Transcript No Slide Title

Improving Patient Safety Culture
Using the AHRQ Hospital Survey
Theresa Famolaro, MPS
Westat
Westat
1650 Research Blvd.
Rockville, MD 20850
[email protected]
301-738-3547
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Objectives
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Present an overview of the AHRQ Hospital
Survey on Patient Safety Culture and its
Comparative Database results
Discuss ways to improve patient safety culture
using your survey results
Review success stories of using the survey for
patient safety improvement
Discuss future survey activities
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What is Patient Safety Culture?
“The way we do things around here”
Exists at
multiple
levels:
Beliefs, values & norms
Shared by staff
System
Organization
Department
What is
Unit
• Rewarded
• Supported
• Expected
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Why you should do a culture survey?
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Raise staff awareness about patient safety
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Diagnose and assess patient safety culture
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Identify strengths and areas for improvement
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Examine change over time
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Evaluate the impact of patient safety initiatives
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Conduct internal and external comparisons
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Background
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Hospital Survey on Patient Safety Culture
(HSOPS)
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Developed by Westat, funded by AHRQ
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Survey development process:
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Reviewed literature & existing surveys
Interviewed hospital staff
Identified key areas of safety culture
Developed survey items & pretested
Obtained input from researchers & stakeholders
Pilot tested in 21 hospitals with 1,437 respondents
Final survey released November 2004
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HSOPS Patient Safety Culture Dimensions
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42 items assess 12 dimensions of patient safety culture
1. Communication openness
2. Feedback & communication about error
3. Frequency of event reporting
4. Handoffs & transitions
5. Management support for patient safety
6. Nonpunitive response to error
7. Organizational learning--continuous improvement
8. Overall perceptions of patient safety
9. Staffing
10. Supv/mgr expectations & actions promoting patient safety
11. Teamwork across units
12. Teamwork within units
Patient safety “grade” (Excellent to Poor)
 Number of events reported in past 12 months
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HSOPS Comparative Database
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HSOPS Comparative Database
2012 Report
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1,128 U.S. hospitals, 567,703 respondents
Average # respondents per hospital = 503 staff
 650 trending hospitals
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Survey modes
Paper 21%
 Web
66%, In 2007 was 25%
 Both
13%
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Average hospital response rate = 53%
Paper 61%
 Web
51%
 Both
49%
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Hospital Work Areas
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Medicine
Surgery
Many areas/no specific area
ICU
Radiology
Emergency
Lab
12% (62,688)
10%
8%
7%
6%
6%
5%
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Staff Positions & Patient Contact
Nursing
35% (191,402)
 Technicians (EKG, Lab, Radiology, etc)
11%
 Management, administration
8%
 Unit assistant/clerk/secretary
6%
 Physicians, PAs, NPs
6%
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76% had direct interaction with patients
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Hospital Strengths
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Hospital Middle Composite Scores
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Hospital Areas for Improvement
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Patient Safety Grade
100%
80%
60%
45%
40%
30%
20%
20%
4%
1%
Poor
Failing
0%
Excellent Very Good
Good
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Number of Events Reported
100%
80%
60%
55%
40%
27%
20%
12%
4%
2%
0%
None
1 to 2
3 to 5
6 to 10 11 to 20
1%
21 or
more
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How Do I Compare My Results?
• Compare Percent Positive Results
• Compare Results by Hospital and
Respondent Characteristics
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Improving Patient Safety Culture
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Action Planning for Improvement
Step #1:
Understand
Your Results
Step #2:
Communicate &
Discuss Results
Step #3:
Create Focused
Action Plans
Step #4:
Communicate
Plans &
Deliverables
Step #5:
Implement
Action Plans
Step #6 and 7:
Track Progress
& Evaluate
Impact and Share
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Actions Taken by Trending Hospitals
Types of Action Taken
Trending
Hospitals
Number Percent
Implemented SBAR (Situation-Background-AssessmentRecommendation)
190
65%
Made changes to policies/procedures
180
62%
Improved compliance with Joint Commission National Patient
Safety Goals
171
59%
Conducted chart audits
166
57%
Improved error reporting system
158
54%
Improved fall prevention program
156
53%
Implemented patient safety walkrounds
136
47%
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Examine Culture at the Unit Level
• Culture clusters in units
• Provide results to each unit
• Empower units to identify areas to improve
• Implement patient safety initiatives at the unit level
• Measure improvement at the unit level
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Improving Patient Safety Resource List
Improving Patient Safety in Hospitals: A Resource List for Users
of the AHRQ Hospital Survey on Patient Safety Culture
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What is the AHRQ Health Care
Innovations Exchange?
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Publicly accessible, searchable database of
over 2,300 health policy and service delivery
innovations and QualityTools
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Successes and attempts
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Innovators’ stories and lessons learned
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Expert commentaries
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Learning and networking opportunities
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Evidence for Patient Safety Initiatives
• March 2013 AHRQ Report
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Making Health Care Safer II: An
Updated Critical Analysis of the
Evidence for Patient Safety Practices
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Lists Top 41 Patient Safety
Improvement Strategies
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Non-clinical initiatives
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Team training in health care
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Interventions to promote a culture of
safety
Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices. March 2013. Agency for
Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/evidence-basedreports/ptsafetyuptp.html
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TeamSTEPPS®
• Developed by Department of Defense (DoD) and
AHRQ
• Teamwork training for health care professionals
• Focuses on organizational culture of safety
• Involves a three-phased process
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A pretraining assessment for site readiness
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Free training for onsite trainers and health care
staff
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Implementation and sustainment
• Comprehensive curriculum
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Success with TeamSTEPPS®
Northshore Long Island Jewish Health System
• Implemented TeamSTEPPS® first in pilot unit
• Administered AHRQ Hospital Survey at baseline
and after TeamSTEPPS® training
• Significant improvement in ALL survey results
(2007 to 2010)
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Nonpunitive response to error +15.9%
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Staffing +15.8%
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Teamwork within units +11.9%
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Overall perceptions of safety +11.8%
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Organizational learning +11.7%
Thomas, L. and Galla, C. Building a culture of safety through team training and engagement. BMJ Qual ity and
Safety. 2013; 22::425–434.
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Leadership WalkroundsTM
• Developed by Allan Frankel, MD, Director of Patient
Safety at Partners HealthCare
• Face-to-face visits by leaders on units
• Leaders discuss patient safety issues with clinical staff
and physicians
• Many concerns related to equipment, facilities, &
communication
• Concerns entered into a database, addressed by
severity
• Demonstrates leadership commitment to patient safety
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Success With Leadership WalkroundsTM
Massachusetts hospitals (7)
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WalkroundsTM training at each site
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Weekly Walkrounds from August 2002-April 2005
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Initially 7 hospitals, only 2 hospitals complied
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Assessed culture at baseline and 18 months later
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Used SAQ survey
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Showed significant increase in scores for 2 hospitals
Frankel, Al. et al. Revealing and resolving patient safety defects: The impact of leadership. Walkrounds on
frontline caregiver assessments of patient safety. Patient Safety and Medical Errors. Health Serv Res 2008
December; 43(6): 2050–2066.
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Just Culture
• Nonpunitive Response to Error lowest composite
in hospital database (2007-2012)
• Improving Patient Safety in Hospitals: A Resource
List for Users of the AHRQ Hospital Survey on
Patient Safety Culture
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Nonpunitive Response to Error: The Fair and Just
Principles of the Aurora Health Care Culture
Patient Safety and the "Just Culture": A Primer for
Health Care Executives
Patient Safety and the "Just Culture": A Presentation
by David Marx, J.D.
Improving Patient Safety in Hospitals: A Resource List for Users of the AHRQ Hospital Survey on Patient Safety
Culture. August 2010. Agency for Healthcare Research and Quality, Rockville, MD.
http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/hospital/resourcelist/hospimpptsaf.html
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Success With Just Culture Training
Aurora Healthcare System
• HSOPS survey 2005
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Aurora hospitals, in 2005, Nonpunitive
response to error: 33%
• Implemented David Marx Just Culture Training
• HSOPS survey 2008
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Nonpunitive Response to error: 40%
Leonhardt, K.(2008). Nonpunitive Response to Error” The Fair and Just Principles of the Aurora Culture . Presented at
CAHPS®/SOPS User Group Meeting 2008. Scottsdale, Arizona.
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Future AHRQ SOPS Activities
• AHRQ Hospital Survey on Patient Safety
Culture Comparative Database
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Next Comparative Database Report, Spring 2014
Next Hospital Data Submission, June 2015
• Revise Hospital Survey (Version 2.0)
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Resources
• AHRQ Hospital Survey on Patient Safety Culture:
http://www.ahrq.gov/professionals/quality-patientsafety/patientsafetyculture/hospital/index.html
• AHRQ Innovations Exchange:
www.innovations.ahrq.gov
• Making Health Care Safer II: An Updated Critical
Analysis of the Evidence for Patient Safety Practices:
http://www.ahrq.gov/research/findings/evidence-basedreports/ptsafetyuptp.html
• TeamSTEPPS®: http://teamstepps.ahrq.gov/
• Leadership WalkroundsTM:
http://www.hret.org/quality/projects/patient-safetyleadership-walkrounds.shtml
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Questions?
[email protected],
1-888-324-9749
[email protected],
1-888-324-9790
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