Ramsay Health Care is a global private hospital group with more than 77,000 employees and a large footprint across 11 countries. Promoting a strong professional accountability culture is an important part of Ramsay’s continuous improvement agenda to deliver safe care for their patients. Starting with an Australian implementation, their aim was to integrate an evidence-based accountability framework that would scale across their organisation and fit with their existing human factors programme.
We wanted a programme with strong integrity we could implement globally
As a large healthcare provider, with over 530 hospitals, day surgeries, pharmacies, treatment facilities, rehabilitation and psychiatric units around the world, Ramsay is aware of the professional accountability challenges facing healthcare organisations. Their focus is to address staff behaviours that do not align to the values of The Ramsay Way; a set of principles defining their culture of quality and safety.
Ramsay undertook extensive research to find an evidence-based accountability framework to fit with their existing human factors programme, which focusses on all staff speaking up in the moment. It was also important the programme could scale, to be implemented internationally across their entire organisation. In the initial implementation across Australia, Ramsay’s scope of delivery for the accountability framework in their private hospital facilities was for doctors. In their public/private facilities the scope included all clinical staff.
The Promoting Professional Accountability programme was ideal for Ramsay’s needs. The programme’s sustainable, organisation-wide framework proven to address unprofessional behaviour has been helping Ramsay to achieve the highest levels of safety and reliability.
Built on the work of Vanderbilt University Medical Centre in the United States of America, the programme has been implemented in Australia, the UK and Asia to help Ramsay identify and address behaviours that do not align with The Ramsay Way. The programme is assisting to contextualise unsafe behaviours and provide the tools and mechanisms to address it.
The Promoting Professional Accountability programme helps identify, engage with and hold accountable staff who demonstrate repeated unprofessional behaviour. It provides a framework for defining critical safety and professionalism standards, and identifying, measuring and addressing behaviours that undermine them. The framework aims to create a checking culture, where people can speak up in the moment and it is welcomed. In the event it is not safe or effective to speak up, a peer-to-peer support model delivers feedback and provides the opportunity for professionals to self-regulate.
Ramsay adopted a two-stage approach to rollout the Promoting Professional Accountability programme in Australia. The first stage was a large pilot encompassing 10,000 staff, implemented over nine months.
Ramsay cited the benefit of the pilot stage was the opportunity to develop a high level of understanding about the programme nuances, and align it to The Ramsay Way. Once the pilot was complete, Ramsay systematically implemented the programme across their other Australian facilities. Overseen by the Executive Project Lead, each Ramsay facility had an Executive Working Party with responsibility for local programme implementation. A series of implementation and communication plans has ensured a consistent rollout across all 73 facilities. Systematic communication at every stage of the programme has been critical for its success.
Ramsay discovered it is important to engage all levels of staff on programme delivery and timelines, and celebrate milestones throughout the implementation. It was vital to continuously define behaviours undermining a culture of safety and quality. Ramsay learnt delivering the right messages at the right time is important for overcoming staff resistance.
Clinical indicators have consistently improved over the six years since the implementation began in 2016. Ramsay Australia achieved its first ever 12 month period with zero sentinel events in June 2020 (01.07.2019-30.06.2020).
Ramsay believe the programme helps define behaviours undermining safety. They discovered staff did not always realise the impact certain behaviours can have on patient safety. For example not being available for clinical handover or after hours calls; being late for theatre etc. In addition to Australia Ramsay Health Care has now implemented the programme across their facilities in Malaysia, Indonesia and the United Kingdom.
The feedback from doctors and clinicians has been extremely positive. They are encouraged by the programme, and feel supported to speak up
This programme is a driving force in improving hospital culture significantly
