September Message from Steven L. Strongwater, MD, CEO

The information below is an employee update of activities at Stony Brook University Medical Center prepared by Stony Brook University Hospital CEO, Steven L. Strongwater, MD. Dr. Strongwater distributes a monthly update that is sent to all hospital faculty and staff to communicate initiatives and activities undertaken at the Medical Center to reach goals in the areas of patient safety, patient satisfaction, and community connections.

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September 2010

There are only 130 academic medical centers (AMCs) across the nation. AMCs are differentiated by their mission to provide excellence in patient care, to teach, to research, and to disseminate discoveries. Like Stony Brook University Medical Center (SBUMC), a typical AMC has an accredited medical school, hospital, and associated faculty. AMCs play a critical role in the delivery system of patient care—bringing the highest standards of quality and access to the most up-to-date treatments. Because AMCs often care for the most critically ill patients, they provide treatment options and skill sets not available within a community hospital setting. AMCs provide our nation’s “stand by” capacity to handle major disasters, trauma patients, burn victims, and other urgent needs requiring advanced skills. AMCs are also a vital part of the nation’s safety net, providing care to millions of uninsured. 

Academic medical centers are part of a larger group of teaching hospitals that provide training to medical students and resident physicians. According to the American Association of Medical Colleges, the nearly 400 teaching hospitals make up just six percent of all hospitals nationwide. They provide:

• 40 percent of neonatal ICUs
• 62 percent of pediatric ICUs
• 61 percent of all Level 1 regional trauma centers
• 75 percent of all burn care units

Teaching hospitals also provide nearly half of all hospital charity care nationwide and a disproportionate share of care to patients who are severely ill or have rare conditions, including:

• 50 percent of surgical transplantation services
• 41 percent of Alzheimer’s centers
• 22 percent of all cardiac surgeries

There is a long list of discoveries generated by academic medical centers, such as vaccines to prevent illness, miraculous cures like total joint replacements, and bone marrow and kidney transplantations. AMCs are places where knowledge continuously evolves and new treatments and cures are identified. At Stony Brook, for example, the original research that led to the discovery of magnetic resonance imaging (MRI) took place. Dr. Paul Lauterbur was awarded the 2003 Nobel Prize in Physiology and Medicine for this work. The teamwork between the National Institutes of Health (NIH) and America’s medical schools and major teaching hospitals serves as the nation’s driving force in the search for cures, new treatments, and better ways to improve health and save lives. AMCs are the training ground for more than 100,000 new physicians and other healthcare professionals annually.

Not well known is that it can take as long as 17 years from the point of discovery of a new medication or treatment for this discovery to come into common usage. Teaching physicians cannot afford that luxury of time, and by virtue of their role, they must be current with new treatments, scientific advances, and the skills to communicate and educate patients, medical students, and other members of the healthcare team. AMC physicians have chosen a different path from community physicians in their pursuit of the tripartite mission of patient care, research, and education.

We are excited by the more than 50 faculty who have joined SBUMC this year. Please welcome:

These physicians are working in nearly every department, including specialists in anesthesia, emergency medicine, gastroenterology, internal medicine, neurology, obstetrics and gynecology, orthopedics, otolaryngology, pediatrics, pediatric rheumatology, pulmonary medicine, radiology, surgery, and urology. SBUMC takes its role as an academic medical center seriously—a limited yet invaluable resource for our nation and the region. We will continue to work to understand and meet the needs for healthcare within Suffolk County.

STONY BROOK PRIDE 

Event kicks off SBUMC’s journey to become a High Reliability Organization (HRO). On August 30 SBUMC kicked off its initiative to redesign the operational model for quality care. In efforts to reach the goal of becoming a “high reliability organization,” unit teams will be formed to work on achieving high reliability at the unit and department level. The kickoff included keynote speaker Kathleen M. Sutcliffe, PhD, Associate Dean for Faculty Development and Research at the Stephen M. Ross School of Business, University of Michigan, co-author of the book Managing the Unexpected.

SBUMC earns Silver Award for heart failure outcomes. The American Heart Association’s Get With The Guidelines®-Heart Failure program granted the award in recognition of SBUMC achieving an 85 percent or higher rate on all heart failure indicators aggregated over a 12-month period. The award means that Stony Brook will be recognized as part of the International Scientific Sessions Conference, which includes being named on an exhibit banner and in an advertisement in the journal, Circulation. Congratulations to the Heart Failure Team!

The Prostate Care Program at SBUMC received a 2010 New York State Proclamation. Assemblyman Robert K. Sweeney presented the proclamation in recognition of continuous prostate cancer screening efforts in Suffolk County—the second proclamation the program has received. The Prostate Care Program is now in its fifteenth year of partnership with the Assemblyman and the North Lindenhurst Fire Department. A citation was presented to Howard L. Adler, MD, Medical Director of the Program; Arlene Shaw, RN, Nursing Director; and staff at a July 26 ceremony. September is National Prostate Cancer Awareness Month. An annual screening is recommended for all men age 40 and over. From September 20 to September 23, free screenings will be available at the Stony Brook Urology Tech Park office in East Setauket. To register, or for more information, call (631) 444-4000.

The Department of Health has approved SBUMC’s application for an autologous bone bank. The bone banking functions (harvesting, storage, and re-implantation) are now included on our skin bank license. Steven Sandoval, MD, is the Tissue Bank Director for this license. The license is provisional and will become a full license following an on-site survey of our facility, which will occur sometime within the next year. This was an arduous process, and thanks go out to Errol Orehek and Dr. Sandoval for their tenacity and patience in completing the multitude of forms, certificates, and applications that made this possible.

Construction of the new 10,000-square-foot Comprehensive Psychiatric Emergency Program (CPEP) annex begins. Part of the Medical Center’s Major Modernization Project, the new CPEP Annex will be located adjacent to the Emergency Department. The Annex has been developed in direct response to the growing demand for psychiatric services in Suffolk County, and will triple the capacity of the existing facility, which currently handles 6,000 visits a year. The new CPEP has been designed with a focus on creating an enhanced environment of care.

Division of Nursing announces organization changes. To better align the Division of Nursing with the strategic plan for the Medical Center, the following organizational changes have been made: Rose Cardin, Associate Director of Nursing for the Cancer Center, has assumed the Associate Director’s role for Psychiatric Services; Margaret Duffy, Associate Director of Nursing for the Heart Center, will take on leadership for the Division’s Education and Magnet missions; Debra Grimm, Associate Director of Nursing for Medicine and Emergency Services, will be expanding her leadership role as the Nursing lead for the Stony Brook Long Island Children’s Hospital; Donna Keehner-Nowak, Associate Director of Nursing for Peri-Operative and Surgical Services, will assume responsibility for Obstetric and Gynecologic Services; and Dan Roberts, Associate Director of Nursing for Quality, Research will now also lead the newly added Nursing Support Services.

J. Clinton Weaver joins SBUMC as Senior Director, Public Affairs and Marketing. This newly created position will bring together all aspects of communications with the goal of improving internal and external communication, as well as enhancing our public relations and marketing initiatives. With more than 20 years of healthcare marketing experience, Mr. Weaver is viewed as a national thought leader, having received over 23 awards from Healthcare Marketing Report and almost 70 awards from the Carolinas Healthcare Public Relations and Marketing Society, and is a member of the Society for Healthcare Strategy and Market Development. He has served as a newspaper journalist and editor, public relations director, and director of marketing and outreach. He holds a BA in Journalism from the University of North Carolina and an MBA with a concentration in healthcare from Fayetteville State University.

Employee of the Month. Congratulations to Marvin Johnson, Sterile Supply Technician, who was selected as the Employee of the Month for September. Mr. Johnson’s colleagues at the Cancer Center describe him as an extremely hardworking and compassionate individual who shows kindness, concern for others, and professionalism. His efforts for patients and staff extend well beyond the realm of his duties at the Medical Center, as there have been countless stories of Mr. Johnson coming to the rescue of patients, family members, and staff members, be it fixing a tire or helping to start a car. Last winter during a blizzard, he came to the aid of an employee whose car got stuck along Nicolls Road. He then followed the employee to the Hospital to ensure a safe arrival.

SBUMC’s Institute for Advanced Neurosciences Web site goes live. The Institute for Advanced Neurosciences has launched a new Web site aimed at providing the most up-to-date information relating to neurosciences services for referring physicians, patients, their families and the general public. Learn about the Centers within the Institute focused on Cerebrovascular and Stroke care, Skull-base Surgery, Neuro-oncology, Spine, Epilepsy, Neuromuscular disease and ALS, Adult and Pediatric Multiple Sclerosis, Autism, Sleep Disorders, and the core services that support these specialty centers. To learn more about Stony Brook’s Institute for Advanced Neurosciences, visit www.StonyBrookNeurosciences.org.

SBUMC introduces its Medical Student for a Day program. On August 16 and 17, local and New York State government officials, as well as healthcare industry representatives, became medical students for a day in SBUMC’s first “Project Medical Education” (PME). The project is a national program designed to help public officials make informed decisions on issues affecting the future of medical education. Participants became “medical students” and took a fast-track med school path learning via lectures and hands-on training about medical education, clinical initiatives, and the importance of research. PME took place throughout SBUMC, including a Hospital tour and visits to School of Medicine labs in the Health Sciences Center.

PATIENT SAFETY

SBUMC completes first general thoracic surgery data submission to the Society of Thoracic Surgeons. Decision Support Services (DSS) is collaborating with the Department of Cardiothoracic Surgery (CTS) to complete SBUMC’s first General Thoracic Surgery registry semiannual data submission to the Society of Thoracic Surgeons in September 2010. Participation in this registry will augment improvement in the quality of cardiothoracic surgical care. In January 2010, CTS began collecting and recording data in the Apollo Advance application, supported by DSS. The first submission will include data for surgeries occurring from January through June.

Poster presented at the Mayo Clinic Conference earns recognition. A poster titled “An Efficiency-Based Multi-criteria Strategic Planning Model for Ambulatory Surgery Centers” was presented at the Mayo Clinic Conference on Systems Engineering & Operations Research in Health Care and earned an Honorable Mention. The poster provided an overview of the paper published in the Journal of Medical Systems by Herb Lewis, PhD, Thomas Sexton, PhD, and Melissa Dolan, MS. The paper proposes a methodology for identifying the ideal procedure mix and volume for Ambulatory Surgery Centers. Strategic scenarios were used to demonstrate the methodology. These strategic scenarios resulted in both greater reimbursement and a lower total number of complications.

Institute for Healthcare Improvement (IHI) accepts Stony Brook University Hospital (SBUH) poster. The Institute for Healthcare Improvement accepted a poster submitted by the Pediatric Hematology/Oncology Committee for presentation at the IHI’s 22nd Annual National Forum on Quality Improvement in Health Care, December 5-8, highlighting outcomes relating to a successful decrease in central line related infections for this high risk population. The CLABSI (central line associated bloodstream infection) rate has decreased 76.7 percent compared to the same time last year.

SBUH organ donor conversion rates are recognized. Stony Brook continues to save lives through organ donation, as 26 people were able to receive lifesaving transplantation procedures due to seven patients who died and became organ donors during the period of January through July 2010. The conversion rate of 88 percent (7 out of 8 patients) exceeds the national goal of 75 percent that is set by the United Network for Organ Sharing. Nationally, there are over 108,000 people currently waiting for a transplantation procedure.

Lean event leads to process changes to improve performance. The Departments of Medicine, Emergency Department and Bed Control are collaborating to implement recommendations that were generated from a recent Admission Process Lean event facilitated by Quality Management. The focus is to streamline the process of admitting a patient to a medicine service bed. Using the lean concepts and principles taught to the group prior to the event, the team developed a new process focused on eliminating waste, promoting value, standardizing communication, and increasing staff and patient satisfaction. The new changes are currently being tested and implemented.

Reducing Hospital Acquired Infections. Congratulations to the following units for their efforts to reduce hospital-acquired infections:

• 0 reported central line infections in the Medical Intensive Care Unit (MICU) for 6 months (February-July 2010)
• 0 reported central line infections for Pediatric Intensive Care Unit (PICU) for 16 months (April 2009 - July 2010)
• 0 reported VAP (ventilator-associated pneumonia) infections in the MICU for 7 months (January-July 2010)
• 0 reported VAP infections in the Neonatal Intensive Care Unit (NICU) for 8 months (November 2009 - June 2010)
• 0 reported VAP infections for Pediatric Intensive Care Unit (PICU) for 14 months (June 2009 - July 2010)

Rapid Response Team (RRT) calls increase since last year. Designed to reduce cardiac arrest codes, SBUMC has put in place Rapid Response Teams (RRT) to respond immediately, 24 hours a day, seven days a week, to acute deterioration in patient status throughout the Hospital. These teams can be activated by healthcare providers and/or patients and families. RRTs have been successful. SBUMC reached an all-time record number of RRT calls for the period of July 2009 through June 2010. The team received 889 calls, the highest number of calls for a 12-month period since the team began in December 2005. Currently, the Hospital is focusing on educating patients, family members, and visitors to call a Rapid Response, when appropriate. Flyers were posted in all patient rooms to provide information on how to call a Rapid Response by dialing 321.

Striving to improve the response to Code Blue calls. The Mock Code Blue Committee is conducting planned and unplanned mock codes. Each month, one to three units are scheduled for focused education with staff for a hands-on one-to-one exposure to the use and management of emergency equipment needed during a Code Blue. A planned event is conducted on every shift each month, followed by an unplanned event at the end of the month on one of the units.

Acute Myocardial Infarction (AMI) core measure composite score improves. A statistically significant improvement was noted in the AMI core measure composite score for the first quarter of this year. SBUH achieved 97.2 percent for the AMI composite score, the highest score achieved thus far for this metric. This improvement was achieved through the collaborative efforts of our physicians and staff to ensure quality care is delivered reliably to our heart patients.

Admitting Department operations undergoes review for improvement opportunities. Management Engineering is conducting a review of Admitting Department operations encompassing all admitting-related functional areas and processes. The review will identify improvement opportunities and enhance organizational effectiveness, process flow, and efficiency of operations. Proper staffing levels and staff utilization to achieve service goals will be determined accordingly. The study begins with a high level review of the organization structure, functional areas, and corresponding supervisor/staff roles. A review of the processes and detailed data collection for analysis will follow. 

A new capacity management system is being developed. Information Technology is partnering with Cerner to design a new capacity management system that will eventually replace the TeleTracking system currently being used to facilitate patient flow. In this project, Management Engineering is providing IT with current and future state documentation and analyses of three related processes: bed tracking, custodial service (housekeeping), and patient/equipment transport. The study results will provide process and workflow information and highlight potential issues that may be critical to the design of this new capacity management system.

PATIENT SATISFACTION

Hospital patient satisfaction goal is set. As part of the institutional priorities set for 2010-2011, Hospital leadership has developed core organizational priorities and set goals under four pillars: Quality, Finance, Relationships, and Best Place to Work. The goal under the Best Place to Work pillar is to improve patient satisfaction as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey question, “Would you recommend this hospital to your friends and family?” The goal is to raise by five percent the percent of survey respondents who say they would “definitely recommend” Stony Brook. As each department develops goals around the pillars for this year, they will align with Hospital goals contributing to the Hospital’s success at meeting the objective. Analysis of our patient satisfaction data shows that the issues most highly correlated to a patient’s likelihood of recommending the Hospital include: staff worked together to care for you, staff includes you in decisions regarding treatments, and response to concerns and complaints.

Patient and Employee Satisfaction Committee invite input from units and departments. Twice monthly, Hospital leadership meets to review and discuss patient satisfaction. Recently, meeting agendas have been augmented to include presentations by Unit and Department managers that show patient satisfaction trends, strengths, and weaknesses, and action plans underway to address issues. At the first of these newly formatted meetings, 15N/S and the ED presented strategies they are actively pursuing to improve satisfaction. On the inpatient units the focus is on making discharge calls to all discharged patients, a proven strategy to that improves both patient care and patient satisfaction and scripting. The ED is also focusing on making more discharge calls and more frequent regular rounding on patients.

Making 16N a quieter place. The staff of 16N is working harder than ever to make their unit a quieter and more restful healing environment for patients. Twice daily clinicians are rounding on patients around the subject. They set expectations, ascertain patient needs, and gauge the success of their efforts. Staff offer patients ear plugs, close doors, dim lights at night, limit visitors at the bedside to two, and offer ear buds to patients watching TV with the volume set high to make it quieter for their roommates. The goal is to raise the Press Ganey score on 16N by six points, in stages.

COMMUNITY CONNECTIONS

Join us to welcome Dr. Kenneth Kaushansky. On Tuesday, September 7, from 5:00 pm to 7:00 pm, a reception will be held in the HSC Galleria to welcome Dr. Kaushansky, newly appointed Vice President of Health Sciences and Dean of the School of Medicine. Dr. Kaushansky comes to Stony Brook from the University of California, San Diego, where he was the Helen Ranney Distinguished Professor and Chair of the Department of Medicine. He is a leading hematologist, both as an accomplished clinician and researcher.

Attend a Town Hall Meeting to learn about important Hospital initiatives. All Medical Center employees are invited to attend a Town Hall Meeting hosted by Hospital CEO, Dr. Steven Strongwater, on Tuesday, September 14, to learn more about the new Stony Brook Long Island Children’s Hospital and the goal of becoming a high reliability organization. The meeting begins at 1:30 pm live in the HSC Lecture Hall 6, with video conferencing in the Hospital Lobby Conference Room; CEO Large Conference Room; OVP Conference Room; 31 Research Way, Conference Room A; and Flowerfield Conference Room. 

Russian healthcare delegates visits SBUMC. Eighteen delegates of the Special American Business Internship Training (SABIT) Russian healthcare delegation visited on August 3. The delegates, screened and selected by the U.S. Department of Commerce, represent industry leaders who are seeking information to improve their healthcare systems. Lectures in health economics, information technology, finance, and human resources were provided in addition to tours of the Medical Center. 

East End fundraiser for Stony Brook Long Island Children’s Hospital raises over $200,000. More than 400 guests joined the Honorable Rudy and Judith Giuliani on Saturday, August 14, at the 30,000 square foot home of Kristen and Joe Farrell in Bridgehampton to support Stony Brook Children’s. Guests enjoyed music, dinner, and dancing as well as a live auction of exciting prizes, including a day of golf with Rudy and Judith Giuliani, auctioned off by Rudy himself. Members of the Stony Brook Development Council, Children’s Hospital Task Force, and other supporters mingled with celebrities in attendance including Greg Buttle, a former New York Jets linebacker, comic and writer, Jackie Martling, and Bill Hemmer, co-host of Fox News Channel’s “America’s Newsroom.”

Fire Island community supports SBUMC breast cancer research. The 15th Annual “Concerned Women of the Grove” fundraiser to support breast cancer research and services was held on August 7. More than 300 attendees generously supported the event and learned about current SBUMC breast cancer research from Allen Meek, MD. To date, the group has raised more than $600,000 for breast cancer research and services at Stony Brook and other organizations, and we are grateful for their ongoing commitment and dedication. 

Summer Soiree raises $205,000 to fight pediatric multiple sclerosis. More than 300 guests filled the Crest Hollow Country Club ballroom on August 5 to dine, dance, and learn about the National Pediatric MS Center at Stony Brook’s rigorous research program from speaker Lauren Krupp, MD. The night’s honoree, Ron Rizzo of Ron Rizzo Jewelry, designed a beautiful butterfly necklace, which was the highlight of the silent auction. A live auction capped the evening’s activities. 

Stony Brook holds 9/11 Memorial Commemoration. On Monday, September 13, at noon, the 9/11 Memorial Commemoration will honor alumni and other members of the Stony Brook family who were lost on September 11, 2001. The outdoor event will take place at the Outdoor Alumni Arch, which is across from the Humanities Building on West Campus. In the event of rain, it will be held in the Student Activities Center Auditorium. For more information, please call (631) 632-6320.

Helping to tackle childhood cancer. September is National Childhood Cancer Awareness Month, and everyone purchasing a ticket to the Stony Brook University Seawolves home opener football game on September 11 will help to tackle childhood cancer. A portion of the ticket sales will support the “Play Fit-Stay Fit!” program sponsored by the Sunrise Fund at Stony Brook University Medical Center. The program is a comprehensive physical therapy and fitness/wellness program for childhood cancer survivors and their families. The game begins at 6:00 pm at the Kenneth P. LaValle Stadium. Tickets are $12 and can be purchased by calling (631) 632-WOLF (9653), or visiting www.GoSeawolves.org. For information about the Sunrise Fund, view the short film, “A New Decade of Hope,” at www.sunrisefund.org.

SBUMC hosts a candlelight ceremony. In recognition of Gynecologic Cancer Awareness Month and Ovarian Cancer Awareness Month, a Candlelight Ceremony will be held on Monday September 20, 5:00 pm to 7:00 pm, at the Stony Brook University Cancer Center. The event will be held rain or shine, and is generously sponsored by LI OCEANS (Long Island Ovarian Cancer Education Advocacy Network and Support). For more information or to RSVP by September 14, please call Michelle Burke at (631) 444-2858.

SBUMC’s Institute for Advanced Neurosciences is hosting its first “Meeting of the Minds” symposium. The symposium is scheduled for Friday, September 24, at the Charles B. Wang Center from 8:00 am to 4:00 pm. This symposium brings together leaders in the field of neurosciences to share the latest advances on four focused sessions including state-of-the art stroke and cerebrovascular care, multiple sclerosis, neuro-oncology, and spinal cord injury. The keynote speaker is Dr. Robert Adams, Professor of Neuroscience, University Eminent Scholar and Director of the South Carolina REACH Program from the Medical University of South Carolina. Dr. Lorna Role, Professor and Chair from Stony Brook University’s Department of Neurobiology and Behavior, and recipient of the National Institutes of Health Director’s Pioneer Award, will be the luncheon speaker. For more information and to register, visit www.stonybrookneurosciences.org/meetingoftheminds or call (631) 444-9975.

Gearing up for the 18th annual Walk for Beauty, Walk for Life. Get your walking shoes ready for Sunday, October 3 and the 18th Annual Walk for Beauty, Walk for Life in Stony Brook Village. The Walk raises crucial funds for breast and prostate cancer research right here at SBUMC. Funds raised also provide wigs and prostheses for patients with breast cancer who otherwise would not be able to afford them. This year our honorees are breast cancer survivors and advocates Judy Granville, Jean Larsen, Lorraine Pace, and Maryann Varvaro. To register for the Walk or for more information please call (631) 444-4000.   

Join SBUMC for the American Heart Association Start! Heart Walk. The Walk will take place on Sunday, October 16, on Stony Brook University’s West Campus. Lee Xippolitos, RN, PhD, Dean, School of Nursing, and Chief Nursing Officer is chair of this year’s effort. To set up a team, donate, or find more information about the Walk visit www.longislandheartwalk.org.

My Last Touch

“Resilience” is the property of a material to absorb energy when it is deformed elastically and then, upon unloading to have this energy recovered. In other words, it is the maximum energy per unit volume that can be elastically stored…. Resilience is a term that has been borrowed from the more exact sciences and adopted by psychology. When used by psychologists it refers to the ability to recover from trauma or crisis. The term has generated much interest on the part of research psychologists and has been used in developing programs to help people cope in the aftermath of traumatic events. (Wikipedia, retrieved August 2010) 

Resilience sounds like something worth having, especially in healthcare, where providers are faced with difficult choices and unpredictable outcomes every day. Indeed, healthcare training builds a foundation for resilience by repeatedly exposing providers to complex, often frightening situations and practicing how to respond. For example, groups of providers train for cardiac arrests. These “code” teams have hundreds of hours of practice in order to calmly, expertly, and efficiently respond to these medical disasters. Similarly, surgeons must train for the unexpected in operating rooms. Increasingly, the medical profession is moving toward the use of simulators to help build resilience and skills without risking patient harm.

As it turns out, resilience also has meaning within the field of safety. James Reason, who has spent his career offering insights into organizational and patient safety, has educated us all about why medical errors happen (The Human Contribution. Unsafe Acts, Accidents and Heroic Recovery, Ashgate, 2008). A critical underpinning is an understanding and acceptance that human beings are inherently prone to make mistakes. These are not intentional, willful, or malicious acts, but simply part of the human condition. Who among us has never forgotten their keys or driven past a highway exit while day dreaming. Human beings are human.

Reason advances the important notion that you can protect against the likelihood of a human error. This can be done by successively eliminating factors that add risk and by building a series of safety nets to maximize the likelihood of safe processes. Reason recognizes that there must be a balance between safety and the cost of putting the safest system in the world in place. Said otherwise, there must be a practical approach to building resilience into work.

Think about hospitals as living organisms. Reason describes the layers in the “organogram” of care delivery. At its base are patients. At the next level is the “turbulent interface between caregivers and patients” (nurses at the bedside). Just above are “frontline healthcare professionals” (physicians); followed by the next layer up of “management.” To enhance patient safety requires all these layers to work together in a seamless way. This can only occur when there is individual mindfulness; collective organizational mindfulness; shock absorbers between the “patient-turbulent interface between caregivers and patients” (harm absorbers); local risk awareness; and resilience.

Individual mindfulness seems straightforward, but typically we don’t spend much time acquiring “error wisdom.” Three elements (Reason’s “three-bucket model”) define the probability of an unsafe act: 1) current state of the individual (e.g., lack of knowledge, fatigue, feeling under the weather, negative life experiences, etc.); 2) context (e.g., distractions, interruptions, lack of time, unavailability of necessary equipment); and 3) the degree of difficulty of the task at hand. Mental preparedness helps reduce risks. In the three-bucket model, this means one has to:

• Accept that errors can and will occur
• Assess the risk probability before embarking on a task
• Have contingencies ready to deal with anticipated problems
• Be prepared to seek more qualified assistance
• Do not let professional courtesy get in the way of checking your colleagues’ knowledge and experience (especially with someone new)
• Appreciate that the path to adverse events is paved with false assumptions and the lethal convergence of benevolence

Resilience is described as having three distinct components:

• The ability to prevent something bad from happening
• The ability to prevent something bad from becoming worse
• The ability to recover once something bad has happened

There are many examples in healthcare where things can quickly go wrong. It would not take long to generate a long list of these. Reason reminds us of simple things that can be done to reduce the vulnerability of an adverse event occurring. High reliability organizations capture these risk-prone processes and contain them, learn from them, eliminate hidden or latent risks, and continue to build systems to capture risks. Organizational mindfulness is greatly enhanced by creating a culture that encourages open and safe communication (no shooting the messenger).

Measurement is an important ingredient in designing safe systems. These should include measures of outcomes, incidents, risky conditions, defenses (e.g., staffing and training), and regular checks to identify potential system gaps.

Reason further describes organizational resilience using a navigational metaphor called “safety space.” Within a given space, you are free to move around. On one side of the space is relative vulnerability or dangerous risky conditions. On the other side is the safety zone. It may not be feasible to always stay in the safest position within this space because of the needs and demands of patient care. But organizational resilience seeks to always pull back in the direction to reduce vulnerability and enhance safety.

At SBUMC we are committed to continuously working to build the safety zone for our patients. Thank you for your willingness to learn about yourselves and to gain an understanding of the science of patient safety. Only when we work together can we make SBUMC as safe as humanly possible.

Prepare and prevent, don’t repair and repent.
—Unknown

Early and provident fear is the mother of safety.
— Edmond Burke  

We are very near to greatness: one step and we are safe; can we not take the leap?
—Ralph Waldo Emerson

Enjoy the journey to world-class care.

Steven L. Strongwater, MD
Chief Executive Officer
Stony Brook University Hospital