Building A Culture of Patient Safety
After I completed my residency program at the University of Florida, I stayed on assuming that I would serve as a medical director in pediatric HIV. At that point, I did not have any background in managing people and running things, so I had to learn the hard way.
When I moved to Dubai, I joined one of the most reputable medical hospitals. After my experience at the University of Florida, I felt ready to take the lead. I asked the administration to give me the position of department chief. It wasn’t easy, but they gave it to me in the end and it was a big success for me. Then I moved to another facility, where I was responsible for improving pediatric services. I tried to implement the healthcare practices from my past experience with children. Although the project was well written and the proposal included everything needed, it failed.
I was trying to implement a medical home concept in the pediatric care services. Basically, I wanted to do it step by step. The first step was to integrate case management to improve care. I was able to get people to support the project, especially the department heads, physicians and some of the nurses, but I was not able to get enough support from administration to help us overcome the obstacles. That’s when I realized the program failed because I didn’t know how important administration leadership was in getting things done.
When it was time for me to change my employer to another hospital that was still being established, I found out about the Safety, Quality, Informatics and Leadership (SQIL) program at Harvard Medical School. It provided the best opportunity to study quality and leadership, and enabled me to apply these skills and knowledge at the new hospital.
I spent six years as a medical director and seven years as the head of the department at American Hospital Dubai. Now I’ve started implementing some of the principles I’ve learned from SQIL to make changes and to improve quality. I also learned how to overcome resistant people and other obstacles, and how to get senior management and leadership involved. If I don’t have all these key components in place—which is the secret to success for any project—I don’t move forward because I know it won’t work. This is one of the most important lessons that I’ve learned from the program.
What’s unique about the program is that it covers most of the main aspects of quality, safety, leadership and informatics, and there’s a good balance of theory and hands-on practice. The timing and structure are also very appropriate for busy physicians. After you develop this background, it can lead you to other research and further your development.
It was about reducing the use of Ceftriaxone, which is a third-generation cephalosporin in pediatric patients. I felt that it was being used too frequently even when it was not indicated, so I started networking with other people in my organization. We formed a task force and then got the administration to buy into the project. Then we started getting people from other departments to support us.
During the capstone project, we learned how to lobby with other people, and it worked fantastically. Now when we send out an email, we include the people who support us and that helps us get even more people on board with our vision. On the other hand, I also learned how to involve resistors. In the past I tried to ignore them, but getting them to be part of the process proved to be very helpful.
So many times we are asked to take on roles that we have no background in, and we end up learning the hard way. But when you get into this program, you learn how to do it the right way.
The initial idea was mine, but when I progressed in the program I learned to hone it with the course content from SQIL. I began by creating an outline and then sent the first draft to the faculty for review. Their feedback basically identifies the areas that are missing in your proposal. When I got all their comments, I went back and reviewed the SQIL modules to find out what tools I could implement to correct my proposal. I listened to the lectures again. I understood what they said the first time, but when it comes to implementation, it’s difficult to see which tools to use unless you start at the beginning of the experience. When I was truly using those tools I thought, “Wow this makes my life much easier.”
Well I think this kind of program is actually helpful at all levels, even if you’re a resident in training, an experienced clinician, or the head of a department. As physicians our main focus is basically to give care to all our patients. So even if you are not interested in leadership or making a change, this should not mean that the values and the commitments of your career are less important. In any situation, whether it’s the front line or leading a project, you have a direct or indirect role in making a change. On the front line, you are the one who triggers the change even if you don’t initiate it. As a leader, you’re the one who initiates the change and gets other people involved.
The other thing is, as physicians, and probably other healthcare providers as well, we are trained only to do the clinical work not to be leaders. On the other hand, hospitals, organizations and other healthcare worker communities look at physicians as leaders. So many times we are asked to take on roles that we have no background in, and we end up learning the hard way. But when you get into this program, you learn how to do it the right way. And that makes it much easier to implement things. I learned so much in the first round of this program, but I learned even more when I went back to the same lectures. Once you get into real-life situations, you can go back and learn even more from the program content.
Honestly, as I mentioned earlier, the program truly gives you the key components to make your project successful. Believe me, when I did my capstone project I never thought I would be able to do something like that without these skills. The hospital that I’m working in right now is in a transitional phase. For us to make any program or any project work, we have to make a change in the culture. With the previous administrations, people would focus only on individual performance, and they were very preoccupied with productivity.
What I want to do in this capstone project is shift the thinking from individual success to something else like quality and realize that productivity is a byproduct that will come anyway. We have to make these changes. I used the skills learned from this program to build up this kind of experience to make the culture change. We saw a cultural change that not only benefited the project that I did in the hospital, but also paved the way for other projects in the future. That’s the most important thing that I learned—you need the key components to make any project successful.
If I were talking to my colleagues about the program, I would say to them: “SQIL should be your first choice if you’re looking for action-oriented learning that will truly prepare you to lead clinical quality and safety in your current or future workplace. It has a global perspective and gives you integrated views of safety, quality improvement, informatics and leadership—it’s not just a label. The whole curriculum is designed around that.”
Abeer Khayat, MD, completed her residency training in University of Florida and is American Board certified in Pediatrics. Currently she is Chief of Pediatrics at American Hospital Dubai, UAE. Prior to her current position, Dr. Khayat was the Director of Pediatric Ambulatory Services at Tawam hospital and served as the Chief of the Department of Pediatrics at Emirates Hospital and Medical Director of Pediatric HIV program at the University of Florida.