LMP Focus Areas

Total Health and Workplace Safety

Stairway to Safety

Spread best practices using this seven-step process from Doug Bonacum, former vice president of safety management at Kaiser Permanente,

Seven steps to learning and change

Doug Bonacum, vice president of safety management at Kaiser Permanente, says San Diego Medical Center’s effort to improve safe patient handling was effective in part because leaders, managers and union members helped others understand and accept the changes being asked of them. 

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He outlines a seven-step process that helps spread successful practices:

  1. Socialization: Conversations in the workplace about the need to try something different. This is a time to build buy-in for change and articulate how changes will benefit employees. In San Diego, this included discussion of the high rate of patient-handling ergonomic injuries and sharing research about how patients feel safer being moved with equipment.
  2. Standardization: Involve frontline employees to eliminate unwarranted variation. UBTs were involved in creating policies, procedures and checklists to ensure patients were matched with the correct type of handling equipment and that equipment was easily retrievable.  
  3. Education: The medical center invested in comprehensive training and refresher courses to prevent drift from safe practices.
  4. Demonstration: Nurses demonstrate proper use of equipment during their training.
  5. Observation and coaching: Peer-to-peer assessments of how the change is working in practice.
  6. Conversation: Honest discussion of why the practice is important and what barriers may still be in the way.
  7. Escalation: When all else fails, the workplace safety director follows up with managers if team members persist in practices that don’t meet current standards of safety.

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