Building a better safety coach program
Systemwide concept improves culture
Continuing Education Objectives
After reading this article, you will be able to:
- Discuss the impact safety coaches can have on patient safety
- Describe how to identify staff who would be ideal safety coaches
- Identify key areas where safety coaches may need additional training
Every healthcare organization is on a constant hunt for ways to improve their internal culture of safety, particularly through employee involvement. For Virginia Commonwealth University Health System (VCU), a relatively new safety coach program has worked to cross borders within the organization and bring more active participation from staff of all levels.
First launched in 2011, the program has more than 160 coaches working across the hospital, all on a strictly volunteer basis.
The initial idea to implement the program came as part of a safety improvement initiative the organization worked on with a consulting group, explained Jenifer Murphy, MHA, CPPS, patient safety manager for the department of performance improvement at VCU Medical Center in Richmond, Virginia. Murphy manages the overall program for VCU.
"We've grown it into something much bigger and what we ask of our coaches is much more collaborative based on feedback from the coaches and our leadership," says Murphy.
As with all quality and improvement initiatives, the safety coach program relies heavily on leadership involvement and investment to really work.
The coaches must apply and be supported by their current manager, and attend a mandatory four-hour training. Monthly training meetings are also a requirement.
Who should be a safety coach?
One of the first qualities a safety coach needs to have, Murphy says, is an honest level of interest.
"First and foremost we look for people who are very passionate about patient safety," she says. "They may have had a good catch in the past [so] we know they have the kind of mind-set we need. We also look for people who are well-respected among their peers, someone who is looked at as a resource or role model."
The organization has integrated a service component to the safety coach role.
"To have a good service experience, you also have to be taken care of safely" as a patient, says Murphy.
Additionally, they "need to be a role model for our safety behaviors and error prevention tools," says Murphy. "They need to know them and know them well."
All employees are trained in the use of those error prevention tools, but coaches show an exemplary ability to use them and also to help others with those tools and processes. To that end, communication skills are also highly important when recruiting safety coaches.
The organization fosters those skills through additional training, as well.
"A lot of our ongoing training is about how to coach using active listening skills, identifying crucial conversations, and how to engage in those kinds of conversations," says Murphy.
Lastly, to be recruited as a safety coach, the employee needs to be in good standing with the organization without any active disciplinary actions or recent unsatisfactory evaluations.
Interestingly, there isn't much of a need for active recruiting, says Murphy.
Recruiting sessions happen twice a year for about 45 new coaches.
"We have a very short application. It's only three questions, but they're very open-ended questions," said Murphy.
The questions are designed to make applicants put thought into their patient safety work, such as describing a recent safety situation and describing a recent service experience they had.
Recruitment is so successful that the organization has the opportunity to whittle down the list if necessary. For example, on occasion VCU has applicants who say that their manager told them to apply?which indicates the manager has trust in that person but that the applicant themselves might not have the passion or level of interest the role really requires.
That being said, the manager has got to be behind that applicant 100% to make sure there is support in their day-to-day work to build in their safety coach requirements.
Recruitment has never been an issue, however. In some recruitment drives, departments have had five volunteers step up when the ideal number was only two or three, and organizers have asked to stagger those coaches into the system.
"I think this is because of the culture of our organization," says Murphy. "If you start this sort of program at a place that hasn't embraced a just culture or a nonpunitive culture it won't be as successful."
The safety coaches were not introduced immediately as part of an organizationwide initiative to improve quality and safety. The formal journey toward changing the overall culture began in 2008, Murphy says, and the coaching concept came in after the health system had a period of time for that nonpunitive culture to become a reality.
"We didn't start with coaches right out of the gate," says Murphy. "It was almost three years into our culture work that we felt we had enough of the organization on board in terms of just culture."
Given what the safety coaches are asked to do, a hospital culture geared toward improvement is key.
"I think what we're asking them to do is not easy," says Murphy. "Depending on who they're trying to coach, it may not be well received. We talk a lot about situations where they had a successful coaching experience and others where things didn't go as well as they may have wanted."
Because the roles are not compensated, it is on the organization to build an environment where someone going above and beyond their everyday job has the support they need to do what is being asked of them.
"We'd have a lot more attrition if we were not as supportive," says Murphy.
The pervasive attitude of understanding among the coaches is also helpful keeping their numbers high.
"They recognize more than others that nobody has an inherent drive to cause harm," says Murphy. "If someone has an error, that wasn't their intent."
Understanding errors is a big part of the training and ongoing meetings coaches engage in. They work on getting into the mind-set of the provider involved in an effort to get a better understanding of what might have occurred in that moment to cause the error.
"We talk a lot about human factors engineering, understanding the mind-set of the person at the time, and try to prevent that same error," says Murphy.
The day-to-day experience of coaches will vary because they can come from such varied roles?VCU has coaches from everywhere, be it clinical, non-clinical, administrative, or beyond.
"There's no criteria aside from being a frontline staff member," says Murphy.
Coaching is a part of their everyday duties?they are expected, if they see an opportunity for coaching on their unit or department, to take advantage of it.
More concrete duties include reporting four observations or interviews with team members to talk about error prevention tools or safety behaviors, and to turn in one safety success story every month, which involves describing a particular example of safety behaviors used in their area.
"One of the reasons the program is so successful is that we try to be very realistic about expectations. We want them to focus on coaching," says Murphy.
The organization is very up front about the time commitment, too, which is roughly two hours per month including meetings. Potential recruits are given ample opportunity to opt out early on when they see firsthand how much time is required to perform the role appropriately.
While recruiting 45 or so new coaches every six months to add to the over 160 current coaches might seem like a large number, with 12,000 employees across the participating campuses, there is still a lot of room to expand.
"Ideally we would like to have one safety coach per area per shift, so there's always a coach on, but that would be in the neighborhood of 400 coaches," says Murphy. "I'd love to get to that point but we don't necessarily have the structure for it yet."
That would also require some additional support staff running the program, which is currently supported by Murphy and one other administrator who, combined, spend approximately ¾ of a full-time employee's hours on the program. Should the program continue to be successful and expand, additional staffing to help manage the coaches and provide resources for those coaches to ask questions could be possible, eventually, but for now, the organization is focusing on supporting the existing program.
That support could potentially come from elevating more senior safety coaches to a sort of veteran-coach role where they are linked to several newer coaches to provide guidance and support.
The organization is also looking at how to involve safety coaches more in improvement projects.
"We're trying to have them as a group identify one single improvement issue they can all take on," says Murphy.
Potentially, that project could be patient identification and using two-patient identifiers.
"That goes across the entire organization. Whether you're clinical or non-clinical, you're going to work with patient IDs," says Murphy.
Despite the time commitment, remarkably few coaches step down once they're brought on board. Those they have lost over the first few years of the program have been almost entirely due to changes in circumstances such as a change in departments or jobs, leaving the organization to pursue another opportunity, or a large life change such as returning to school.
For those who move from one department to another, it is possible to return to the safety coach role once they've settled in to their new role.
"Because it's a generic role, people can move positions and still be a safety coach," says Murphy. "If someone moves units they'll ask if they can still be a coach and we say, 'Talk to your manager.' We always recommend that, because patient safety comes first; they take a hiatus for six months or so to give them time to learn their new position and then they can be reactivated."
"They really enjoy it. It's so different from other things they're working on. It's not a committee," says Murphy.
That enthusiasm and retention has helped build bridges across departments that often don't have a chance to interact. To encourage this, it is suggested to coaches to occasionally go visit a department they don't often get to see face to face to build a more direct personal relationship with them. "They talk to people all the time but there's a difference between knowing who the voice on the other end of the line is or not."
While interdepartmental or interdisciplinary interactions have increased, so has communication up and down the ladder in the organization. Leaders have come to rely on the coaches "as a ready-made focus group?they ask, can we get the safety coaches' opinion on this? What do they have to say?" says Murphy.
"It's amazing the number of coaches who went to the lab, or to bed management," says Murphy.
For those just starting out with their own safety coach program, Murphy has two pieces of advice.
First, start small.
"Start with a pilot group you already know to be champions in this area," says Murphy. "When we picked the coaches, we were also looking at their managers?we knew we needed strong leaders."
Secondly, make sure you know new coaches are going to need more support on the front end.
"You may want to be proactively checking in with them, seeing how it's going, giving positive feedback, or asking them to share a great story" with the group, says Murphy. "You can't really overdo it with some of the positive feedback when they start."
Safety Coach Role Description
1. Has a passion for safety and service, demonstrated through commitment to the [organization's] vision of being aligned with the goal of zero events of preventable harm to patients, team members, and visitors, and by consistently demonstrating our culture and mission.
2.Demonstrates the ability to recognize safety and service concerns and situations and take appropriate action to reduce or eliminate risks for potential harm and promote service excellence.
3.A role model and champion for [organizational expectations, patient safety and error prevention tools] and provides coaching to team members on how to adopt and apply the tools, standards, and behaviors.
4. Demonstrates the ability to use critical thinking to proactively solve problems, including:
a. Identifying systems issues contributing to problems.
b. Using interprofessional and interdepartmental collaboration to achieve effective issueresolution.
c. Appropriately speaking up and escalating concerns, as needed.
5. Demonstrates the ability to communicate clearly, including:
a. Being approachable and demonstrating good active listening skills.
b. Excellent and effective verbal and written communication.
c. Willingness to speak up across the chain of command.
6. Is [an organizational] team member or contracted team member in good standing and is a thought-leader, but not in a formal leadership position.
a. No disciplinary actions or equivalent for contracted employees, in the past six months.
b. Satisfactory performance evaluation (Fully Meets, Exceeds Expectations, or Exceptional).
c. Does not complete performance evaluations for other team members.
7. Completion of [required training and education in the areas of patient safety and error prevention.]
Safety Coach Expectations and Responsibilities
1. Attend monthly Safety Coach meetings for networking, communication, and skills development.
a. Individual Safety Coach: You are allowed two excused absences and two unexcused absences. Anabsence is excused if notification is received prior to the meeting.
b. Multiple Safety Coaches: Areas with more than one Safety Coach are allowed to rotate meetingattendance responsibilities. If this is the case, your area is allowed one excused and one unexcused absence. You are encouraged to rotate meetings so that each Safety Coach has an opportunity to attend meetings.
2. Participate in Safety Coach training to further knowledge of [organization-specific training for error prevention and patient safety] and enhance coaching skills and techniques.
3. Meet regularly (at least once per month) with unit/area leadership to discuss safety observations, successes, and barriers to safety.
4. Encourage the adoption and application of the [organization's expectations for] error prevention tools and behaviors.
5. Complete four monthly safety observations in his/her unit and/or area and submit one success story per month.
a. Submit one story [organization should determine method of submission, via online portal or other option].
b. [Alternate options for submission such as email or survey tool can be included here.]
6. Provide peer coaching, 5:1 feedback, and cross-checking in his/her work environment to promote safe and highly reliable practice.
7. Provide regular safety reports to unit/area.
8. Utilize, and encourage others to utilize, [organization-specific] safety reporting mechanisms to appropriately report any patient, staff, or visitor safety concerns, specifically the PSN.
Leader Expectations for Safety Coaches
1. Introduce your Safety Coach to your staff and explain the role of the Safety Coach.
2. Provide dedicated time for the Safety Coach to participate in Safety Coach Program activities (approximately 2?3 hours per month).
a. Monthly Safety Coach meeting
b. Peer coaching and observations
3. Meet with your Safety Coach at least once per month to discuss:
a. Results of team member observations.
b. Team member responses to coaching activities.
c. Success and/or barriers to coaching.
d. Review of Safety Coach Meeting content and communications for team members.
4. Take appropriate action when safety and service concerns are brought forward through using established [organization] resources (i.e. occurrence reports, Daily Check In or Safety Huddles, safety rounds, or escalation using chain of command).
5. Provide a forum for the Safety Coach to update team members on a monthly basis about Safety First activities (i.e. at team member meeting, via safety bulletin board, etc.)I understand the responsibilities and expectations of both the Safety Coach and the Leader.
I understand the responsibilities and expectations of both the Safety Coach and the Leader.
Safety Coach Date