July 22, 2022

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Culture And Behaviours

‘I help keep kids safe, and there is nothing more rewarding,’ SHP meets Jenna Merandi

Ahead of EHS Congress, taking place in Berlin in September, SHP catches up with speaker Jenna Merandi, Medication Safety Officer at Nationwide Children’s Hospital, to discuss proactive safety and how proactive safety observations can be incorporated within a business.

Tell me a little about your background, how you got into safety and the role you are in today.

Jenna MerandiJenna Merandi (JM): “I obtained my Doctor of Pharmacy degree at West Virginia University College of Pharmacy. Following completion of my PharmD, I began a two-year administrative and clinical residency training program at Nationwide Children’s Hospital in Columbus, OH while obtaining my master’s degree at The Ohio State University in Health-System Pharmacy Administration.

“During my residency training, I was directly involved in a medication error. Following this event, it allowed me to see first-hand, the robust system review, supportive culture, and the actions taken to prevent this type of event from recurring. It was in those days and weeks ahead, I realised, that I wanted to focus my career on safety.

“After my residency training was complete, I was hired by Nationwide Children’s Hospital as a medication safety pharmacist and now serve as the Medication Safety Officer (MSO). In my current role, I work closely with interdisciplinary teams and frontline staff to learn from everyday work and identify system-based interventions to prevent errors in healthcare. As Medication Safety Officer, I serve as a co-leader on hospital-wide Adverse Drug Event Quality Collaborative and work with teams to operationalise proactive safety concepts and tools while enhancing learning opportunities to help keep our paediatric patients safe.

“I provide strategy, innovation, and expanded views about safety (Safety Differently) to help lead our journey to best medication outcomes.

“Through my work as MSO, I have served in various national leadership roles including founder and chair of the Children’s Hospital Association Medication Safety Leaders Collaborative, co-leader of the Solutions for Patient Safety (SPS) Safety II Think Tank and have provided numerous presentations and webinars around operationalising Safety II/proactive safety concepts in healthcare, development of second victim peer support programs, as well as other various topics.

“When people ask me what I do in my role? I simply state, “I help keep kids safe” and there is nothing more rewarding than doing this each and every day.”

You are a believer in of the Safety II approach, but prefer the term, ‘proactive safety’. Why is that and how has that resonated with staff in the healthcare sector?

(JM): “I am a believer in the Safety II approach, and a believer in various other theories in safety. I prefer to utilise the term ‘proactive safety’ as it is more recognisable, understandable and actionable by frontline healthcare staff. Additionally, it can encompass variety of theories vs. just singling out safety II only.

“Traditional safety efforts (safety I approach) are still widely utilised and valued in healthcare. Therefore, when expanding the lens to also focus efforts to analyse complexity and adaptability of a system that results in success (safety II approach), there is a tendency to label safety I vs. safety II. By doing this, it may lead to staff indirectly assigning value distinctions (safety II is better than safety I) instead of seeing both approaches as complementary.

“In healthcare, we have often spent less time focusing on the presence of capacities that enhance successful outcomes (for example, psychological safety amongst team members, team dynamics, resource availability, etc.) as more time is spent focusing on the more conventional study of failures (how and why things went wrong). However, there is a lot of opportunity to analyse complex systems and why they succeed (as this happens majority of the time).

“Though traditional safety concepts are valuable and still utilised, there is opportunity to incorporate modern safety theories such as resilience engineering, Safety II, Safety Differently and Human and Organisational Performance.

“My goal as an MSO is to evolve the way safety professionals are practicing to improve medication related outcomes.”

How have you incorporated proactive safety observations and what have you learned from those observations?

(JM): We have started utilising proactive safety observations and Learning Teams to better learn from everyday work. This has allowed us to identify areas of both risk and excellence.

“Through these observations we have identified system weaknesses such as technology failures that might lead to work arounds related to barcode scanning, ways to enhance set up in our automated dispensing cabinets to better error proof during removal of high-risk medications, and various other interventions.

“Other learnings observed have included why certain high performing teams continue to have successful outcomes. Asking questions using an appreciative inquiry approach has been a way to redesign the way we ask questions. For example, asking staff ‘think about a complex process that went well, what were the good catches, and what was it about the team, their behaviours, or system that helped contribute to a successful outcome?’ Through these conversations and observations, it brings greater understanding of how people adapt to overcome challenges and how can we ensure this happens again that way in the future.”

What are you top three tips for how to operationalise safety II theory into practice?

  1. Utilise proactive safety huddles – to anticipate and plan for potential risks when performing safety critical tasks. Proactive safety huddles can be utilised to enhance communication and raise concerns from a team in complex and unique situations.
  2. Widen the lens of focus to expand learning opportunities – incorporation of learning teams and learning from successful every day work is just as important as learning from undesirable events and outcomes. Learning from those that do the work, evaluating environmental factors, and utilising simulation to identify latent safety threats can all help contribute to making a system safer.
  3. Try not to introduce SII as something ‘new’ and avoid focusing on the terminology and language – Instead, talk about what it is, what it adds, and how it broadens the lens to what safety is and can be. Safety II harnesses the expertise of people on the frontlines doing the work. We can learn from their excellence as well as the risks they identify.

Finally, you will be speaking at EHS Congress in Berlin in September, what can delegates expect from your session?

(JM): “You can expect to hear innovative ways modern safety concepts are being operationalised in healthcare. This session will draw upon various modern safety theories and real-life application in a high-risk area such as medication safety in one of the largest paediatric hospitals in the United States. Delegates can also expect to hear ways this has been successful and challenges and barriers that exist.”

Hear more from Jenna Merandi at the 2022 EHS Congress, taking place in Berlin from 13-14 September. Her session, ‘Safety II Applications in Healthcare: A New Paradigm for Improving Safety,’ takes place on day one of the conference.

Click to register for your place and to see the full EHS Congress agenda.

Click here for more from EHS Congress on SHP.

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