Peer Coaching Leads to Safer Care

Safety coaches share best practices for patient safety with their colleagues

One night late at work, Tanya Torosian received an unusual request.

She’s a pediatric clinical pharmacist who works the overnight shift at Hassenfeld Children’s Hospital, and that night she was given a medication order that exceeded the standard dose range for a child. Tanya contacted the provider who had requested the medicine and together they spoke about their shared concern with the physician specialist at 4:30 a.m. Tanya explained the patient’s other medications and together they agreed to maintain the current dosage.

Tanya isn’t just a pharmacist. She’s also a Safety Coach, and the training she received for this special role equipped her with several important skills she used that night. “The tools I gained as a safety coach—to ask clarifying questions, stop and resolve, and don't proceed in the face of uncertainty—helped me to resolve this issue,” Tanya says.

Deanna Steffens, BS, Pharm, MS Pharm, BCPPS, (left) and Tanya Torosian, BS, Pharm, MS Pharm, BCPPS (right) are not only sisters. They’re also Pediatric Clinical Pharmacists and Safety Coaches at Hassenfeld Children’s Hospital. 

The Safety Coach Program supports hospital staff as they provide care to patients and families. It was created by the Children’s Hospitals’ Solutions for Patient Safety network, and in early 2020, it was tested and implemented by Sala Institute for Child and Family Centered Care, which leads patient safety and quality initiatives at Hassenfeld Children’s Hospital.

Safety coaches are on the front lines working in hospital units to ensure medical and surgical care is safer for patients. They have been trained to observe colleagues’ work behaviors, and provide feedback and positive reinforcement to their peers about safe patient care practices.

According to Fiona Levy, MD, executive director of Sala Institute, any faculty or staff member with an interest in and commitment to patient safety can become a coach. “We ask our unit leaders to think broadly when nominating someone to the program, and as a result we have doctors, nurses, nurse practitioners, pharmacists, patient care technicians, and patient unit assistants,” says Dr. Levy.

Through the training program for new coaches, the Sala team shares peer coaching techniques and provides advanced education to participants on safety behaviors and tools. “We develop our safety coaches as communicators, educators, role models, observers, storytellers and ultimately change agents within their respective units” says Rebecca Kerns, senior project coordinator at Sala Institute.

There are three core behavioral expectations explored throughout training that reinforce a shared responsibility to deliver safe patient care across the hospital. Together these three expectations demonstrate a deep commitment to patient and staff safety:

  1. Everyone Makes a Personal Commitment to Safety
  2. Everyone is Accountable for Clear and Complete Communication
  3. Everyone Supports a Questioning Attitude

Safety coaches reinforce these expectations and tools on their units. Not only do they coach their colleagues in real time, but they also model best practices. Deanna Steffens, who happens to be Tanya’s sister and also a pediatric clinical pharmacist and safety coach, says, “While we used safety practices before, now the Safety Coach Program has given additional training and strengthened our investigating, documenting, and sharing efforts.”

Pradeep Mally, MD, division director of neonatology, has witnessed this deepened focus on safety firsthand in the Neonatal Intensive Care Unit (NICU). “Right now, it's a culture change in the NICU,” says Dr. Mally. “During every shift there are at least two safety coaches who are identified in the NICU. Over the last couple of months we have seen increased use of safety behaviors and tools, and every staff member feels supported in providing the safest possible care to newborns and the greatest comfort to families.”