Lori Notowitz, Director of Patient Safety & Advocacy, talks about what the hospital does to keep patients safe and what patients can do to contribute to their own safety. Listen to an interview or read the transcript below.

UVM Medical Center: How can you improve the healthcare that’s provided to you? That’s essentially what we’ll be talking about on today’s show. Of course, delivering safe patient care is mainly the responsibility of clinicians and all of the staff who support them, but families and patients also play a key role in preventing medical errors and reducing harm. We’ll be walking through a few of the key things you and your loved ones can do to make sure you’re getting the safest care possible. We’re also going to learn about some of what goes on behind the scenes here at the UVM Medical Center to reduce medical errors and generally ensure the safety of our patients. Our guide today is Lori Notowitz, Director of Patient Safety and Advocacy at the UVM Medical Center. That’s part of the Jeffords Institute for Quality. Thanks for coming.

Lori Notowitz: Thank you for having me.

UVM Medical Center: Let’s start with what patients can do, because I think it’s something people don’t think about as much. I think some of it relates to being a little intimidated or hesitant to speak up. What are some of the key things they can do?

Lori Notowitz: You mentioned speaking up, and that’s exactly what they should be doing. It’s a very human reaction to feel intimidated when you walk into a hospital or a doctor’s office. There’s a whole process that’s happening. You’re part of system, and it’s a big system with a lot of gears turning, and it’s very complex. For most people who don’t have the medical background, it’s hard to know what to ask and when to ask it. Is it okay to ask? We want to encourage people to definitely speak up. We train our doctors and nurses to not only ask questions of patients, but to encourage patients to ask questions of us, and to hear what they have to say so we can make sure that they understand their care and have no questions.

UVM Medical Center: One of the things that just seems so simple, but it’s really the key to a lot, is cleaning hands, washing hands. Talk about that.

Lori Notowitz: Absolutely. Hand hygiene is crucial in preventing the spread of infection from one patient to another. It’s something that we stress very highly here at the hospital and within doctors’ offices. There are sinks for hand washing. There’s foam or hand gel for people to use between patients, before and after patients. Sometimes people forget. We understand that people are human, and they are going to make human errors, especially if they’re busy or distracted. And so we really encourage our patients and their families to remind providers if they haven’t foamed in, or washed their hands, or used the hand sanitizer. Just say, “Hey, you know, I didn’t see you use the hand sanitizer.” That’s all they have to say. It’s hard to get the courage up sometimes to speak up, but we do expect it of our patients and their families. Nobody’s going to be insulted. We’re going to be happy that you reminded us.

UVM Medical Center: The other thing is there’s usually somebody else in the room at the bedside with the patient. Maybe if the patient’s not comfortable with this kind of thing, they can say, “Hey, cn you ask them about that?”

Lori Notowitz: That’s a good point. One of the things that we suggest for patients to stay safe is to bring somebody with them, a trusted friend or a family member. Not only can that person do things like remind the provider to wash their hands if they’ve forgotten, but they’re also a second set of ears and eyes to listen to what the provider is telling the patient, and maybe help them ask questions, especially if you’re getting a diagnosis. I’ve been in that situation myself where the doctor’s telling me something and my head is just spinning with all of the information. Having a trusted friend or family member with you as an advocate can be really helpful.

UVM Medical Center: Yes. Just bring a notebook and take notes.

Lori Notowitz: Exactly. The other thing we encourage patients to do is to, if you have a question, don’t be afraid to ask it. Then when you get the answer, if you still don’t understand, keep asking until you understand, because it’s worse to go home and not have a full understanding of your condition, or your treatment, or the medications you’re supposed to be taking than to ask a couple of questions. Nobody wants you to go home and not understand what you’re supposed to be doing. We want the patients to understand their treatment options. We tell patients to really ask the question, what are the options for me? What are the risks of this treatment or therapy? What are the benefits of it? Really have all the information together to weigh your options in an informed way.

UVM Medical Center: One thing I thought was interesting is the technique of repeating back what your doctor or clinician just said in your own words. Then they can judge at that point whether or not you got it.

Lori Notowitz: That’s a technique we use in adult education to make sure that the recipient of the education really understands what’s been taught. We train our doctors and nurses to ask open-ended questions. To say, “All right. Explain back to me what I just told you,” or “Tell me your understanding of what we just discussed.” Sometimes people can do it and sometimes they can’t. What that lets us know is, okay, we didn’t explain this well enough. We have to go back and we have to explain it again, or in a different way, or in written format to make sure the patient and/or their family members understand.

UVM Medical Center:  You’re listening to Lori Notowitz. She’s Director of Patient Safety and Advocacy at the UVM Medical Center which is part of the Jeffords Institute for Quality. We’re talking today about your role as a patient in making sure that you get safe care. A lot of it depends on just feeling comfortable to speak up and not feel like the provider’s going to take it the wrong way, or feel like you’re criticizing them. That’s not easy for people, but it’s something we really encourage you to do. The other thing that I was noting is that some of this is about goal setting and making sure that you understand what your clinician wants you to be doing, and that it’s something you think you can achieve.

Lori Notowitz: Correct. We want everyone to be an informed consumer of healthcare. There are things that patients and families can do to make sure that we’re providing the right care for them. We want to know what medications they’re on. Having a list of medications, the dosages, when they were prescribed, how you’re taking them, who prescribed it – that’s helpful for your doctor or nurse to know. When you come into the hospital, we want to make sure that the medications we’re prescribing for you while you’re in the hospital don’t interact in a negative way with the medications you’ve been taking at home. When you go in for your annual checkup with your regular primary care physician or your family practice provider, bring your medications in a bag to your appointment so that they can look at everything that you’ve been prescribed and make sure there’s no duplication of therapy, that you’re not taking something you should’ve stopped taking, or that you’re missing something. Medication management is tremendously important. That’s helpful.

If the doctor prescribes a medication for you and you feel that you can’t afford it, let them know, because there may be cheaper options that they can prescribe instead. If you decide you’re not going to take the medication for whatever reason let your doctor know because they may be able to work with you or explain it, or just understand what the barrier is to taking that medication, and maybe have some alternative.

UVM Medical Center: I mentioned at the beginning that there’s a lot that goes on behind the scenes to support clinicians and patients in getting to the safest patient care. Actually, I should note that the UVM Medical Center rates very well nationally compared to other academic medical centers on patient safety. In fact, I think we were number one a few years back. That takes everybody rowing in the same direction. This is, I think, what you’re focused on every day.

Lori Notowitz: Right. I’m very fortunate to be able to work with the Jeffords Institute for Quality. The Jeffords Institute for Quality’s goal is to coordinate ongoing performance improvement activities throughout the organization to make sure we’re providing the highest quality care and the safest care possible. My role, and I have a great team of people that I work with, is to look at the systems and the processes that underlie the care that we provide and make sure that if there’s opportunities for errors to happen in those systems and processes, that we identify them, hopefully proactively, and that we put enough barriers in place whereby if an error were to occur, it doesn’t reach a patient or it doesn’t harm a patient. That’s our overall goal. It’s an interesting job. We get to work with people from all departments in the organization throughout the hospital, all the doctors’ offices, and with some of our affiliates as well. It’s really interesting and always a lot of fun.

UVM Medical Center:  This really wasn’t formalized in healthcare, this sort of patient safety focus, for a long time. It seems like it’s come along the last 10/20 years.

Lori Notowitz: There’s always been a role for patient safety in healthcare, but it wasn’t really until the mid-1990s where patient safety became a thing in hospitals where there were staff that were devoted to patient safety, and where the science of patient safety actually became organized and able to be put in play in the hospital.

UVM Medical Center: You can have all that in place, but the other ingredient that’s really important is a culture around quality. Everybody’s got to buy-in. What are some of the things you do, your office, you personally do, to create that culture?

Lori Notowitz: That’s an excellent question. The patient safety culture is crucial to everything we do in this organization. It really underlies and is the foundation of the care we provide. It’s every single person’s job. It’s not just the Department of Patient Safety, it’s the whole organization regardless of your role. We expect everyone to be aware of and participate in patient safety activities throughout their day. We’ve had many, many, instances where people who are in non-patient care roles have identified safety issues and brought them to our attention, and they were really important safety finds. We’ve been able to make improvements because of that. We know that it’s everybody’s role.

The way we create this culture is that we make it non-punitive. At the University of Vermont Medical Center, we have an electronic online event reporting form for people to report to us any patient safety issue they identify. They can report anonymously because it’s not about the person, it’s about the issue. Although they have the option to do that, 99% of the time people put their names on it because they’re not afraid. That is the mark of a positive safety culture. We know that if we don’t hear about it, we can’t fix it.

When something happens that is not an ideal outcome and we want to fix it, we involve the people who are on the front lines. They’ve had experience with a report that’s been filed, and then working with our team and leadership in the organization to really drill down into, why did this happen? What’s going to prevent it from happening again? And how do we fix it? So they see the results. We recognize and reward people for reporting good catches. It’s a very positive and upbeat culture, and that results in more reporting, more identification of issues, and we’re able to be very proactive and prevent those safety issues from reaching a patient.

UVM Medical Center: The connection we were talking about at the beginning is patients feeling comfortable speaking up, and really it’s the same thing with employees feeling comfortable to bring things to attention and not feel like they’re causing trouble or something.

Lori Notowitz: Absolutely. We have a non-retaliation policy. If somebody ever felt like there was negative feedback as a result of reporting something, we want to know about it, because we don’t tolerate it. What’s really important is that we get the information so we can make the care safer. It’s all about the patient.

UVM Medical Center:  If people wanted to know more about the whole topic, what should they do?

Lori Notowitz: Well, you could look at the hospital website, and there’s certainly information on quality and safety there. Another thing patients can do is go to the National Patient Safety Foundation website and there’s a lot of resources there for patients on how to stay safe. And that is at www.npsf.org – National Patient Safety Foundation. Lots of materials on how to stay safe.

UVM Medical Center:  I’m afraid we’re out of time, but I want to thank my guest today, Lori Notowitz, who is Director of Patient Safety and Advocacy at the UVM Medical Center which is part of the Jeffords Institute for Quality. Thanks for coming.

Lori Notowitz: Thanks for having me.

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