Portuguese is the national language in Brazil, so you might assume an IHI faculty member and intensivist from Scotland would find the language barrier difficult to overcome. However, with a respect for local customs and culture — and attentive interpreters who are tolerant of my accent! — I immediately felt at home.
In fact, on more than one occasion, the language differences my colleagues at Associação Congregação de Santa Catarina (ACSC) and I had to negotiate helped me view the work of patient safety from a fresh perspective.
Salus Vitae is a patient safety initiative developed in partnership with IHI by ACSC, a non-profit, faith-based health care system. It’s composed of three work streams: leadership for patient safety, building frontline improvement skills, and a results-oriented Breakthrough Series Collaborative (BTS). I serve as faculty in the 12-hospital Collaborative, which seeks to reduce ICU-acquired, device-related infections (VAP, CLABSI, and CA-UTI) by 50 percent over 18 months in 13 ICUs.
Right from the start, conversations with my Brazilian colleagues have been thought-provoking. For example, the English translation of the initiative’s name is worth pondering: “Salus Vitae” means “safety of life.” It sums up very plainly what our work is about.
I’ve also had profound discussions while talking about something as basic as setting an aim. At the launch of the Collaborative, I recall talking with the head of the ACSA, Sister (or “Irma” in Portuguese) Lia Gregorine, about our high-level aim of a 50 percent reduction in device-related infections in 18 months. The Salus Vitae BTS is not about “reducing infection or harm to our patients,” she asserted. “It’s about alleviating suffering.” Thinking of our efforts this way reminds us what harm really means.
Doing so much of our work in translation has its challenges, but the language interpreters have been wonderful. I find the way they simplify my words to be enlightening. They interpret “person-centeredness,” for example, as “humanizing health care.” Using these words helped a physician in the Collaborative comprehend the spirit of what I was trying to say. “Now we understand and we are one,” he told me. “We are human beings caring for human beings.”
Fear of Zero
As I work with critical care teams in Europe, the Middle East, and Latin America, I come across challenges that are both familiar and unique. In Brazil, for example, I faced the “we’re different” mentality I have encountered many times before.
They told me they were different because of what they called their “fear of zero.” They had tried to reduce VAP and CLABSI unsuccessfully in the past, and what they saw as their failure left them demoralized. They were convinced that it was impossible.
Consequently, at first they only wanted to aim for a 10 percent reduction during the Collaborative. We pushed back gently but firmly. We asked them to humor us. We provided practical advice and steadfast support. We talked about patients harmed by infections and developed a sense of urgency for improvement.
When we talked to them about conducting small tests of change, they seemed to find the approach refreshing. Testing changes with one doctor, one nurse, and one patient — rather than the old “spray and pray” approach — was a revelation, especially as they started working together and seeing the benefits of the “all teach, all learn” philosophy.
Over time, these teams who were at first convinced they couldn’t do it started to see progress. After a little over a year, most of the ICUs in the Collaborative have reduced their ICU-acquired, device-related infection rates, with some achieving the elusive zero. To date across the system, we have seen CLABSI and CA-UTI rates cut almost in half. VAP rates have also seen a sizable reduction.
Words like “safety” or even “harm” can lose their impact because we use them so often. Sometimes having to think about what we mean more carefully compels us to remember why we do what we do. In our global patient safety and quality improvement community, we may use different words, but we share the same dedication to making care better for our patients and their families.
Kevin Rooney, MBChB, FRCA, is Professor of Care Improvement, University of the West of Scotland, and a consultant in Intensive Care and Anaesthesia at the Royal Alexandra Hospital in Paisley, Scotland.
You may also be interested in:
Patient Safety Executive Development Program (Sept. 7–13, 2017 | Cambridge, MA )
IHI's 3rd Latin American Forum on Quality and Safety in Healthcare (August 28–30, 2017 in São Paulo, Brazil)
Two Countries, One Culture of Patient Safety