Zoom On: Dr Donna Prosser

What are your key areas of interest and research?

The things that I’m most interested in are patient- and family-centred care and care coordination, because I believe that those are the two areas we haven’t focussed on enough in recent decades. We’ve been trying really hard to improve quality and safety for 20 years, but we still have a long way to go.

We still have a clinician-centred way of delivering care, not a patient-centred one. It used to be that the bedside nurse in a hospital was the care coordinator, but that’s not the case anymore; there’s not enough time in the day. So, care coordination has become a big problem both in the hospital as well as across the entire health-care continuum. There isn’t anyone who effectively does that for all patients, so right now, patients have to be their own care coordinator.

I am very interested in doing research to improve both the clinician’s ability to coordinate care and the patient's ability to understand and take ownership of care.

The COVID-19 pandemic has highlighted the negative effects of not having people around to advocate for patients in a clinician-focussed atmosphere, and the need to put patients first. When COVID-19 hit, one of the first things hospitals did was eliminate visitation. This significantly increased medical errors and patient safety issues because those eyes and ears – that is concerned family members who could speak up on behalf of the patient – weren’t there. These problems could be mitigated by transitioning to a patient-focussed system.

What are the major challenges in your field?

My field is quality and safety improvement. I’ve been working in this field for twenty years to eliminate patient harm and death. We’ve been working really hard in this space, but we have a long way to go. Sometimes it can be disheartening. One of the challenges is motivating healthcare professionals and reminding them to keep going with patient safety. We can achieve this goal.

One central concept to improving healthcare quality is to transition from the current systems to what is known as a High-Reliability Organisation or HRO. An HRO is an organisation that operates free of error for long periods of time. They do this by sticking to established protocols and by ensuring a culture of communication.

I believe that becoming an HRO is not optional for healthcare systems, just as it’s not optional for airlines, nuclear submarines, or other high-risk enterprises, which must work tirelessly to ensure safety 24/7.

In healthcare, we are taught to be independent thinkers. It’s all about ‘my license’ when we’re being trained. Pilots are not trained this way – they are trained to be a team and to help each other. In healthcare, everyone wants to do the right thing, but they don’t see the entire journey a patient goes through from beginning to end.

Becoming an HRO in healthcare is hard work, but it’s critical to reducing harm. Here are a few steps our hospitals can take towards becoming an HRO:

• Anticipate errors before they occur. HROs have a preoccupation with failure. They’re constantly looking for mistakes. If a mistake happens, they drill down and learn from it.
• Learn to admit mistakes. In healthcare, hospitals worry about their brand. The last thing hospitals want to do is to admit that they made a terrible mistake. So, we have to overcome this mindset, that we don’t admit mistakes.
• Break through the culture of intimidation and fear. Admit that you don’t know things. This is not part of our culture in healthcare, but we need to break through the stigma.

What is your top management tip?

My advice is to keep things simple when thinking about process improvements. More specifically:

Keep it simple. We make performance improvement way more than it needs to be, using complicated terminology borrowed from engineering. That’s because we borrow performance improvement concepts from external professions like engineering, but they use their own terminology. If you use the same jargon in healthcare, clinicians will shut down in an effort to not look stupid. This can make it more difficult to engage healthcare clinicians and providers in performance activities.

Make it easy for frontline workers to know what they need to do. There can be many different improvement teams across an organisation. For example, critical care, emergency, quality, risk management departments can all be working on their own projects, and the right hand doesn’t know what the left hand is doing. As a result of this uncoordinated structure, healthcare workers can face a barrage of information from many angles. This can confuse people on the front line. Instead, keep communication very clear and simple.

If we want to get to be highly reliable, we need a foundation of safety and reliability. Being on the same page is very important to becoming an HRO. We must take into account human factors such as information overload in our quest for zero preventable deaths.

What would you single out as a career highlight?

Joining the Patient Safety Movement Foundation! When I joined PSMF, I was a consultant and joined as a partner. When I attended the midyear planning meeting last September, I felt like I had found my people. Never before had I been in a room with so many people who thought the same way I did about quality and safety.

If you had not chosen this career path you would have become a…?

I have no idea, because when I was four years old, I decided to be a nurse, and I’ve never wavered from that. I can’t imagine what I would do if I weren’t in healthcare.

What are your personal interests outside of work?

My family – my husband and two girls, ages 25 and 27, as well as our extended family – is extremely important to me. I also love the outdoors, hiking, yoga, meditation and reading.

Your favourite quote?

From famous management expert Peter Drucker: “Culture eats process for lunch.”