Microcollaboratives

Background: Providers have been inhibited from openly talking about patient events by current protections (e.g., peer review or attorney-client privilege). While that inhibition may be appropriate in cases involving a workforce member who is at fault, when dealing with systems issues, open discussion is appropriate because systems issues are not isolated problems. When working with a PSO, providers can broadly share information — both within an organization and with other providers. Systems issues are by their very nature widespread — sharing can speed learning and help develop best practices.

Microcollaborative: A grandiose name for a simple concept, microcollaboratives occur when colleagues informally gather to discuss a few cases and common issues, and help each other. This structure provides objectivity and shared expertise, along with shared improvement. Experience shows that these informal meetings are valuable in facilitating patient-safety improvements. The gathering can be of any group from more than one hospital, and can even vary from meeting to meeting. The group may include CMOs, CNOs (or the two together), CEOs, pharmacists, respiratory therapists — the choice is up to the participating hospitals, and may vary depending on the cases selected for discussion.

Ground Rules:

1. Only hospitals with a signed CHPSO contract may participate.
2. Start with a few cases (one to three) per hospital.
3. Choose cases that involve systems issues.
4. Only discuss cases in which a report of the incident has been or will be sent to CHPSO.
5. In the discussion, concentrate on systems issues, not on an individual’s culpability (even if an individual is at least partially culpable for the event).
6. A report on the discussion during the microcollaborative is not needed.
7. Documentation of the discussion is optional.
8. Do not identify any of the providers involved.
9. Participants may go back to their institutions and talk about the cases for the purposes of improving patient safety or quality of care, but cannot identify the originating hospital or any of the involved providers.

Protection: Everything produced by this activity (verbal discussions, documents, subsequent discussions at other hospitals, etc.) is Patient Safety Work Product and is protected.

Startup Assistance: These meetings can be self-sustaining, but assistance will be provided for the first few meetings to facilitate discussion and help choose cases. There is also the opportunity to involve outside experts (e.g., human factors experts) in some of these meetings.