SWAT: Empowering Staff to OWN Their Environment Through Peer Accountability

Purpose:
This offering describes a staff-driven quality and safety initiative to prepare a surgical unit for readiness in all areas of regulatory significance, as well as the everyday practices ensuring quality and patient safety.

Significance:
Maintaining a safe environment while delivering patient care which yields optimal patient outcomes is the expectation in today's healthcare arena. A unit leadership team facilitated a model process of preparedness that starts at the staff level.

Strategy and Implementation:
Nursing leadership of a 30-bed surgical unit identified an opportunity to optimize unit safety and quality. Goals were to prepare for an upcoming regulatory survey and foster peer accountability. An existing mock ‘SWAT tool,' consisting of 48 generic environmental and safety items, was customized. The intent was for each staff member to be accountable for a single item every time they worked, thus eliminating gaps and omissions. Essentially 65 staff members would be performing a SWAT regularly, versus a small core group. SWAT tasks sorted for job roles were randomly assigned to each employee. Job charts identifying the individual and assigned SWAT item were posted. Every team member 'SWATs' their item and signs and dates the chart every time they work. Items identified as problem areas on the unit were duplicated for consistent coverage. Items of vulnerability are covered by all shifts. Visibility of the job charts continues to cultivate peer accountability and self discipline.

Evaluation:
Hospital quality staff conduct mock reviews to prepare for surveys. When reviewed after implementation of the new SWAT model and process, the unit was rated as “Ever Ready”. Within the first week of implementation, 85% of staff completed their SWATS and began holding their peers accountable.

Implications for Practice:
The front-line staff driven process is successful because it involves every team member and empowers them to always perform best practices. The SWAT model and process not only improves quality and safety for patients, but also assists in maintaining a state of “Ever Ready”.