Victoria Schmid joined Island Health as Quality and Safety Director in September 2015 after five years in a similar role with the Saskatoon Health Region in Saskatchewan. We met in her office at Royal Jubilee Hospital where she shared her views on IHealth and how the new electronic health record can improve patient safety. She also described Island Health’s new quality governance structure and what she sees as most valuable about BC PSLS.
Q: Island Health is the first health authority to implement an electronic health record (EHR). Did that influence your decision to take on your new role?
VS: I was excited to come to a place where they were thinking about transforming the way they view quality of care across the healthcare system. An EHR can’t solve all the problems we face in healthcare, but there’s huge opportunity to prevent safety events from happening when you have a system like that in place.
There’s also a great deal of support for IHealth from the highest levels of our organization. Dr. Brendan Carr, our President and CEO, has been very supportive. We’re going live in Nanaimo in March and spreading across the entire island after that. The plan is that all Island Health facilities will be using an EHR by 2018.
We’ll be first health authority in BC to have an EHR up and running and I’m excited to be a part of that.
Q: How will IHealth and PSLS work together?
VS: That’s something we’re working through now.
So much of what we do in Quality and Safety and with PSLS is linked to IHealth. An EHR is going to create a whole new dataset that we haven’t had access to before. That’s going to help us identify where we need to focus as a system in order to improve the care we provide.
I’d like to see a link to PSLS within the EHR so staff can report a safety event within the same system. We (Quality and Safety) have formed a partnership with the IHealth team and we’re having those conversations.
So IHealth is going to improve how we deliver care at Island Health, similar to PSLS, but it’s unfortunate that all the EHRs that will eventually be setup across BC won’t be the same, in terms of the lack of ability to easily transfer patient information across the province.
Q: Would one EHR for the province make more sense?
VS: Maybe. But it’s complicated. Each health authority is so unique – the contexts are so different from the population they serve to how they do business. So I’m not sure that would be possible given how our healthcare system works in BC.
We’re pleased with the vendor we’ve chosen for our EHR at Island Health because they’re bringing best practices from all the other organizations that use and have implemented their system. We’re learning from people who have successfully done this before and we feel confident that we’re on the right track.
Q: Let’s talk more about PSLS. What do you see as most valuable about the system?
VS: All the severity level 4s and 5s (patient safety events involving severe harm or death) come directly to me so I review those and meet with the team about the follow-up that’s occurred. But when you look at root causes, often the level 4s and 5s can be isolated incidents.
What I find more valuable is sitting with teams and reviewing the events that are level 1 through 3 because that’s the bulk of what’s going on.
For me, there’s a ton of value in digging deeper into good catches and no harm events.
For example, you can see what percentage of the time we’re not giving the right medication, based on voluntary reporting. We may catch those errors before the wrong medication gets to the patient, but that one moment when all the holes line up could be really terrible. If we can learn from the good catches (when something is caught before it reaches the patient) we can make system improvements to ensure it doesn’t happen again.
Q: So managers could spend more time analyzing lower severity PSLS events?
VS: Yes, and people are talking about that more now. But there’s still a lot of uncertainty with how to dig deeper into those lower severity events and how to move forward with that knowledge in a way that will improve patient safety.
What we’ve done at Island Health is create a new clinical quality governance structure, which now forms the basis for how we oversee quality and safety across the region for all our different program areas – surgery, mental health, addiction services, seniors, etc.
We package up PSLS data in a way that shows managers what the trends are in their area. So we say…here’s your level 4 and 5 events that you need to pay attention to, but also take a look at your level 1 through 3 events, so you know what those big areas are that you can dive into for process improvement.
Q: Does that mean your team spends time helping managers to understand their PSLS data?
VS: Exactly. PSLS data can be incredibly overwhelming and asking frontline staff to pull reports themselves isn’t always the best option. We’ve decided that pushing data out to people is more effective. It’s been great to see that coming together and we’re giving people data that’s meaningful for them.
Plus, we’re creating a robust structure around informatics, analytics and quality support with the implementation of IHealth. I’m hoping that will help us focus on root cause because, to me, that piece is still missing.
Q: How can we help managers think about contributing factors when they’re reviewing PSLS events?
VS: It’s an interesting thought. If I’m a manager and I see that 100 falls have been reported in my area for the past year, I want to know…what is actually happening to cause those falls? I’m not sure we’ve built the capacity within our leaders and Handlers to actually be able to get to root cause.
The real value for us as a system is to look at root causes. So if I pull my clinical governance team together for surgery I want to know what the top three root causes are for our safety events. That’s how we create a robust system.
But, that’s not just a PSLS fix, that’s a whole system fix where we’ve built enough skill and knowledge within our Handlers to do that. So there’s a partnership opportunity there. We need to have people in Quality and Safety assigned to a certain number of Handlers to coach them and build that capacity.
Q: Would you say we’re moving in that direction? How can we build that capacity?
VS: For me it’s about focus. Healthcare is so complex and there’s so many different things going on at once that it’s really hard for people to focus on what’s really important. We’re at a place where creating any kind of process rigour within that complexity just gets too overwhelming – that’s when things fall through the cracks.
But we’re getting there.
We see it as our job to help people focus on their PSLS data and quality and safety – to help managers and directors embed quality and safety into what they already have on their plates.
Quality needs to be driven by how we’re providing services and how we’re providing standards of care. I’m seeing that conversation shift at Island Health and it’s wonderful to see that happening.
You can reach Victoria by email at Victoria.Schmid@viha.ca