In a morning huddle, the staff on Wascana Rehabilitation Centre’s Unit 2-5 discuss the importance of safety in their daily work, and how the concept of Stop the Line offers them the autonomy to make the right decision when it matters.
“When we share the current problems facing the team, we can get everyone’s input and identify solutions to issues that could pose a safety concern to us or our residents,” says an employee on the unit. “When we Stop the Line, it’s immediate.”
Located in the Regina Qu’Appelle Health Region, WRC’s Unit 2-5 has 68 staff, 39 residents and one respite bed. The unit was approached by the Region in January 2015 to pilot Stop the Line and got to work in May.
At that time, there was not a lot of understanding of what we were trying to do. With time came more understanding about what Stop the Line actually is – staff identifying, fixing or escalating safety issues – our staff felt more empowered and consequently became more engaged in the process.” – Shelley Serle, Unit 2-5 Manager, Extended Care/Veteran’s Program
The unit’s culture experienced gradual change as staff felt that their safety concerns were being heard and addressed – and Safety Alert/Stop the Line huddles allowed for discussion.
The change in culture is resulting in less harm to patients and staff as the team’s focus shifts from mitigation to early detection/prevention – and the improvements are measurable. Unit 2-5 tracks several safety indicators including the number of safety incidents reported (potential and actual), the number of falls and medication incidents, and the number of serious incidents (levels 3 and 4).
All of these measures have been improving since Stop the Line was introduced at Unit 2-5. For example, the number of staff incidents resulting in lost time has steadily decreased, from seven in 2014-2015, to three in 2015-2016 to one during the first six months of 2016-2017. The unit also went two months with no medication errors. Staff are increasingly recognizing potential hazards and fixing them before they can cause harm.
“Stop the Line supports problem solving as a team. Leaders and managers support the discussion, but solutions come from the staff including our continuing care assistants,” says Shelley. “Employees like that they aren’t being told what to do, instead they are working together to find the solution that works for the team, in the moment.”
Stop the Line represents an evolution of safety practices that already occur in many areas. It builds on – and elevates – these practices and offers clear expectations for the times patients, families and staff encounter a potentially unsafe situation,” – Kate Fast, provincial Safety Alert/Stop the Line Initiative Lead
What does Shelley Serle suggest for managers just starting to implement Stop the Line?
• Start with one or two huddles a day, where you’re asking staff to identify any potential safety issues. During the first eight weeks there will be lots of discussion and time spent out on the unit; it’s a great juncture to reinforce with staff that if a safety concern is raised, it will be addressed.
• Think of Stop the Line as part of daily visual management. It is often nothing that managers don’t already do, but it is formalized. Staff are empowered by the explicit process for escalating concerns.
• Track and document identified safety issues: Was it reported? Was it a priority? Was it rectified? A safety book or a visibility wall with metrics is a great way to document discussion.
• At the beginning there will be many issues identified. This can feel overwhelming but, with experience, staff learn to fix safety issues themselves in the moment.
• To keep implementation going takes a lot of energy and leadership. But stay the course. It’s worth it!
Regina Qu’Appelle Health Region continues to work toward an environment with zero harm to patients, clients, residents, practitioners and staff. To achieve this, every employee in the Region is being asked to Stop the Line when they need to.
Photo: Shelley Serle and her team at their morning huddle, talking about how important safety is to them and how to Stop the Line when necessary.