INTERNSHIP PROGRAM /CLINICAL PRACTICUM .../media/med ed student...INTERNSHIP PROGRAM /CLINICAL PRACTICUM APPLICATION (Please print clearly and legibly) APPLICANT INFORMATION ...

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INTERNSHIP PROGRAM /CLINICAL PRACTICUM APPLICATION (Please print clearly and legibly)

APPLICANT INFORMATION First Name __________________________ MI_____ Last Name_________________________ Home Address ____________________________ City________________ State _______ Zip____________ Home Phone: _______________________________ Alternate Phone: ______________________________ School E-mail: _______________________________ Alternate Email: ______________________________ Summa Employee: Yes No SCHOOL INFORMATION College/University: _______________________________ Major: _____________________________ City and State: ________________________________ Web Address: _________________________ Faculty Advisor’s Name and Department: _______________________________________________________ Faculty Advisor’s Phone: _______________________________ Email: _____________________________ Academic Status(check one): 1-Freshman 2-Sophomore 3-Junior- 4-Senior Graduate/Post-Graduate

Expected Graduation Date (Month/Year): _______________________ INTERNSHIP / PRACTICUM PLACEMENT Complete this section if you received, prior to completing this form, pre-approval from a Summa employee or department to complete an internship or practicum at a Summa Health System facility.

Department: _______________________________________ Hospital Campus: ___________________________

Preceptor or Supervisor Name: _________________________________ Job Title: ___________________________

Manager or Director Name: ________________________________________________________________________

When do you expect to begin and complete the internship or practicum: ____ / ___ /___ to ____/____/____ Month Day Yr Month Day Yr

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APPLICANT AGREEMENT I understand, while interning at Summa Health System, any usage of cellular devices (smart phone, cell phone, tweeting, facebook, etc) are prohibited. All patient information and results you may come into contact with must be keep confidential and may be reported only to those professionals directly involved with the patient’s treatment and care. Failure to comply may result in dismissal from the clinical site. I have read the internship/clinical practicum forms for Summa Health System and hereby certifies that all information provided in this request is accurate, and that submission of this request does not guarantee placement into an experience. I further understand that approval and placement of an experience is at the discretion of Summa Health System and may require a criminal background and/or a health screening. _____________________________ _________________________ _________ Applicant Signature Printed name Date

Revised date: 7/24/2014

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PARTICIPATION LIABILITY WAIVER AND RELEASE FORM

In consideration of my being permitted to participate in workforce/career development programs I, the undersigned, in full recognition and appreciation of the dangers and hazards inherent in this activity, agree to assume all risks and responsibilities surrounding my participation in this activity. Further, I do for myself, my heirs, and personal representative(s) agree to defend, hold harmless, indemnify, release, and forever discharge Summa Health System, and its officers, agents, and employees from and against any and all future claims, demands, or causes of action, on account of damage to personal property, personal injury or death which may result from my participation in any Summa career-related program. HAVING READ AND UNDERSTOOD THIS AGREEMENT, I VOLUNTARILY AND KNOWINGLY SIGN BELOW.

Signature

Printed Name

______________________________________________________________________________

EMERGENCY AND SAFETY INFORMATION FORM

Consent for Emergency Treatment In the case of an injury while serving as an intern at Summa Health System, I give my consent for the Hospital, its physicians, employees and agents to render emergency and other necessary medical treatment. I, _________________________________, release the Hospital, its physicians, employees and agents from any claim of unlawful invasion of the person of the minor predicated on consent to perform the emergency treatment in question. ___________________________________ Self__________________________ Applicant Name (Please Print) Relationship ___________________________________ _____________________________ Signature Date Emergency Contact Person: Name ________________________________________________ Relationship ______________________ Home Phone ___________________ Work Phone ___________________ Cell Phone:_________________

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Summa Health System

INFORMATION CONFIDENTIALITY & SECURITY AGREEMENT This Information Confidentiality and Security Agreement (the “Agreement”) is entered into by and between Summa Health System, hereinafter referred to as the “HOSPITAL” and _____________________________ hereinafter referred to as the (Name of student intern/observer) “WORKFORCE MEMBER”. Workforce means employees, volunteers, trainees, and other persons whose conduct, in the performance of work for a covered entity, is under the direct control of such entity, whether or not they are paid by the covered entity. HOSPITAL shall provide access to HOSPITAL’s confidential information, including, but not limited to, protected health information, financial information, business methods and practices, business and marketing plans, intellectual property, computer systems, patient and employee information, telephone systems and other electronic and paper systems (“Confidential Information”). To ensure Confidential Information integrity, security, and confidentiality WORKFORCE MEMBER hereby agrees to the following:

1. Confidential Information regarding an individual patient’s health, treatment, or payment for health care is protected by both Federal and State regulations. Severe penalties can be imposed on WORKFORCE MEMBER and on HOSPITAL if he/she fails to protect against the release of any Confidential Information that may be disclosed intentionally or unintentionally during his/her employment or association with HOSPITAL.

2. WORKFORCE MEMBER will not disclose Confidential Information except as directly required to carry out the purpose of his/her employment or association with HOSPITAL. WORKFORCE MEMBER will not seek more than the minimum amount of Confidential Information necessary to carry out the purpose of his/her employment or association with HOSPITAL. WORKFORCE MEMBER will not carry notes, lists, records or other Confidential Information in any form away from HOSPITAL without specific permission. A breach of confidentiality will occur if WORKFORCE MEMBER releases Confidential Information for patients he/she may personally know. Any Confidential Information acquired as part of the WORKFORCE MEMBER’S HOSPITAL employment or association is not to be repeated to family, friends or family members of the patient.

3. WORKFORCE MEMBER will not violate ethical rules of behavior or Hospital policies, including, but not limited to, HOSPITAL’s policies on Release of Patient Information, Patient Rights, Information Access/Control and other policies which protect Confidential Information.

4. WORKFORCE MEMBER is responsible for his/her security code, authorization code, electronic signature, or other Password, if assigned (“Password”). WORKFORCE MEMBER understands that his/her Password is the equivalent of his/her signature. The WORKFORCE MEMBER shall be responsible for all work done under this Password. WORKFORCE MEMBER will not disclose his/her Password to anyone nor will the WORKFORCE MEMBER attempt to learn another WORKFORCE MEMBER’s Password or WORKFORCE MEMBER will not write down or store Password in an unsecured location, transmit the Password online, particularly by email, or any other practice that would put availability, accuracy, or confidentiality of Hospital’s data, media, or equipment at risk. The WORKFORCE MEMBER will not share computer Passwords with anyone by permitting others to use the computer on their log-on.

5. WORKFORCE MEMBER will notify his/her immediate supervisor to arrange for a Password change if he/she

has a reason to believe the confidentiality of his/her Password has been compromised.

6. WORKFORCE MEMBER will adhere to HOSPITAL policies regarding installation, copying and use of HOSPITAL owned computer software. Specifically, installation of unlicensed computer software on HOSPITAL owned equipment is prohibited by U.S. copyright laws, and may involve civil and criminal penalties.

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7. WORKFORCE MEMBER understands that any violation of this Agreement is a violation of HOSPITAL policy and will result in disciplinary action. The WORKFORCE MEMBER’S signature below also acknowledges that they have been instructed and they understand their duty and responsibility to maintain the confidentiality and security, both now and in the future, of any Confidential Information acquired at HOSPITAL.

8. The obligation to protect against the release of Confidential Information which WORKFORCE MEMBER has

agreed to in this Agreement shall survive the termination of the WORKFORCE MEMBER’s employment or association with HOSPITAL. Upon termination of WORKFORCE MEMBER’s employment or association with HOSPITAL, WORKFORCE MEMBER shall return to HOSPITAL, without making or retaining copies thereof, all documents, records, notebooks, computer disks or similar repositories containing Confidential Information.

9. This agreement shall be governed by and interpreted in accordance with the laws of the State of Ohio, without

regard to its conflict of law principles thereof. IN WITNESS WHEREOF, the WORKFORCE MEMBER has signed this agreement as of this date, _____________ (Today’s Date) in the capacity set forth under his/her signature and acknowledges receiving a copy of this agreement. _______________________________________ ___________________________________ WORKFORCE MEMBER Date DATE (Signature of student intern/observer) ___________________________________________ _______________________________________ WORKFORCE MEMBER DEPARTMENT (School) (Printed name of student intern/observer) ___________________________________________ _______________________________________ Employee Number or Badge Number Cost Center

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My signature below verifies that I have reviewed and understand the information provided

in the Mandatory Organization Information (MOE) presentation and the Standards of

Behavior booklet and that I agree to adhere to the Safety information outlined in the MOE

presentation and demonstrate Summa Health Systems Standards of Behavior at all times.

__________________________________ ________________

Name Date

Name of School Attending

H:share\clinicalrotations\GradStudentORT\MOE&SE Agreement.docx

S U M M A H E A L T H S Y S T E M

Standards of Behavior“acts of excellence”

I am pleased to share with you Summa Health System’s Standards of Behavior. Based on our philosophy of “servant leadership”, to serve the patient, or to serve those who do, these standards were developed by our fellow employees throughout our health system to ensure we provide the highest level of compassionate care to our patients, their families and members of our communities.

Our Standards of Excellence distinguish us among our peers in the healthcare industry. These guidelines promote the best in ourselves and each other. By practicing these behaviors and coaching each other to achieve these standards, we enhance each patient’s experience and create a positive, productive and respectful working environment for ourselves. Each of us is the face of Summa. We are the individuals our patients look to – and count on – during their most difficult hours. I am grateful for your commitment to honor these standards and thank you for your continued, unwavering dedication to our mission, vision and values.

“I will…” It all begins with

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In good health,

Tom StraussPresident and Chief Executive OfficerSumma Health System

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You are what people see when they arrive here.

Yours are the eyes they look into when they’re frightened and lonely.

You are the voices people hear when they ride the elevators and when they try to sleep and when they try to forget their problems. You are what they hear on their way to their destinies. And what they hear after they leave those appointments.

Yours are the comments people hear when you think they can’t.

Yours is the intelligence and caring that people hope they’ll find here.

YouSummaare 3

If you’re noisy, so is the hospital. If you’re rude, so is the hospital. And if you’re wonderful, so is the hospital.

No visitors, no patients, no physicians or coworkers can ever know the real you, The you that you know is there — unless you let them see it. All they can know is what they see and hear and experience.

And so we have a stake in your attitude and in the collective attitudes of everyone who works at the hospital. We are judged by your performance. We are the care you give, the attention you pay, the courtesies you extend.

Thank you for all you’re doing.

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acts

acts of excellence

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appearance and attitude

courtesy, concern and communication

teamwork

safety

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acts of excellence

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aappearance and attitud

eI will help create a welcoming environment by

greeting everyone I encounter throughout my

workday and demonstrate respect and compassion

through my words, tone of voice and body language.

I will be respectful of diversity among all patients/

customers/employees/volunteers and members

by demonstrating sensitivity based on race, color,

national origin, religion, sex, sexual orientation,

gender identity or disability.

I will maintain a pleasant attitude and be

approachable at all times while at work.

I will be proactive with my patients/customers/

members and offer assistance, including wheelchair

assistance, before being asked, especially to those

who appear to be in need of special assistance or

are physically challenged.

I will eliminate phrases such as, “That’s not my job,

I’m busy, I don’t have time, or we are short-staffed”

from my vocabulary. If I am unable to meet a patient/

customer’s request, I will find someone who can help.

I will “manage up” (speak positively) of other

employees, departments and entities when talking to

our patients/customers.

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I will always ensure my appearance is clean,

professional and in accordance with Summa Health

System.

At all times, I will wear my identification badge

above my waist with my photo facing outward.

I will not eat, drink or chew gum during any patient/

customer interactions.

I will assist in maintaining a quiet, calm and

professional environment.

When representing Summa Health System

outside of the workplace, whether it is a speaking

engagement, fundraising event or athletic

competition, I will be responsible for my actions.

I am Summa!

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n cCourtesy/ConcernI will offer to assist people who look lost or those

who ask me for help by taking them directly to their

destination. If I am unable to escort them, I will find

someone who can escort or take them to the nearest

staffed information desk.

I will be conscientious of confidential and sensitive

information; therefore, I will not talk about any patient/

customer/member or employee in any public area

including hallways, elevators and food service areas. I

will respect privacy by knocking and identifying myself

before entering any doors or curtained areas.

I will address all issues with patients, families, visitors,

members, physicians, co-workers and others discreetly

so I do not interfere with the service of other customers.

I will follow the existing HIPAA policies and protect

patient’s, member or employee privacy by not

discussing confidential or sensitive information that

may be overheard in any public area, including

hallways, elevators, and/or eateries.

Courtesy (Specific to Hallways and Public areas)I will always acknowledge patients/customers/

members, employees and volunteers in the hallway

with a smile and/or greeting.

I will take pride in my environment by helping

to maintain an organized, uncluttered and clean

environment and will pick up litter using appropriate

infection control techniques.

I will not eat or lounge in any public area, i.e.,

lobbies; waiting rooms, etc.

In a parking deck/lot, I will drive at a safe speed and

only park in designated employee areas.

Courtesy (Specific to Elevators) When holding conversation on an elevator, I will use

a quiet tone and not discuss patient information.

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I will allow others to exit the elevator prior to inviting

waiting patients, guests and employees to enter the

elevator ahead of me. I will pay close attention and

offer assistance to those with special needs.

I will use designated elevators for transporting

patients and/or specimens where applicable.

CommunicationI will follow the components of the AIDET model

of communication in appropriate situations at all

times:

A Acknowledge

Eye contact + Smile + Greet I will promptly welcome people in a friendly

manner, smile warmly and maintain eye contact.

I Introduce

First Name + Role/Purpose I will address people formally, using Dr., Mr.,

Mrs., Miss, Ms., unless permission is given

to address them differently—avoiding terms

such as “honey”, “dear” or “sweetie” as

these terms are sometimes considered

disrespectful.

D Duration

Talk about Time & Delays

I will show respect for people’s time by

informing them of anticipated wait times

and the cause for any delays. I will provide

them with periodic status updates and

thank them for waiting.

E Explanation

Offer Explanations & Keep It Simple

I am Summa, I will do whatever it takes to

satisfy my customer.

T Thanks

Show Appreciation & Gratitude

I will end my customer encounters by asking

“Is there anything else I can do for you?” or

a similar statement.

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Communication - TelephoneTelephone conversation is a “Moment of Truth” that

forms our customer’s first impression; therefore, I

will use the following guideline as my initial greeting:

• Internal call – Begin with department, my

first name, “How may I help you?”

• External call – Begin with “Thank you for

calling Summa (campus), department, my first

name, “How may I help you?”

I will determine the urgency and meet the needs of

the caller, if possible.

There will be no “blind transfers.” Prior to

transferring any call I will provide the correct

telephone number to my caller. When actually

transferring a call I will wait until someone answers

the call. If I should receive voice mail, I will ask the

caller if they wish to leave a message. I will then

follow the needs of my customer.

If I need to place the caller on hold, I will first obtain

the caller’s permission. I will not lay the phone down.

I will acknowledge the caller repeatedly while they

are waiting. When retrieving a call on hold I will

always thank the caller for waiting.

After ensuring all needs of the caller are met, I will

close the call by asking, “Is there anything else I

can help you with? Thank you for choosing Summa

Health System.”

If I need to leave a voicemail message I will speak slowly,

clearly, and concisely. The message also will include the

name of my department, my full name, my complete

phone number and a descriptive message of why I called.

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Communication (Specific to cell phone usage)Use of cell phones is limited and subject to the following

guidelines: (Departments may establish more stringent

guidelines for cell phone usage as necessary.)

Business: • Iwillusediscretioninpublicareaswhenusingmy

cell phone to respond to e-mails, pages, etc.

• Wheninameeting,Iwillusediscretionwhen

responding to urgent emails, texts or pages.

• Asacourtesy,Iwillsetmyphonetosilentalertmode.

Personal: • Allurgentpersonalcallsandtextsaretobekeptto

a minimum. Abuse of this privilege will lead to

disciplinary actions.

• Employeesmaydiscretelyusecellphonesduring

lunch and/or break periods in designated areas.

All other locations are prohibited.

• Cellphonesaretobesilencedwhennotinuse.

• Picturetakingand/orrecordingswithcellphonesis

strictly prohibited.

• UseofSummaoutletstorechargecellphonesin

public areas is prohibited.

Communication (Specific to Email) I understand my email account was provided to me as a

means of business communication and/or departmental

operation. I will not abuse this account by using it for

personal or social reasons.

I will check my email several times throughout the day

and respond as soon as possible, being respectful of

private and confidential information.

I will consider a different means of communication when

three or more email messages have been exchanged in an

attempt to reach a conclusion.

I will use the “reply to all” function only when necessary

and avoid sending one word replies like OK and thank you

unless it is necessary.

I will use the “Out of Office” function to notify others when I

am away for a period of time and indicate what steps to take if

assistance is needed.

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tI will take full responsibility for my own actions,

decisions and performance and welcome

constructive feedback and suggestions if

improvement is needed.

I will work in collaboration with my co-workers,

positive in finding solutions and support a blame-

free environment.

I will “manage up” other employees and

departments, creating a great working relationship.

I will welcome new team members and make every

effort to help them be successful in their role.

I will arrive on time to all meetings and other

scheduled events. Doing this demonstrates respect

and courtesy to the leader and/or speaker.

I will be mindful of operational differences between

Summa entities and provide complete phone

numbers, full names with job titles and maps when

communicating.14

What We Do

safe

ty

Practice with a Questioning Attitude

Think critically about the things seen and heard during the work day.

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2 31 4Our Safety Behaviors

What We Believe

What We Do

Practice with a Questioning Attitude

Think critically about the things seen and heard during the work day.

1. Reflect and resolve

2. Stop in the face of uncertainty

1. Repeat back/read back with phonetic and numeric clarifications

2. Ask clarifying questions

3. Use SBAR-Q to transfer information

1. Self-check using STAR 1.Crosscheckandcoach

2. Speak up for safety usingARCC

Communicate Clearly Engagethroughprofessional, clear and complete verbal and written

communications.

Focus on the Task Take the time to carefully attend

to important details.

Support Each Other Be accountable not just for our own actions but for our

teammates’ as well.

• SBAR-Q = Situation, Background, Assessment, Recommendation, Questions•STAR = Stop, Think, Act, Review• ARCC = Ask a question, Request a change, Communicate a ConCeRn, use ChainofCommand

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sPractice With a Questioning AttitudeThink critically about the things seen and

heard throughout the day.

• Reflect and resolve

• Stop in the face of uncertainty

Communicate ClearlyEngagethroughprofessional,clear

and complete verbal and written

communications.

• Repeat back/read back with phonetic

and number clarifications

•Ask clarifying questions

•Use SBAR-Q to transfer information

Focus on the Task •Take the time to carefully attend to the

important details.

• Self-check using STAR

Support Each OtherBe accountable not just for our own actions,

but for our teammates’ as well.

• Crosscheckandcoach

• SpeakupforsafetyusingARCC

I will follow my organization’s hand hygiene

policy.

I will be responsible for creating a safe,

secure and accident-free environment and

address any noticeable safety hazards.

I will request help whenever necessary

to ensure my own safety, i.e., asking for

an escort from Protective Services or

assistance lifting or moving an item, etc.

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I have read and understand Summa Health System’s Standards of Behavior. I agree to demonstrate them

consistently with all customers, including:

I commit to practice these standards daily and understand that failure to do so may result in disciplinary

action up to, and including, termination of employment.

Printed Name:

Employee ID Number:

Signature:

Campus:

Department:

Date:

Patients, families & visitors

Health plan members

Co-workers

Summa employees in other departments and entities

Physicians

Volunteers

Vendors

Anyone with whom I come in contactduring the course of my workday is a customer. c

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S U M M A H E A L T H S Y S T E M

SER-13-19200/CS/KH/6-13/2500

Summa Health System is an Integrated

Healthcare Delivery System that provides

coordinated, value-based care across the

continuum for the people and populations

we serve. We hold ourselves clinically and

financially accountable for health outcomes

in our communities.

2015 Student Mandatory Education

CODE RED Fire

• Rescue – persons in immediate danger

• Alarm – must be sounded, pull station and call 757

• Contain Fire- close doors, lights left on

• Extinguish - small fires if possible, use P.A.S.S. technique below

Try to remain Calm and never turn your back on a fire

• Pull – the pin to unlock the spray trigger

• Aim – at the base of the fire

• Squeeze – the trigger to release extinguishing agent

• Sweep – at the base of the fire

CODE BLACK Bomb Threats

• If you receive a phoned bomb threat, try to keep the caller on the line. Get the attention of another person and clue him/her to call the code at 757.

• Do not touch or move any suspicious packages in

your area.

• If you are elsewhere in the facility, stay away from the location of the Code Black.

CODE YELLOW Mass Casualty/Disaster

• Routine admission and treatment processes are not adequate to meet the expected number of casualties

• At work, stay in your area until called.

• At home and called in - bring your ID badge and enter hospital through security entrance .

Code Brown Missing Adult Patient

• Patients that are missing and/or have walked away

from the unit. RN is responsible for initiating this code.

• Telecommunications operator to page Code Brown on

the overhead paging system. • If missing patient is found, ask him/her to return to

his/her room with you.

CODE VIOLET Combative or Violent Person

• If you are near the combative person, move a safe distance away and call the code if nobody else has.

• Code Violet activated by calling 757 from any phone or by using the panic button located at all nurses stations and some patient areas

Code Adam Missing infant or child

• If you are the first person at the location when an infant/child is determined

to be missing, call in the Code Adam, dial 757 • Look out for anyone carrying large packagers, totes or duffel bags into baby

areas

• The facility goes into a “lockdown” situation in which nobody is allowed to enter the building and people are asked to not leave the building. All exterior doors will be alarmed and hospital staff will be keeping watch on all exits.

Code Blue Medical Emergency

• If you are the first person on the scene when someone is found unexpectedly unresponsive, call in the Code Blue and follow the

American Heart Association guidelines for Basic Life Support.

CODE SILVER Hostage or armed person situation

• Observing by sight or overhearing that a person has a weapon or

claiming to have a weapon or gun. • If you are in the location of the situation and able to safely leave, do so

immediately. • Dial 53277

ELECTRICAL SAFETY • All electrical equipment used in the hospital must pass electrical safety

criteria; contact Facilities Engineering Department to have equipment inspected.

• Never use extension cords for patient care equipment (except in power-outage situations to connect to outlets on emergency power).

• Use only approved, inspected, surge-protector power-strips for non-patient care equipment.

• Never handle electrical equipment or plugs with wet hands. • Never unplug equipment by tugging on the cord; always grasp the plug. • Never heat cloth items in a microwave; use only warmers specific for that

purpose.

Hazardous Materials Safety

• You have the right to know about potential hazards from any chemicals you might be exposed to while performing patient care.

• Read the label on the container. All containers must have labels. Do not use materials that are not labeled.

• Review the Safety Data Sheet (SDS) forms for the chemicals used in the area where you are working.

• Use the appropriate Personal Protective Equipment (PPE) when working with hazardous materials.

• Never eat, drink, apply cosmetics, or handle contact lenses in an area where chemicals are currently in use.

• If you have an unprotected exposure to a hazardous chemical, see your preceptor.

INFECTION CONTROL • The single most important step to infection control is hand washing. • You must always wash your hands:

– After using the restroom. – Before handling food, beverages, or eating utensils. – Before and after removing patient care gloves. – Before and after direct patient contact. – Whenever visibly soiled.

• If you have an unprotected exposure to a patient’s blood or other potentially infectious material: – If splashed in the eyes, nose, or mouth flush immediately with

running water. – If exposure is on intact skin, wash immediately with soap and water. – If exposure involves puncture of your skin by a needle or other sharp

object, wash the puncture site with soap and water, see your preceptor

CORPORATE COMPLIANCE

• We want any student to feel free to speak up about concerns without fear of getting in trouble. Summa Health System maintains a corporate ethics hotline. Anyone may use it to report suspected violations of any hospital policy or federal, state, or local law.

• Compliance Hotlines:

Summa Health System: 1-800-421-0925 Summa Physicians Inc: 1-800-527-6215

Tornado Safety

• In the event of a tornado watch for our area, the operator will make an announcement over the public address system using the specific language of the National Weather Service. The announcement will be repeated hourly during the duration of the tornado watch.

• In the event of a tornado warning, the operator will announce it using the specific language used by the National Weather Service. The warning will be repeated every 15 minutes during the time of the tornado warning.

Patient Rights and Confidentiality • Patients have rights related to their care and the services we provide

them. Information on patient rights is provided to each patient at the point of registration and is also available in the “Guide to Patient Services” which inpatients receive upon admission.

• One very important right has to do with the patient’s privacy and our commitment to maintaining confidentiality. You are not entitled to browse information on patients, family members, or friends. You are not to gossip about patients. You may not even tell others that someone is a patient here unless that is part of your duties.

• We maintain confidentiality because it is the ethical thing to do. But it is important to always remember that we are required by HIPAA to protect the privacy of patient health information and there are legal consequences if we don’t.

Cultural DIVERSITY

• Summa’s Vision: To be recognized as having a caring and diverse environment exemplifying a satisfied and engaged workforce.

• Cultural Diversity is not just a factor of country of origin, race, religion, sex, and age. People are also diverse in their values, education, political views, sexual orientation, social status, and even in personality style, communication style, and how they process information. Another factor in diversity is physical and mental disabilities.

• In order for people to be able to work well together, it is important to respect one another as individuals and appreciate the contributions each person makes. We all need to demonstrate cultural sensitivity.

SERVICE EXCELLENCE • Please see attached Standards of Behavior booklet

Patient Safety

We have developed a Patient Safety Toolkit to help us keep our patients safe. We have four basic safety behaviors and associated error prevention tools we expect everyone to use. Below is a table showing our toolkit. Please review the attached hand out on “I’m 4 Safety” to learn more about our patient safety behaviors and error prevention tools.

18That’s more than healthcare. That’s smartcare.

What we Believe in(Our Safety Behaviors)

What we Do(Our Error Prevention Tools)

1. Practice with a Questioning AttitudeWe think critically about the things we see and hear during our work day.

1. Reflect and Resolve2. Stop in the Face of Uncertainty

2. Communicate ClearlyWe’re responsible for professional, clear, and complete verbal and written communications.

1. SBAR-Q to transfer information2. 3-way Repeat Backs/Read Backs3. Clarifying Questions4. Phonetic and Numeric Clarifications

3. Focus on the TaskWe take the time to carefully attend to important details.

1. Self-check using STAR

4. Support Each OtherWe’re accountable not just for our own actions but for our teammates’ as well.

1. Crosscheck and Coach2. Speak up for Safety using ARCC

Our Safety Behaviors for Error Prevention

SBAR-Q = Situation, Background, Assessment, Recommendation, QuestionsSTAR = Stop, Think, Act, ReviewARCC = Ask, Request, Communicate a Concern, Chain of Command

Other Information • In event of unusual occurrence, such as an injury on hospital property,

please notify a Summa employee to initiate proper unusual occurrence report.