Selected Podcast
Is a Hospital Safe for Patients During a Pandemic?
Cynthia Kellerman, RN, MSN, Market Patient Safety Officer for Tenet Health Central Coast, discusses her role in the hospital, what type of hospital setting provides a culture of safety and changes that have taken place due to COVID-19.
Featuring:
Cindy is the Market Patient Safety Officer for Tenet Health Central Coast, which includes Sierra Vista Regional Medical Center in San Luis Obispo, CA and Twin Cities Community Hospital in Templeton, CA. In this role, she is responsible for patient safety program development and staff engagement towards improving the culture of safety and event reporting.
Cindy has been with Tenet Health for more than a dozen years. Her previous Tenet roles include Interim Director of Critical Care, Clinical Nurse Specialist in Critical Care, Coordinator of Palliative Care and bedside Registered Nurse in the Definitive Observation Unit. Prior to Tenet, Cindy was Coordinator of Methodist Hospice and on faculty at Clarkson College’s Bachelor of Science in Nursing program, both in Omaha, NE.
Cynthia Kellerman
Cynthia (Cindy) Kellerman, RN, MSN, received her Bachelor of Science in Nursing from Creighton University in Omaha, NE and her Master of Science in Nursing, Adult Health from Purdue University Calumet in Hammond, IN.Cindy is the Market Patient Safety Officer for Tenet Health Central Coast, which includes Sierra Vista Regional Medical Center in San Luis Obispo, CA and Twin Cities Community Hospital in Templeton, CA. In this role, she is responsible for patient safety program development and staff engagement towards improving the culture of safety and event reporting.
Cindy has been with Tenet Health for more than a dozen years. Her previous Tenet roles include Interim Director of Critical Care, Clinical Nurse Specialist in Critical Care, Coordinator of Palliative Care and bedside Registered Nurse in the Definitive Observation Unit. Prior to Tenet, Cindy was Coordinator of Methodist Hospice and on faculty at Clarkson College’s Bachelor of Science in Nursing program, both in Omaha, NE.
Transcription:
Introduction: This program is a community service and is not intended to be a substitute for medical advice. Listeners, having questions about their health should make an appointment to see their personal physician. Any opinions or statements made during the program are those of the individuals or physicians making the statements and are not the opinions or statements of the hospital.
Prakash Chandran: Many communities are experiencing an increased level of fear and anxiety toward hospital visitations during the spread of COVID-19, fortunately medical professionals are taking action to keep their patients safe while providing the highest quality of health services. We're going to talk about it today with Cynthia Kellerman, Patient Safety Officer at Tenant Health Central Coast. This is Healthy Conversations. The podcast from Tenant Health Central Coast, I'm Prakash Chandran. First of all, Cynthia, what exactly is a patient safety officer?
Cynthia Kellerman: A Patient safety officer is not an officer of the law for one, just to clarify that, but it is an important role and individual found in most healthcare facilities these days. And it connotes a proactive approach toward coordinating patients, safety protocols for safe quality care for all of our patients. The old lingo was a risk manager, which is still a component of a patient safety officer, but that has the bend of reacting to events that have already happened within a hospital safety events. Whereas a patient safety officer really looks at data, the culture of the hospital for the overall safety in a proactive way on what we can do to make our organization safer and stronger for our patients and our staff. The patient safety officer does not have to be a nurse, but is somebody that does have a certain skillset, if you will. Communication skills, leadership, high clinical skills. So they know the questions to ask. When we're looking at safety and protocols for our staff to follow
Host: One question I wanted to ask, you're talking about some of those safety protocols, what type of hospital setting provides a culture of safety in the first place?
Cynthia Kellerman: The culture of Safety has to be a buy in from everybody within the hospital. It's not just a culture. It's the family that we embrace while we're here. It's the coat we put on and we wear, and it's something that just embodies everything we do. And we care for our patients every day. And part of that means that we're very transparent. Every one of us in the hospital is accountable for patient's safety. If there is no hierarchal structure on, if somebody is more accountable than the other, we, if we see something, we say it, something about it, and we do something about it. And we follow up. I meet with employees, new employees that are coming to both of our hospitals every month. And I liken it to when we're at home. If we see if we have toddlers in our home, we do things proactively to prevent risk or harm coming to our toddlers at home, we see something and we do something about it right away. And that's what the culture of Safety in a hospital is as well. So it's a buy in from everybody.
It's being very transparent about what we see and what we see as things that we need to make stronger. Maybe a process that's confusing that needs to be tightened up. So it's understood by everybody. So it's a culture that we all wear every day. As I tell everybody that comes to a new employee orientation, when you're here at our hospital, this is your family. And we take care of our family when we're here. And so we want to know about things before they happen, near miss events as we call them. Near miss events are our opportunity to fix something and make it right before it reaches the patient. A patient safety manager really helps set the tone of a culture of safety. It makes sense. And we want to get that buy in from everybody to be completely transparent in sounding out what those near miss events are and having that day to day communication about what we can improve on.
Host: Yeah. I love that. And one of the things that you just spoke to is being proactive instead of reactive and bringing it down to a level I can understand because I have a small toddler, a little baby girl, and we've been doing so much to keep our home safe for her just as she explores and wanders the new world. So I want to get into some of the changes that you might have implemented post COVID, but I just in general, want to understand more about some of the safety protocols that you put in place to be proactive.
Cynthia Kellerman: An example of a proactive patient safety monitoring or protocol that we did was, a few years ago at both hospitals, I did a comprehensive study of all of our monitoring equipment, meaning cardiac monitoring, telemetry monitoring equipment, and wanting to make sure that it was connecting right, that all the pieces were in place, that we could keep our patients safe. And I found some opportunities that we needed to address right away. And I did this along with one of our biomedical engineers. So I had a complete understanding of what was interfacing with our software and hardware programs. And we put together all of that data. Again, data drives change, and the employees were being very transparent. And by this, nurses, putting patient safety events in the system where there were problems or those near miss events that were speaking to, Hey, we can't see the cardiac rhythm on this monitor, for example. So we kept track of that data. And then I put together a very report and invited a member from higher leadership team at tenant to come in and take a look at this. And they were able to see our proactive approach. They saw the data they thought happened in real time where those gaps were, and we were able to get upgraded equipment and interfacing systems to help keep our patients safe. So that was a great example of using all of the patient's safety officer's role in a proactive way toward keeping our patients safe.
Host: Yeah, that certainly sounds fantastic. And one of the ways, and one of the things that you said that resonated with me is around really looking at the data and helping to inform everyone to make those better decisions. So this kind of leads into my next question around the environment of a highly reliable organization. What exactly does that look like? And how does your role actually weave into that?
Cynthia Kellerman: Our Tenant Health Central Coast Hospitals, Twin Cities and Sierra Vista have adopted a model of being a high reliability organization. And we are certainly on our journey. It's not something that you complete and get a certificate for. It's an ongoing journey and high, reliable organizations are complex. They're fast evolving environments as healthcare is. And so there are different elements that we look at by being a high, reliable organization. And certainly as a patient safety officer, it fits right in. So one thing that I'm always looking at, I tell again, the new employees that are coming to our hospitals, I always have my shoulder pads on with a preoccupation of failure. And I say that it's not meant to be like a Debbie downer, but what it means is that we're a complex structure and we're always wearing those shoulder pads to look at what is around us that could be unsafe for our patients. What could happen? Again, it's that proactive approach.
And we also understand at preoccupation with failure is that big problems don't just emerge in an instant. There's almost always some smaller problems or anomalies that we get precursors or glimpses of. And so we're always kind of had that preoccupation with failure to prevent something big from happening at the same time, we don't assume that if we've got something in place to fix it, say a piece of equipment fails that everything is right. We'll look deeper into things to find an underlying cause. We're reluctant to simplify things, when something does happen, we'll dig deep into the details and really find the root cause as they say in the patient safety industry and where that CSI mentality like a crime scene investigator, we're going to go deep into the weeds to find out what happened. And then we're always evaluating our outcomes. Again, the data speaks. So do the outcomes, tell us that what we did put in place.
Whether it was a proactive initiative or something that we had to do after something happened is our data telling us that we had the outcomes that we were seeking? And we want to be resilient with that. We want to sustain that. So this is not a short fix. We're going to look at her data for quite a long time. And probably one of the key elements of being a high reliable organization is that we defer to the experts behind this, in our dig deep in the weeds, looking at root causes, the expert involved as the person with the hands on knowledge of the operation. It's not a hierarchy or authority. So again, it's getting down to the brass tacks, the person that has the knowledge of the operation at the point of failure, not necessarily the CEO or the chief nursing officer, who's involved with what happened? And that's where the principals of high reliable organizations seek out.
Host: I want to transition now to COVID-19 and how your role has changed and evolved over the past couple months. I'm curious as to how far in advance you were thinking about this preparation for something like COVID. And then afterwards, what changes you've had to personally make as the patient safety officer at Tenant, what changes you've had to make as this pandemic has evolved and grown?
Cynthia Kellerman: My role has changed. And some of it has remained stationary, certainly with COVID that fitting a pandemic, both of our hospitals have had very robust pandemic policies and incident command center protocols in place prior to this is not the first time we've had a pandemic and it's certainly not the first time that we've needed to have our incident command centers open up. So those standardized processes and how we approach emergent events are what we follow and having that in place made the steps necessary seamless. And because it was already set up and determined. With the novel Coronavirus, because it is novel, that part, we had to adapt to new information on a daily basis, and we still get information on a daily basis. We looked immediately to primarily the CDC, the Centers for Disease Control out of Atlanta, Georgia, and our own local San Louis County Public Health Department for our directors and guidance. We had information coming from them in real time to help adjust. So we prepared from the very start by having our standardized policies in place for both pandemic policies and procedures, and then running our incident command center, right from the get go. And then as the novel Coronavirus has declared itself over the last several months. And we're learning more about it. We've made adjustments through our incident command center as a result.
Host: It's wonderful to hear all of the things that you've been doing to be proactive and see eternally vigilant to make sure that the hospital environment is as safe as possible, but still there are going to be people that are apprehensive about coming in. Just for the record. I'd love to hear from you. Is it safe for people to come to the hospital to receive the healthcare that they need?
Cynthia Kellerman: Absolutely. And I want everyone to know that we screen everybody, all visitors, all employees are screened. Every time they come into the hospital, the set of standard screening questions, and they're required to wear our simple surgical blue masks. First of all, we screen all staff and all visitors patients are also screened and there is a specific nurse driven protocol for those patients who are tested for COVID-19. Anybody that's having an elective surgery or plan surgery done is tested for COVID-19 prior to going to surgery. That's another key element of safety. We also have covert safe units that are kept separate from those people who are under investigation for COVID or those whose results have come back positive for COVID-19. So the people that are on COVID safe units can rest assured that nobody else on that unit has COVID-19 that they're kept safe that way. Our staff also wear their masks all the time while they're caring for our patients.
So we're wearing our masks, the whole shift that we're caring for patients and following our infection control protocols. So it is absolutely safe. We do realize that some patients might seek out medical attention, not wanting to come to the hospital, and they still might have questions about whether they need to have an elevated level of care by coming into our emergency rooms. So within the last few weeks, Tenant Health Central Coast has established telehealth through the emergency department. And so folks can go online and get screened by a triage nurse, and that will help determine if they need to be seen by emergency room physician and come in or not. And so we have found the telehealth, a website and access for patients to be quite helpful in helping relieve our community members’ minds, whether they need to seek out a higher level of care by coming into our emergency rooms.
Host: Thank you so much, Cynthia, for putting all of us at ease, truly appreciate everything that you do. And everyone else there at Tenant Health being proactive to keep all of us safe and healthy while we go get care. That's Cynthia Kellerman, a patient safety officer at Tenant Health Central Coast. Thanks for checking out this episode of Healthy Conversations. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. This has been Healthy Conversations, a podcast from Tenant Health Central Coast. Thanks, and we'll see you next time.
Introduction: This program is a community service and is not intended to be a substitute for medical advice. Listeners, having questions about their health should make an appointment to see their personal physician. Any opinions or statements made during the program are those of the individuals or physicians making the statements and are not the opinions or statements of the hospital.
Prakash Chandran: Many communities are experiencing an increased level of fear and anxiety toward hospital visitations during the spread of COVID-19, fortunately medical professionals are taking action to keep their patients safe while providing the highest quality of health services. We're going to talk about it today with Cynthia Kellerman, Patient Safety Officer at Tenant Health Central Coast. This is Healthy Conversations. The podcast from Tenant Health Central Coast, I'm Prakash Chandran. First of all, Cynthia, what exactly is a patient safety officer?
Cynthia Kellerman: A Patient safety officer is not an officer of the law for one, just to clarify that, but it is an important role and individual found in most healthcare facilities these days. And it connotes a proactive approach toward coordinating patients, safety protocols for safe quality care for all of our patients. The old lingo was a risk manager, which is still a component of a patient safety officer, but that has the bend of reacting to events that have already happened within a hospital safety events. Whereas a patient safety officer really looks at data, the culture of the hospital for the overall safety in a proactive way on what we can do to make our organization safer and stronger for our patients and our staff. The patient safety officer does not have to be a nurse, but is somebody that does have a certain skillset, if you will. Communication skills, leadership, high clinical skills. So they know the questions to ask. When we're looking at safety and protocols for our staff to follow
Host: One question I wanted to ask, you're talking about some of those safety protocols, what type of hospital setting provides a culture of safety in the first place?
Cynthia Kellerman: The culture of Safety has to be a buy in from everybody within the hospital. It's not just a culture. It's the family that we embrace while we're here. It's the coat we put on and we wear, and it's something that just embodies everything we do. And we care for our patients every day. And part of that means that we're very transparent. Every one of us in the hospital is accountable for patient's safety. If there is no hierarchal structure on, if somebody is more accountable than the other, we, if we see something, we say it, something about it, and we do something about it. And we follow up. I meet with employees, new employees that are coming to both of our hospitals every month. And I liken it to when we're at home. If we see if we have toddlers in our home, we do things proactively to prevent risk or harm coming to our toddlers at home, we see something and we do something about it right away. And that's what the culture of Safety in a hospital is as well. So it's a buy in from everybody.
It's being very transparent about what we see and what we see as things that we need to make stronger. Maybe a process that's confusing that needs to be tightened up. So it's understood by everybody. So it's a culture that we all wear every day. As I tell everybody that comes to a new employee orientation, when you're here at our hospital, this is your family. And we take care of our family when we're here. And so we want to know about things before they happen, near miss events as we call them. Near miss events are our opportunity to fix something and make it right before it reaches the patient. A patient safety manager really helps set the tone of a culture of safety. It makes sense. And we want to get that buy in from everybody to be completely transparent in sounding out what those near miss events are and having that day to day communication about what we can improve on.
Host: Yeah. I love that. And one of the things that you just spoke to is being proactive instead of reactive and bringing it down to a level I can understand because I have a small toddler, a little baby girl, and we've been doing so much to keep our home safe for her just as she explores and wanders the new world. So I want to get into some of the changes that you might have implemented post COVID, but I just in general, want to understand more about some of the safety protocols that you put in place to be proactive.
Cynthia Kellerman: An example of a proactive patient safety monitoring or protocol that we did was, a few years ago at both hospitals, I did a comprehensive study of all of our monitoring equipment, meaning cardiac monitoring, telemetry monitoring equipment, and wanting to make sure that it was connecting right, that all the pieces were in place, that we could keep our patients safe. And I found some opportunities that we needed to address right away. And I did this along with one of our biomedical engineers. So I had a complete understanding of what was interfacing with our software and hardware programs. And we put together all of that data. Again, data drives change, and the employees were being very transparent. And by this, nurses, putting patient safety events in the system where there were problems or those near miss events that were speaking to, Hey, we can't see the cardiac rhythm on this monitor, for example. So we kept track of that data. And then I put together a very report and invited a member from higher leadership team at tenant to come in and take a look at this. And they were able to see our proactive approach. They saw the data they thought happened in real time where those gaps were, and we were able to get upgraded equipment and interfacing systems to help keep our patients safe. So that was a great example of using all of the patient's safety officer's role in a proactive way toward keeping our patients safe.
Host: Yeah, that certainly sounds fantastic. And one of the ways, and one of the things that you said that resonated with me is around really looking at the data and helping to inform everyone to make those better decisions. So this kind of leads into my next question around the environment of a highly reliable organization. What exactly does that look like? And how does your role actually weave into that?
Cynthia Kellerman: Our Tenant Health Central Coast Hospitals, Twin Cities and Sierra Vista have adopted a model of being a high reliability organization. And we are certainly on our journey. It's not something that you complete and get a certificate for. It's an ongoing journey and high, reliable organizations are complex. They're fast evolving environments as healthcare is. And so there are different elements that we look at by being a high, reliable organization. And certainly as a patient safety officer, it fits right in. So one thing that I'm always looking at, I tell again, the new employees that are coming to our hospitals, I always have my shoulder pads on with a preoccupation of failure. And I say that it's not meant to be like a Debbie downer, but what it means is that we're a complex structure and we're always wearing those shoulder pads to look at what is around us that could be unsafe for our patients. What could happen? Again, it's that proactive approach.
And we also understand at preoccupation with failure is that big problems don't just emerge in an instant. There's almost always some smaller problems or anomalies that we get precursors or glimpses of. And so we're always kind of had that preoccupation with failure to prevent something big from happening at the same time, we don't assume that if we've got something in place to fix it, say a piece of equipment fails that everything is right. We'll look deeper into things to find an underlying cause. We're reluctant to simplify things, when something does happen, we'll dig deep into the details and really find the root cause as they say in the patient safety industry and where that CSI mentality like a crime scene investigator, we're going to go deep into the weeds to find out what happened. And then we're always evaluating our outcomes. Again, the data speaks. So do the outcomes, tell us that what we did put in place.
Whether it was a proactive initiative or something that we had to do after something happened is our data telling us that we had the outcomes that we were seeking? And we want to be resilient with that. We want to sustain that. So this is not a short fix. We're going to look at her data for quite a long time. And probably one of the key elements of being a high reliable organization is that we defer to the experts behind this, in our dig deep in the weeds, looking at root causes, the expert involved as the person with the hands on knowledge of the operation. It's not a hierarchy or authority. So again, it's getting down to the brass tacks, the person that has the knowledge of the operation at the point of failure, not necessarily the CEO or the chief nursing officer, who's involved with what happened? And that's where the principals of high reliable organizations seek out.
Host: I want to transition now to COVID-19 and how your role has changed and evolved over the past couple months. I'm curious as to how far in advance you were thinking about this preparation for something like COVID. And then afterwards, what changes you've had to personally make as the patient safety officer at Tenant, what changes you've had to make as this pandemic has evolved and grown?
Cynthia Kellerman: My role has changed. And some of it has remained stationary, certainly with COVID that fitting a pandemic, both of our hospitals have had very robust pandemic policies and incident command center protocols in place prior to this is not the first time we've had a pandemic and it's certainly not the first time that we've needed to have our incident command centers open up. So those standardized processes and how we approach emergent events are what we follow and having that in place made the steps necessary seamless. And because it was already set up and determined. With the novel Coronavirus, because it is novel, that part, we had to adapt to new information on a daily basis, and we still get information on a daily basis. We looked immediately to primarily the CDC, the Centers for Disease Control out of Atlanta, Georgia, and our own local San Louis County Public Health Department for our directors and guidance. We had information coming from them in real time to help adjust. So we prepared from the very start by having our standardized policies in place for both pandemic policies and procedures, and then running our incident command center, right from the get go. And then as the novel Coronavirus has declared itself over the last several months. And we're learning more about it. We've made adjustments through our incident command center as a result.
Host: It's wonderful to hear all of the things that you've been doing to be proactive and see eternally vigilant to make sure that the hospital environment is as safe as possible, but still there are going to be people that are apprehensive about coming in. Just for the record. I'd love to hear from you. Is it safe for people to come to the hospital to receive the healthcare that they need?
Cynthia Kellerman: Absolutely. And I want everyone to know that we screen everybody, all visitors, all employees are screened. Every time they come into the hospital, the set of standard screening questions, and they're required to wear our simple surgical blue masks. First of all, we screen all staff and all visitors patients are also screened and there is a specific nurse driven protocol for those patients who are tested for COVID-19. Anybody that's having an elective surgery or plan surgery done is tested for COVID-19 prior to going to surgery. That's another key element of safety. We also have covert safe units that are kept separate from those people who are under investigation for COVID or those whose results have come back positive for COVID-19. So the people that are on COVID safe units can rest assured that nobody else on that unit has COVID-19 that they're kept safe that way. Our staff also wear their masks all the time while they're caring for our patients.
So we're wearing our masks, the whole shift that we're caring for patients and following our infection control protocols. So it is absolutely safe. We do realize that some patients might seek out medical attention, not wanting to come to the hospital, and they still might have questions about whether they need to have an elevated level of care by coming into our emergency rooms. So within the last few weeks, Tenant Health Central Coast has established telehealth through the emergency department. And so folks can go online and get screened by a triage nurse, and that will help determine if they need to be seen by emergency room physician and come in or not. And so we have found the telehealth, a website and access for patients to be quite helpful in helping relieve our community members’ minds, whether they need to seek out a higher level of care by coming into our emergency rooms.
Host: Thank you so much, Cynthia, for putting all of us at ease, truly appreciate everything that you do. And everyone else there at Tenant Health being proactive to keep all of us safe and healthy while we go get care. That's Cynthia Kellerman, a patient safety officer at Tenant Health Central Coast. Thanks for checking out this episode of Healthy Conversations. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. This has been Healthy Conversations, a podcast from Tenant Health Central Coast. Thanks, and we'll see you next time.