and lead training and continuing education: To be determined, this will be higher at the beginning then taper off, $800/year ongoing?

Solutions: One Standard tools:

I. Videos: Introduction to infrastructure needs (communication, culture of safety, teamwork, accountability+)

II. Documents: Checklists, hand-off reports, workflows and more