The singer-songwriter, author, and Nobel Laureate Bob Dylan wrote a song called "All Along the Watchtower" that has been covered by a number of artists across several different musical genres, most famously by the artist Jimi Hendrix (Hendrix's version is listed at number 47 on Rolling Stone magazine's 500 Greatest Songs of All Time). The song is packed with meaning, but beyond that it's just a really great song!
According to Merriam-Webster's online dictionary, a watchtower is a tower for a lookout, built to specifically create an elevated observation point from which a sentinel or guard may observe the surrounding area. The sentinel's main job is to prevent a surprise attack - in other words, to protect and keep everyone else safe. Note also that the Joint Commission uses the word in their classification system, defining a "sentinel event" as "any unanticipated event in a healthcare setting resulting in the death or serious physical or psychological injury to a patient, not related to the natural course of the patient's illness." In other words, a "sentinel event" is an early warning indicator of a (usually) much bigger safety issue in an organization.
I would like to keep with this theme and build upon our discussion of high reliability organizations, and more specifically, U.S. Navy aircraft carrier flight operations (see the last few posts). Specifically, most high reliability organizations have adopted this watchtower or sentinel concept. For example, the Officer of the Deck, or OOD is an individual on every ship who serves as a direct representative of the ship's commanding officer and who is given certain responsibilities, authority, and oversight to maintain normal, safe operations while a ship is underway at sea or in port. While in port, the OOD is stationed on the quarterdeck (the entry point to the ship). At sea, the OOD is stationed on the bridge and is in charge of navigation and safety of the ship (until relieved of these duties by the commanding officer or his/her designee). The Naval Institute Press publishes a book called the Watch Officer's Guide which provides further details on these roles and responsibilities. Importantly, several individuals on the ship will serve as the OOD in such a way that there is always an OOD either on the quarterdeck (while in port) or the bridge (while underway at sea) for every hour of the day.
So the next logical question is this - do hospitals, in their quest to become high reliability organizations, have a similar role to the OOD? Interestingly enough, at least one hospital (my own) has borrowed this concept in developing a role called the Safety Officer of the Day. The Safety Officer of the Day (SOD) is a relatively experienced physician (we currently have two surgeons, one anesthesiologist, two emergency medicine physicians, and three to four pediatric subspecialists who share this role) who have the authority and responsibility to assist frontline physicians and nurses with mitigating any safety and/or communication concerns on our inpatient units. These individuals generally serve as the SOD for a week-long block and attend our inpatient bed huddles (two per day) and daily operations briefings (every morning), where they role model and reinforce key safety behaviors, provide coaching, and escalate any concerns, when appropriate. The SOD works closely with the Manager, Patient Services (MPS), an experienced nurse who is tasked with patient flow, safety, and nurse staffing throughout the day. The SOD/MPS dyad is an important part of our overall patient safety plan, which over time has resulted in a significant improvement in situation awareness, decreased code events, and timely and appropriate transfer to the Pediatric Intensive Care Unit.
There are certainly other ways to model the OOD concept in health care organizations, but we believe that the SOD/MPS dyad is one of the most important design changes that we have implemented to improve the early recognition and treatment of patients who are at risk of clinical deterioration in the inpatient environment. The SOD serves as a sentinel in our watchtower to help keep our patients safe!
No comments:
Post a Comment