Hardwiring safety at MGH 365 days per year: It starts every day at 9:15 a.m.

By: Ellen Samek, Corporate Communications Intern

Dr. Ian Fraser does the same thing every morning at approximately 9:15 a.m.

He makes his way to a meeting room on G2 for the Michael Garron Hospital (MGH) daily safety check.

Since June 2017, a representative from each department, usually a director or manager, and members of the executive team meet every day, either in-person or via teleconference to discuss the state of safety at the hospital.

The goal of these meetings is to achieve 100 per cent safety, 365 days per year.

Each meeting follows the same scripted formula created by Dr. Fraser, Chief of Medicine and former administrative resident Ryan Hinds.

The meeting starts with a welcome greeting and a review of how many days it has been since the last critical incident, never event and rescue index event.

Any new and unresolved reports of safety concerns involving patients, staff or operational issues from the last 24 hours are raised and discussed at this forum.

Once the issues are discussed a plan is put in place to resolve the issues as soon as possible.

“We decided to start doing it for a month or two, five days a week to see how it would go and by the second week we were meeting seven days a week instead of just five,” says Dr. Fraser. “It just took off from there because people immediately saw its value.”

Safety risks and potential incidents that could happen over the next 24 to 72 hours are also discussed.

All reported safety issues are recorded and tracked in a custom database created by hospital information technology staff.

Safety issues discussed include everything from workplace violence events, potential outbreaks, staffing shortages and power outages to mini bag shortages.

“Once we had a shortage of the mini bags we use for patients' medication administration. A hurricane destroyed the plant in Puerto Rico that makes them,” says Janice Ward, the Manager for Quality and Organizational Safety at MGH. “This was first raised at a Safety Huddle. Following that meeting we were able to quickly come together to determine a plan with ways to deal with it.”

For Janice, the daily safety checks have done so much more than manage a mini bag emergency.

“The culture of safety has changed,” she says. “People are more aware of what's happening in their own area and in other areas in the organization.”

“I think the reason we've seen such success since we launched is because right from the beginning we had executive buy-in. Some key meetings that run in the organization always stop when it's time for the daily checks and then resume after when the call is finished. They really prioritize it. The fact that it happens every single day, bar-none, is a testament to our leadership at MGH.”

The daily safety checks have been nine years in the making.

“I realized in listening to informal conversations on the frontlines that not everybody knew at the same time where the risks were,” says Dr. Fraser. “People reacted to an event afterwards often with a delay. If the issue had been identified early there could have been a quicker reaction.”

“Then I realized that I couldn't go to the board and tell them what the state of safety was for patients and for providers in the organization, and that just wasn't right,” he said.

Yet, the true turning point for Dr. Fraser was the death of a patient.

“She was admitted to one of our wards. Everyone assumed critical care outreach was available when it wasn't and we ended up rescuing her late,” he says. “She was young with her whole life ahead of her. The infection she had was rare. If that had occurred today, we would have identified the risks sooner and prevented it because we would have known the ward needed more staff.”

“I made a promise to her partner that I would ensure this never happens again.”

Thanks to the daily safety checks, it never has.

For Dr. Fraser, the future of these daily safety checks is all about continuing to recognize risks before they happen.

“We're going to use the information we gather from the daily safety checks over the next months and years to identify patterns to anticipate risks even weeks in advance to react more proactively.”