Introduction
A key characteristic of children’s hospitals is an increase in safety events. Statistics indicate that the pediatric population in hospitals experiences adverse events three times more frequently than adults. The safety concerns are exacerbated by the fact that children and infants alike cannot always communicate when something is wrong or when their symptoms are worsening. Instead, they depend on their caregivers or parents to offer the appropriate intervention to their needs. This background led Arkansas Children’s Hospital (ACH) to set a goal of reducing emergency transfer rates by 40% through the implementation of the evidence-based Watcher Program (Evans et al., 2021).
Background
High-reliability organizations (HROs) refer to organizations that strive to achieve efficiency, safety, and quality goals by applying five key principles. These principles include a reluctance to simplify, which entails acknowledging the intricacy of the work and the likelihood of failure in unexpected and new ways. The second principle is sensitivity to operations, which includes an enhanced awareness of the state of relevant processes and systems.
The third, deference to expertise, involved valuing staff’s insights and prioritizing the most relevant and knowledgeable staff members over those with more seniority (Evans et al., 2021). The practice of resilience encompassed prioritizing emergency training for multiple system failures that seemed improbable but could still occur. The last principle is being preoccupied with failure, which involves regarding instances that are almost failures as opportunities for improvement.
In the assessment, planning, and actions taken by ACH, it is evident that the hospital has practically incorporated the HRO characteristics. In the assessment, ACH acknowledged the probability of failure and, thus, the complexity of the work (Evans et al., 2021). The intervention to safety events incorporated the watcher criteria and algorithm implementation in the hospital. This shows that the hospital was mitigating the likelihood of failure by finding a simple way to identify patients who meet the watcher criteria, thus exemplifying the first principle.
There was also the sensitivity to operations, where ACH was aware of its systems and processes. Its primary objective was to increase situational awareness and ensure that contingency plans were in place for patients at risk of deterioration. The hospital was aware that the outcome of its measurements would be a rate of emergency transfer per 10,000 non-ICU patient days (Evans et al., 2021). It was also evident that, in the planning and implementation of the patient watcher algorithm, ACH was an HRO that adhered to the principle of deference to expertise.
It valued the nurses’ insight by assigning the nursing team, primarily the RN, the duty to activate the algorithm, thus enabling the patient’s evaluation. The implementation stage demonstrates the practical application of the resilience principle (Evans et al., 2021). This point acknowledged that, although unlikely, potential system failures may occur and implemented the Watcher program through a pilot phase that will prioritize emergency training for many of these possible failures.
The initial pilot phase was implemented in the Infant-Toddler Unit (ITU), and the dedicated nursing and physician team worked together to ensure the program’s success. The process was preoccupied with failure because it had a final phase in the Intermediate Medical Unit (IMU) and hematology-oncology areas, following the initial phase in the ITU, which revealed that ACH recognized the need for further improvement (Evans et al., 2021). This was particularly because the team in the second phase had raised concerns about the need for improvements. The success in the first phase showed the need to potentially check the program’s success in other areas by implementing it further.
ACH Team Utilization of the 4E+2 Principles
Ideal alignment is associated with a positive effect on team engagement and performance. Particularly, engagement helps yield better organic results, presents higher productivity, better retention rates, increased communication, and higher work satisfaction (Evans et al., 2021). One of the best easy ways to ensure a team’s engagement and performance was through the 4E+2 principles. The 4Es are engage, educate, execute, and evaluate, while the 2Es are endure and expand.
Engagement entailed bringing staff together, informing them, and inquiring about how their contributions would positively impact the program (Evans et al., 2021). It is clear that in implementing the watcher program, this was particularly the case in the hematology-oncology and IMU areas. The engagement resulted in stakeholders expressing concerns about the program’s value for high-risk patient populations and in higher-acuity areas.
Educating entailed ensuring nurses, psychiatrists, and all other staff knew how to implement the program and their specific roles. Education was conducted effectively, as evident from the start of the project. A small group of the hospital’s safety leaders met to discuss plans for implementing the project. Subject matter experts and an interprofessional team were involved, thus enabling staff in the area to draw on the expertise and knowledge of these expert teams (Evans et al., 2021).
Execution involved demonstrating how the program would be implemented while ensuring its success. This has been achieved through the program’s deployment. The ACH team successfully deployed the Watcher program through a pilot phase, initially in the Infant-Toddler Unit (ITU) and subsequently in the hematology-oncology and IMU areas. It was implemented prudently, with concerns raised earlier addressed in the second phase.
The fourth E evaluation entailed reviewing the performance and results of an activity. Performance and results were assessed using data collected from each unit, compiled on a checklist-based form. Emergency transfers to the ICU were an important measure, and charts were used to compare these transfer rates over time (Evans et al., 2021). The conclusion was that the Watcher program was a success.
As far as the 2Es were concerned, the first enduring aspect was sustainability, and the second was expansion, which implied the project’s ability to spread. The watcher program helped address safety events, particularly among pediatric populations, and its success rate exemplified its sustainability. The fact that it has been tested in two phases across different patient populations suggests it could be expanded.
Technology in Safety Challenge Identification, Sustainability, and Opportunities
Technology is widely adopted in healthcare settings, offering the potential to improve both the quality of care and patient safety. In particular, the implementation of technology in certain high-risk areas, such as emergency transfers, has a significant impact. This impact includes reducing mortality through identifying challenges in safety events. The benefits offered render the technology sustainable.
In ACH, the Watcher program’s technology played a significant role in reducing emergency transfers and enhancing situational awareness (Evans et al., 2021). The program was a reliable system that used technology, particularly an algorithm, to detect, mitigate, and escalate patients who were clinically deteriorating. Thus, it enabled the hospital team to manage transfer events proactively in a controlled, safe, and timely manner.
Thus, implementing it is a systematic process that enables the early management and recognition of deteriorating patients. It enabled the healthcare team and nursing staff to intensify care, reduce the risk of delayed care, and provide the family with a sense of security. These advantages that the technology offers are a guarantee of its sustainability. The Watcher program offered the opportunity to further the application of technology in the hospital.
By enabling accurate diagnosis and determination of the proper care to be offered, the Watcher program can integrate with technologies such as electronic health records. It also offers room for further research on how its information can be used with technologies such as predictive analysis and data integration.
How ACH Used 4Ps
The pertinent management of transitions can minimize the risks associated with change. The 4Ps model offered a suitable strategy and recommended structure for ensuring innovation excellence, particularly in healthcare settings. The model is based on the fundamental principle that organizational excellence is attained by the following 4Ps: purpose, picture, plan, and part. Purpose entailed describing why it is important to make the change (Bridges, 2009). ACH clearly defines the importance of adopting the watcher program.
The purpose is presented in the background section, where ACH had a design that was responsive to emergencies rather than predictive. This increased the number of safety events, specifically among children’s hospitals. Thus, as a necessary intervention, the watcher program was inevitable. The picture depicts the future, as the product description makes clear, where ACH asserts that early response and recognition of clinical worsening are key to patient safety. Thus, a system that enables early response and recognition paints a picture of a more efficient future.
A plan entails describing the required steps to achieve the goal. The ACH clearly stated how the watcher program was to be implemented to achieve patient safety. It clearly described the pilot phase and the role of a team, including the team leader and the patient’s primary RN, in activating the algorithm. It concluded with a discussion of the efficiency measures that led to the program’s success. The part involved defining each employee’s role by designating the patient’s primary RN as the algorithm’s activator via the ACH. This, together with the nursing team lead’s notification by phone or digital pager about the watcher classification and algorithm activation, illustrated the demarcation of roles for each player.
Conclusion
Arkansas Children’s Hospital successfully implemented the Watcher program to promptly identify deterioration among hospitalized children. This paper has reviewed the case study and assessed ACH’s program implementation against the 5 HRO characteristics, which it successfully implemented. It has also explored the 4E+2, examined the role of technology, and how the 4Ps have been incorporated in the implementation.
References
Bridges, W. (2009). Managing Transitions: Making The Most Of Change (3rd ed.). Perseus Publishing.
Evans, S., Green, A., Roberson, A., & Webb, T. (2021). Implementing a watcher program to improve timeliness of recognition of deterioration in hospitalized children. Journal of Pediatric Nursing, 61, 151-156.