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Safe Strategies
As Hopkins Hospital's new patient safety coordinator, Lori Paine is on a critical mission

Lori Paine started out as a bedside nurse. Now she is the very face of patient care.

Lori Ann Paine

Born: Sept. 7, 1965, Attica, New York

Education: B.S.N., Nazareth College of Rochester, 1988; M.S., Applied Behavioral Science, JHU, 1994

Career Highlights: Nurse, Gyn/Ob; coordinator, Patient Care Delivery Model; senior project administrator, Operations Integration; women’s health program coordinator; patient safety coordinator, The Johns Hopkins Hospital

Family: Husband: John Texter, physician’s assistant, cardiology; two children: Zeke, 3, Emma, 1.

Hobbies: Golf, volleyball, outdoor family activities, laundry

She had a 7-month-old baby at home, but Lori Paine was in an area hospital, hooked to an IV antibiotic to stanch a persistent infection. It would be only a matter of 24 hours, her doctors assured her, before she could go home. But on day two, Paine told them she wasn't getting any better. And on day three, they figured out why: She was on a pediatric dose of antibiotic.

Paine was finally discharged on the fifth day with a clean bill of health. Three years later, she sees clearly how a host of classic oversights conspired to produce this one medical mistake. "It was about poor communications. It was about lack of team-work. It was about no one listening to me when I said I wasn't getting better."

Today, Paine is patient safety coordinator for The Johns Hopkins Hospital. It's a new position, one she describes as an "evolving role." Elsewhere, other hospitals are instituting similar posts, as a new "science" in health care-safety-emerges. A veteran nurse, Paine knows how important this new science is. "Every single one of us would be lying to ourselves if we denied that we had ever made mistakes," she says. "And all of us are either patients or family of patients. Safety is something we simply cannot ignore."

Paine stepped into the new post last April and began by leading the Patient Safety Committee, the group that sets and monitors the hospital's safety agenda, through an eight-week planning process. The exercise resulted in the safety strategy, anchored by eight key goals (see box), that she is now coordinating.

To key people in to the new strategy, for example, Paine has organized a series of quarterly grand-round presentations on safety for the entire hospital staff. To engage patients and families, she works with units to make sure patients receive daily care plans and daily goals sheets. To improve the "culture of safety," she coordinates rounds made by senior executives. These rounds are part of the Comprehensive Unit-based Safety Program, or CUSP, an eight-step exercise now in place in at least 10 different units that begins and ends with staff assessments of safety. To ensure that safety is incorporated into facility design, Paine sees to it that someone knowledgeable about the science of safety sits on every committee involved with the development of the new buildings.

Paine grew up in a family of nurses in upstate New York and was herself practicing as a nurse by the time she was just 19-a fact that makes her shudder today. In 1988, with a B.S.N. under her belt, she came to Baltimore to join her sister, Lisa, then head of Hopkins' nurse midwifery service, in Gyn/Ob. Paine began as a staff nurse in Labor and Delivery and rose to acting nurse manager within six years. Simultaneously, she was pursuing a master's degree-surprisingly not in nursing-but in applied behavioral science. She concentrated on organizational development and behavior, an area, she says, "that was more in line with my personal interests. I was fascinated by organizations and understanding them."

In 1995, she got the chance to put her advanced degree to work. It was the heyday of "re-engineering," and, seeking to filter out inefficiencies in the way care was provided, dozens of work groups were striving to produce a paradigm of collaborative nursing called the Patient Care Delivery Model. Paine coordinated the effort. "It gave me exposure to a broader view of the organization." Moving on to senior project administrator in Operations Integration, she gained "an even broader perspective on the entire Health System, its structure and politics."

In July 2002, with safety and quality emerging as key themes in health care, Hopkins established its Center for Innovation in Quality Patient Care. The center would harness ideas for improving care and transform them into reality. Paine was the first person hired, as a coach overseeing another nursing initiative, "Touch Time." Her Innovations experience, combined with her clinical background and various administrative roles, made her, says Beryl Rosenstein, vice president for medical affairs and chairman of the Patient Safety Committee, "a perfect person for the role of patient safety coordinator. Lori has great organizational skills. She deals well with people, knows how to manage data and understands organizations."

Now Paine's safety work is beginning to bear fruit. Some of the CUSP units are showing marked improvement in the "culture of safety." Paine has been involved in developing a computerized system that can flag potential medication errors, and it will roll out in several ICUs in the near future. When signs point to an overdose, for example, "this new system will spit that out as a marker. It's automated; it doesn't rely on anyone reporting it," she says. "Using this automation can help us get to where harm lives."

Patient Safety Goals

Eight objectives to guide The Johns Hopkins Hospital’s safety strategy over the next three to five years:

  1. Improve communication
  2. Improve teamwork
  3. Improve the culture of safety
  4. Incorporate patient safety into facilities design
  5. Reduce complexity
  6. Engage patients and families as partners in safety
  7. Develop valid measures of patient safety
  8. Align resources/incentives with patient safety
Paine's career trajectory from bedside nurse to the very face of patient safety at Hopkins Hospital is a testament to nursing as an extraordinarily rich breeding ground that can lead to countless types of health care careers. "My nursing career is a foundation that has made it possible for me to feel I could do lots of other things," says Paine. "I still miss the immediate gratification of the bedside, but the work I'm doing today has a broader reach. I want to play a role in continually improving patient care."

- Anne Bennett Swingle




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