A gap in front-line staff training — and how Lifespan is closing it

Erica Carbajal

“If you see something, say something.” It’s a phrase familiar to front-line staff who hospitals and health systems in large part rely on to report safety risks and events, but in many cases, a key component is missing: Training.

Those who work outside of healthcare quality may assume such training for front-line staff is common, though both anecdotal reports and survey data demonstrate otherwise. In a 2019 survey of healthcare quality leaders, only 33% of respondents said employees at their organization are trained and educated in quality work.

“We say a lot about what should happen in healthcare, but we spend very little time telling people how to do that,” Stephanie Mercado, president and CEO of the National Association of Healthcare Quality, told Becker’s.

This is the impetus that drove NAHQ to develop a quality training course for staff that walks through how to actually identify safety risks and events, what the expectations are after an error or potential error is spotted, and the process improvement cycle to prevent future incidents. Every year, about 10,000 frontline employees at Providence, R.I.-based Lifespan are required to complete the training.

“Whether someone is hired — they’re new and you’re onboarding them to the organization — or if [they] work at the bedside and have been working in patient care for a long time, there is a need to go back and remind people of what their connection is to a greater discipline,” said Nidia Williams, PhD, vice president of quality and patient safety at Lifespan, where employees have long been required to complete annual training on compliance and risk management.

“I don’t think quality and safety is any different. I think there’s an annual responsibility for everybody to brush up on their competencies regarding safety and certainly regarding quality,” Dr. Wiliams, who is also a NAHQ board member, told Becker’s.

The training is structured to essentially demystify what should happen when an employee sees something that may pose a risk for or has caused a patient safety event, and then breaks down how to perform a root cause analysis and corrective action plan to fill in gaps that led to or posed a risk for an error.

“There’s really not a lot of consistent standardized training in quality and in safety” to reduce variation and lay out expectations for front-line staff, Dr. Williams said.

At Lifespan, the quality training has been in place for about three years and is now incorporated into the onboarding process for new employees. Lifespan has since seen a boost in the number of near-miss events reported by staff, which prompted the system to build a “good catch” program, where leaders on a monthly basis congratulate staff who point out an issue that could have led to a significant error but ultimately didn’t. The effort enables the system to investigate safety issues and ensure failure areas are corrected.

“You want to catch and learn about these system and process issues that could result in failure before they actually do, so having the near-miss events be entered with greater frequency really told us that the culture of safety was growing and developing,” Dr. Williams said.

Ultimately, the need for quality training stems from the fact that the healthcare workforce comes from diverse backgrounds in terms of education, Ms. Mercado and Dr. Williams explained. Each healthcare profession has its own set of competencies that different educational programs develop curriculum around.

“This is appropriate when nuanced content is involved, and even to provide a competitive edge between academic programs,” Ms. Mercado said. “However, this becomes problematic when we are attempting to prepare a workforce together post-graduation and they don’t share common vocabulary, skills or behaviors related to universal topics like quality and safety.”