The SCAHRM SOURCE Newsletter


February 2019

By Farnaz Datomi, MS, CPHRM
Director of Risk Management & Patient Safety, Kaiser Permanente

Storytelling has been a traditional and even ancient means of passing on wisdom and culture. Stories connect us. In healthcare, providers can and should share stories of their actual experiences, including associated emotions. Stories of successes, failures and even devastating medical errors/accidents can provide valuable learning information. Storytelling, when balanced, can be the most effective tool for change. We must challenge leaders and executives to allow sharing of stories with both positive and negative outcomes — a healthy balance of both.

Stories are welcomed where the culture — at all levels — promotes transparency, authenticity and psychological safety. Stories will not be told if storytellers feel unsafe, not acknowledged, or not genuinely heard. Caregivers must have the psychological safety to share experiences without fear of retaliation, punishment or criticism.

In January 2019, I heard a panel discussion organized by the Patient Safety Movement Foundation. Various patient safety experts discussed a paradigm shift in hospital safety. I was fascinated by Dr. Helen Macfie, the Chief Transformation Officer of Memorial Healthcare System, who commented on five key components necessary to achieve a vigorous hospital safety program:

  1. Involve patients and families. Be transparent and have conversations about errors and what is being done to prevent reoccurrence.
  2. Have bold goals for quality and safety: We all have heard the phrases, “we are below the national average,” and “we are below the benchmark.” Transforming and striving for goals such as “zero harm” and “always” should be the standard.
  3. Storytelling: Patient stories matter. Passing them through all levels of an organization is vital. Starting meetings (Quality, Safety and Board) with stories of patients can put everyone in the right frame of mind and focus the conversation.
  4. Involve patients in design.
  5. Resourcing: Putting financial support behind safety teams to make effective change.

These key components also direct and help us ask the right questions and request relevant data (e.g., experience/grievance; peer review; liability and incident reporting; and, other important data that leaders can access). We must help connect the data rather than looking at the data in divisional siloes.
Once transparency is welcomed and psychological safety is achieved, we will have open and honest conversations about patient safety and employee safety. Perfunctory conclusions such as “healthcare is not perfect,” “errors happen,” and “no harm no foul,” will be replaced by goal-oriented problem solving like “did we miss anything?” and “the outcome might not have changed but I feel we missed the boat on…”.

Healthcare organizations are faced with various levels of liability exposure: monetary fines, civil liability, class action lawsuits, criminal liability, and increased employee illness and injury rates. All have a concomitant increase in cost and decrease in productivity. An organization committed to patient and employee safety — at all levels — will minimize liability exposure.

I have heard many stories from nurses, doctors, supervisors, and patients/families that have moved me and have transformed me as a risk manager and patient safety leader. My father’s unexpected death in a hospital a day prior to his discharge is a story that I never felt the courage to tell. I blamed myself for his passing. I did not reach closure because I stayed silent. Based on my own experience, I believe that while not every story is relevant or productive, many are.
Stories should not be used to humiliate or assign blame. Rather, the telling of stories should be embraced as a learning tool to bring awareness and constructive change. Providers and employees should be encouraged to tell stories of their experiences. Grant them psychological safety and they will tell their stories.

About the Author

Farnaz Datomi has served in various positions in hospitals for over 20 years, 17 years of which in management of risk and patient safety areas. Farnaz is currently the Director of Risk Management and Patient Safety for one of the Kaiser Permanente facilities in Southern California. Farnaz in her roles either has either ran or maintained the functions of Risk, Patient Safety, Hospital Safety, Claims, and Insurance (most lines of coverage). Farnaz’s training extents beyond risk management and include Ombudsman-Mediator, Just Culture/Culture of Safety, and Patient Safety Executive training.
In her role as the director of risk management and safety services, she had the oversight of Work-Place Violence Program and IIPP (Illness Injury Prevention Program) including all necessary education, training, and performance monitoring. Farnaz has had the oversight of the hospital claims handling program, various lines of coverage and supported and coordinated an early resolution/mitigation process whenever possible.