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"Do you have any safety concerns today?"
That's the question Sylvie Robinson, Manager, 7 South, Toronto Rehab, asks each member of her team, every single morning during their safety huddle.
"Since March we have identified 78 safety concerns," says Sylvie. "It's well above our goal of 30 per month.
"We report every single concern, even the ones we've heard before because we don't want to tune out anything at all."
So far Sylvie has heard about slippery, soapy shower floors, dangerously similar medication labels, insufficient staffing levels, patients at high risk of developing pressure ulcers and even tripping hazards caused by building design flaws.
Nothing is too big, or too small when the group of up to 25 staff members meets together at the huddle board.
Eight other units at UHN, including the three other MSK units at Toronto Rehab, have started their own safety huddles. Also huddling now are two surgical units, an ambulatory clinic, a general internal medicine unit and a cardiac unit.
When a serious issue arises that a manager can't resolve, or which might also impact other units, it is escalated and addressed later at the site-level safety huddle.
"The huddles reinforce the message that safety is everyone's job, no matter what their role is," says Sylvie. "Identifying these safety concerns allows us to prevent them from escalating to the point where someone is harmed.
"It's the small things that matter and I remind people of that every day."
The goal of the huddle is to ensure no patient or staff member is ever harmed at UHN. It's a structured approach to becoming a high reliability organization by working safer and smarter.
Talking about safety concerns daily prevents complacency by keeping it top-of-mind and it also provides people with a forum for reporting any risks they see.
To build accountability for speaking up, and to make sure everyone is engaged, the manager asks every attendee if they have a safety concern. Doing so quite often uncovers a concern that would otherwise not have been raised.
"The safety huddles make everyone feel like part of the team," says Renemae Lopez, Registered Nurse, 7 South. "It's an opportunity for everyone to talk and participate because safety is a topic we're all involved in.
"When we bring up an issue we know something will get done because a person is always assigned to it and they report their actions back to the team the next day. It's focused and it creates an open environment with no blame."