Designing for behaviour:
Increasing patient safety in complex environments
In partnership with University Health Network and Ignite Consulting, we have been working with Excellus Blue Cross on an initiative to improve patient safety outcomes across a set of Upstate New York hospitals for over 4 years. The Moment works with two of these hospitals, both of which are within the Mohawk Valley Health System in Utica. Participating units are working on a variety of patient safety metrics: e.g. falls or infection prevention, using front line ownership as the main driver of change.
Beginning in a small set of units and scaling out to the broader organization, we used a highly participatory action learning, coaching and implementation program to encourage rapid design thinking toward locally sensitive solutions. Unit staff used conversational structures and processes to connect deeply with patient needs within the context of their unit, define local problems to be solved, ideate collaboratively, and prototype and test new behaviours. As coaches, we are helping each unit team to learn dialogic processes that will encourage discovery and action, and are coaching them to become coaches themselves, making the work and the results sustainable.
Participating teams have decreased pressure ulcers by 71%, increased hand hygiene compliance by 58% and decreased fall rates by over 20% across the collaborative. Front-line staff are changing the stories they tell others about the problems on their unit — from “we are a designated stroke unit (or oncology unit, or behavioural unit, or orthopaedic unit etc.) so we will have falls” to “Falls? Not on my shift!”. Where once a drop of 10% was considered an almost unattainable falls reduction target, one unit has lowered their falls rate by almost 40% and has sustained their success over three years of work. Experienced project teams are now coaching other units with creative problem solving tools, and are developing a working culture that supports their ongoing success.