Transcript Slide 1

Have Safety Culture Data, Will Travel?
Sallie J. Weaver, PhD
Assistant Professor
Dept. of Anesthesiology & Critical Care
Medicine, and
Armstrong Institute for Patient Safety & Quality
Roadmap
1. What is patient safety culture?
2. Why does it matter?
3. I have data….but now what?
4. Some food for thought regarding acting on
data
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Armstrong Institute for Patient Safety and Quality
Sounding the Call for a
Culture of Safety
• “Health care organizations must develop a
culture of safety such that an organization’s
care processes and workforce are focused on
improving the reliability and safety of care for
patients”
• Joint Commission Leadership Standard:
– Leaders create and maintain a culture of safety
and quality throughout their organization
• NQF Safe Practice #2
– Culture measurement, feedback, and
intervention
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Armstrong Institute for Patient Safety and Quality
The Armstrong Institute Model to
Improve Care
Translating Evidence Into
Practice
(TRiP)
1. Summarize the
evidence in a checklist
2. Identify local barriers to
implementation
3. Measure performance
Reducing preventable
patient harm
Comprehensive Unit based
Safety Program (CUSP)
Pre-Work: Measure clinician
and staff perceptions of safety
culture (HSOPS Survey)
•
Emerging Evidence
•
Local Opportunities
to Improve
1.
Educate staff on
science of safety
•
Collaborative
learning
2.
Identify defects
3.
Recruit executive to
adopt unit
4.
Learn from one
defect per quarter
5.
Implement teamwork
tools
4. Ensure all patients get
the evidence
• Engage
• Educate
• Execute
• Evaluate
Technical Work
Adaptive Work
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What is Safety Culture?
• Perceived priority of safety
relative to other goals
Culture
• Culture is the compass team
members use to guide their
behaviors, attitudes, &
perceptions on the job
• What will I get praised for?
• What will I get reprimanded for?
• What is the “right” thing to do?
Armstrong Institute for Patient Safety and Quality
Behavior on
the Job
Outcomes
-Patient & Family
Safety
- Care Provider
Safety 5
What Are Core Aspects of
Safety Culture…
Formal and
informal leader
actions &
expectations
Teamwork
processes
(e.g., back-up
behavior)
Feedback,
reward, and
corrective
action practices
Communication
patterns &
language
Resource
allocation
practices
Culture
of
Safety
Error-detection
and correction
systems
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Armstrong Institute for Patient Safety and Quality
Why Safety Culture Matters
1. Safety culture is related to outcomes
 Patient outcomes




Patient care experience
Infection rates, sepsis
Postop. hemorrhage, respiratory failure, accidental puncture/laceration
Treatment errors
 Clinician outcomes
 Incident reporting, burnout, turnover
2. Safety culture influences the effectiveness of other
safety and quality interventions
 Can enhance or inhibit effects of other interventions
3. Safety culture can change through intervention
 Best evidence so far for culture interventions that use multiple
components
Armstrong Institute for Patient Safety and Quality
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CUSP & Safety Culture
 Safety Culture is typically measured “PreCUSP”: Before interventions begin
• Provides a baseline to diagnose barriers and
facilitators that can impact improvement efforts
• Then can be measured 12-18 months following
start of improvement efforts
 Use reliable and valid survey instrument
• Hospital Survey on Patient Safety (HSOPS)
 CUSP is the intervention that you will use to help
you improve culture results
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Armstrong Institute for Patient Safety and Quality
Part II
I HAVE MY DATA…BUT NOW WHAT?
Prepare your Elevator Speech:
What is the Hospital Survey on Patient Safety
(HSOPS)?
 Suite of survey tools = SOPS
• Hospital
• Medical office
• Nursing home
 Background & Frame of Reference:
• Sponsored by: Agency for Healthcare Research & Quality
• US federal agency charged with conducting and supporting research
to improve patient safety and care quality
• Developed by Westat, public release in 2004
 Participants are asked to choose 1 to 5 for each question:
1 Strongly Disagree 2 Disagree 3 Neither Agree nor Disagree 4 Agree 5Strongly Agree
1 Never 2 Rarely 3 Sometimes 4 Most of the time 5 Always
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Armstrong Institute for Patient Safety and Quality
HSOPS Questions & Composite
Scores
10 Composite Scores
(“Dimensions”)
Number of
Questions
Example Question
1.
Supervisor/manager expectations &
actions promoting patient safety
4
B1. My supervisor/manager seriously considers staff
suggestions for improving patient safety.
2.
Organizational learning-continuous
improvement
3
A9. Mistakes have led to positive changes here
3. Teamwork within unit
4
A1. People support one another in this unit.
4.
Communication openness
3
C4. Staff feel free to question the decisions or actions of
those with more authority.
5.
Feedback & communication about error
3
C1. We are given feedback about changes put into place
based on event reports.
6.
Nonpunitive response to error
3
A8. Staff feel like their mistakes are held against them.
(negatively worded)
7.
Staffing
4
A2. We have enough staff to handle the workload.
8.
Hospital management support for
patient safety
3
F8. The actions of hospital management show that
patient safety is a top priority.
9.
Teamwork across hospital units
4
F4.There is good cooperation among hospital units that
need to work together.
4
F5.Important patient care information is often lost during
shift changes. (negatively worded)
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10. Hospital handoffs & transitions
HSOPS Questions & Composite
Scores –continued4 Outcome variables
Number of
Questions
Example Question
1.
Overall perceptions of safety
4
A15. Patient safety is never sacrificed to get more
work done.
2.
Frequency of event reporting
3
D1.
When a mistake is made, but is caught and
corrected before affecting the patient, how
often is this reported?
3.
Patient safety grade (of hospital
unit)
1
E1.
Please give your work area/unit in this hospital
an overall grade on patient safety.
4.
Number of events reported in the
last 12 months
1
G1.
In the past 12 months, how many event
reports have you filled out and submitted?
 Plus background questions about respondents
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Armstrong Institute for Patient Safety and Quality
HSOPS Scoring
• Scoring guidelines created by AHRQ
• Scores represent the % of positive responses
– % who gave a score of 4 or 5
1 Strongly Disagree 2 Disagree 3 Neither Agree nor Disagree 4 Agree 5Strongly Agree
1 Never 2 Rarely 3 Sometimes 4 Most of the time 5 Always
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Armstrong Institute for Patient Safety and Quality
Your medical
center
Your medical center
Your medical center
Your medical center
Your medical center
Your medical center
Your medical center
Your medical center
Your medical center
Interpreting Composite Scores:
• The big picture view
Armstrong Institute for
Safety and
• Patient
Higher
isQuality
better
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Questions provide a deeper dive:
• For positively worded items, more green is
better
Armstrong Institute for Patient Safety and Quality
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Your medical
center
Your medical center
Your medical center
Your medical center
Your medical center
Your medical center
Your medical center
Your medical center
Your medical center
Interpreting Composite Scores:
• The big picture view
Armstrong Institute for
Safety and
• Patient
Higher
isQuality
better
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Questions provide a deeper dive:
• For negatively worded items, more RED
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Institute for Patient Safety and Quality
isArmstrong
better
Next Steps: Creating a Debriefing
Plan
• Debriefing is…
– A semi-structured conversation among frontline
clinicians and staff that is usually led by a designated
facilitator
• Purpose…
1. Encourage open communication, transparency,
and interactive discussion about the survey
results
•
Across all levels
2. To engage clinicians and staff in generating and
implementing their ideas about how to create an
effective safety culture in their work area
Armstrong Institute for Patient Safety and Quality
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Some points to cover in your
debriefing plan
Decision points for project team
How many debriefing sessions will be held?
Debriefing plan
Who will facilitate each debriefing session?
When will debriefing(s) be held?
Where will debriefing(s) be held?
Who is responsible for taking notes and recording
ideas from each session?
If you conduct more than one debriefing session, who
is responsible for collating notes and ideas for
improvement from the different sessions?
How will the CUSP team ensure there is follow-up on
the action items from the debriefing session(s)?
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Armstrong Institute for Patient Safety and Quality
Keep in mind…Culture Change can seem
Hard Because Culture has Three Layers…
(Schein, 2010; Scorzoni, 1982)
1. Behaviors, norms, processes
enacted on the job, feedback &
reward systems
2. Espoused values, goals,
philosophies, formal
policies
3. Underlying
assumptions
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Armstrong Institute for Patient Safety and Quality
Keep in mind…Culture Change can seem
Hard Because Culture has Three Layers…
(Schein, 2010; Scorzoni, 1982)
1. Behaviors, norms, processes
enacted on the job
Safety climate surveys
focus diagnostic
measurement here
2. Espoused values, goals,
philosophies, formal
polices
3. Underlying
assumptions
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Armstrong Institute for Patient Safety and Quality
Keep in mind…Culture Change can seem
Hard Because Culture has Three Layers…
(Schein, 2010; Scorzoni, 1982)
1. Behaviors, norms, processes
enacted on the job
2. Espoused values, goals,
philosophies, formal
policies
Deeper levels addressed by:
 Debriefing
3. Underlying
 Involvement of unit members
assumptions
 Leaders who model the values and
align assumptions
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Armstrong Institute for Patient Safety and Quality
Culture Change Can Seem Hard Because it
Involves both Unlearning and Re-Learning
Refreeze
Learn &
Rebalance
Unfreeze
Lewin, 1951;
Schein, 2009
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Armstrong Institute for Patient Safety and Quality
Changing Culture in Practice:
National CLABSI Project Example
• Baseline HSOPS survey
Target non-punitive response to error
• What did they do?
– Clarified the language and definitions of events,
errors, glitches with all unit clinicians & staff
• Education campaign to define and differentiate process
errors (e.g., expected behavior not clear, not known) from
intentional violations
• Created shared mental model about expected safety
behavior, as well as what to report, when, and when/how to
follow-up
• Follow up…hot off the presses!
Non-punitive response, communication openness, supervisor
support
Armstrong Institute for Patient Safety and Quality
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In Sum
1. Review the survey report for your unit
2. Can be helpful to distill the report down into 3-5 key slides
3. Decide when, how, and where to debrief your teammates
(and leaders) on these results
• Be prepared to listen
• Ask for feedback
• Ask teammates to help come up with solutions
4. Gather a small group together and use the “culture
debriefing tool” to examine the roots of problem areas
and begin to formulate strategies for improvement
• Next call with Jill Marsteller & Mike Rosen Aug 9
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Armstrong Institute for Patient Safety and Quality
Thank you!
Sallie J. Weaver, PhD
ACCM, and
Armstrong Institute for Patient Safety and Quality
[email protected]