Transcript No Slide Title

Hospital Survey on
Patient Safety Culture
MATER DEI HOSPITAL
2008
PLEASE DO NOT CITE – UNPUBLISHED MATERIAL
For further information about this feedback report, contact:
Name DR RICHARD ZAMMIT
Title DIRECTOR HEALTH CARE SERVICES STANDARDS
Address PALAZZO CASTELLANIA MERCHANTS STREET VALLETTA, MALTA
Phone 00356 22992655
Email [email protected]
Survey Background
The Hospital Survey on Patient Safety Culture is sponsored in the USA by the
Quality Interagency Coordination Task Force (QuIC), a group established in
accordance with a 1998 Presidential directive to ensure that all Federal agencies
involved in purchasing, providing, studying, or regulating health care services
are working together and toward a common goal of improving quality care. This
research is funded in the USA by the Agency for Healthcare Research and
Quality (AHRQ).
The development of this safety culture assessment tool included a review of
the scientific literature pertaining to safety, error and accidents, as well as error
reporting. In addition, hospital employees and managers were interviewed to
identify key patient safety and error reporting issues. Other published and
unpublished safety culture assessment tools also were examined.
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Survey Measures
The Hospital Survey on Patient Safety Culture is designed to measure:
Four overall patient safety outcomes:
1.
Overall perceptions of safety
2.
Frequency of events reported
3.
Number of events reported
4.
Overall patient safety grade
The research survey also is intended to measure:
Ten dimensions of culture pertaining to patient safety:
1.
Supervisor/manager expectations &
6. Nonpunitive response to error
actions promoting patient safety
7. Staffing
2.
Organizational learning – continuous
8. Hospital management support
improvement
for patient safety
3.
Teamwork within units
9. Teamwork across hospital units
4.
Communication openness
10. Hospital handoffs & transitions
5.
Feedback & communications
about error
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Survey Methodology
In MAY – JUNE 2008, the Hospital Survey on Patient Safety
Culture interview was conducted to a sample of 400 staff at
MATER DEI HOSPITAL. Overall, 369 responses to the survey
were recorded, a 92% response rate.
The face to face interview method was chosen to maximize
response rates.
In this feedback report, the percentages of employee responses
to specific survey items are grouped according to the safety culture
dimensions being assessed. Some percentages shown in the
graphs may not add to exactly 100 percent, due to rounding.
Due thanks to Dr Christine Baluci who carried out these interviews
during her Public Health training programme with the Department for
Health Care Services Standards and Ms Carmen Azzopardi for data
inputting.
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Demographic Data about Respondents
1. Primary
hospital work area, department or clinical area where
respondents spend most of their work time:
10.6 % No specific unit
13.8 % Medicine (non-surgical)
22.8 % Surgery
7.0 % Obstetrics
11.4 % Pediatrics
4.9 % Emergency department
6.5 % Intensive care unit
0.8 % Mental health
2.2 % Rehabilitation
2.7 % Pharmacy
3.0 % Laboratory
5.4 %Radiology
5.1 % Anesthesiology
3.8 % Other
NIL % (Blank/Missing)
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Demographic Data about Respondents
1.cont: Position in hospital of staff interviewed:
47% nurses
12% other
10% technicians
4% administration
7% patient care asst/hospital aide
13% attending staff physician
5% therapist
2% pharmacists
Demographic Data (continued)
3. Time worked
--in the hospital
(hours/week)
--in the hospital
(years)
--in their current
hospital work area
(years)
--in their current
specialty (years)
1% Less than 20 hours
9% 20 to 39 hours
90% 40 hours or more
5% Less than 1 year
23% 1 to 5 years
21% 6 to 10 years
19% 11 to 15 years
15% 16 to 20 years
17% 21 years or more
20% Less than 1 year
25% 1 to 5 years
24% 6 to 10 years
15% 11 to 15 years
10% 16 to 20 years
6% 21 years or more
7% Less than 1 year
25% 1 to 5 years
23% 6 to 10 years
18% 11 to 15 years
15% 16 to 20 years
12% 21 years or more
4. Percentage of respondents with direct interaction or contact with patients:
91%
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Main Findings: Strengths
Teamwork within units – The extent to which staff support one
another, treat each other with respect, and work together as a team was a
patient safety composite with the highest average percent positive
response (75%), indicating this is an area of strength. The survey item
with the highest average percent positive response (83%) was: ‘People
support one another in this unit’.
Patient safety grade – The majority of respondents within Mater Dei
Hospital (68 percent) gave their work area or unit a grade either ‘A –
Excellent’ (16 percent) or “B – Very Good” (52 percent) on patient safety.
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Main Findings: Areas for Improvement
Non punitive response to errors – The extent to which staff feel that
their mistakes and event reports are not held against them and that
mistakes are not kept in their personnel file was the patient safety
composite with the lowest average percent positive response (39
percent), indicating this is an area with a potential for improvement. The
survey item with the lowest average percent response (34 percent) was:
‘Staff worry that mistakes they make are kept in their personnel file’.
Number of events reported – On average, the majority of
respondents (70 percent) reported no events over the past 12 months. It
is likely that this percentage represents under reporting of events and is
identified as an area for improvement because patient safety problems
may not be recognised or identified and therefore may not be addressed.
.
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Overall Perceptions of Safety
Survey Items
1. Patient safety is never sacrificed to get more
work done. (A15)
2. Our procedures and systems are good at
preventing errors from happening. (A18)
R3.
It is just by chance that more serious
mistakes don’t happen around here. (A10)
% Strongly Disagree/
Disagree
18
12
% Neither
17
41
R4.
R
65
22
40
% Strongly Agree/
Agree
66
20
14
40
45
We have patient safety problems in this
unit. (A17)
Indicates reversed-worded items.
NOTE: The item letter and number in parentheses indicate the item’s survey location.
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Frequency of Events Reported
Survey Items
% Never/
Rarely
1. When a mistake is made, but is caught and
corrected before affecting the patient, how
often is this reported? (D1)
2. When a mistake is made, but has no potential
to harm the patient, how often is this reported?
(D2)
% Sometimes
58
19
64
24
% Most of the
time/Always
27
23
22
14
49
3. When a mistake is made that could harm the
patient, but does not, how often is this
reported? (D3)
NOTE: The item letter and number in parentheses indicate the item’s survey location.
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Number of Events Reported
Respondents were asked to indicate the number of events they had reported in the past 12
months.
1. In the past 12 months, how many event reports have you filled out and submitted?
(Survey item G1)
100%
80%
70
60%
% of Respondents
40%
20
20%
Zero or
No response
7
1 to 2
3 to 5
1
1
1
6 to 10
11 to 20
21 or
more
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Overall Patient Safety Grade
Respondents were asked to give their work unit an overall grade on patient safety.
2. Please give your work area/unit in this hospital an overall grade on patient safety.
(Survey item E1)
100%
80%
60%
52
40%
20%
30
% of Respondents
16
1
A
Excellent
B
Very Good
C
Acceptable
D
Poor
1
E
Failing
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Supervisor/Manager Expectations &
Actions Promoting Patient Safety
Survey Items
% Strongly Disagree/
Disagree
% Neither
% Strongly Agree/
Agree
1. My supervisor/manager says a good word
when he/she sees a job done according
to established patient safety procedures. (B1)
10
17
73
2. My supervisor/manager seriously
considers staff suggestions for improving
patient safety. (B2)
8
19
73
R3.
R4.
Whenever pressure builds up, my
supervisor/manager wants us to work
faster, even if it means taking shortcuts. (B3)
My supervisor/manager overlooks patient
safety problems that happen over and over.
(B4)
65
18
77
17
10
R
Indicates reversed-worded items.
NOTE: The item letter and number in parentheses indicate the item’s survey location.
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13
Organizational Learning—Continuous Improvement
Survey Items
% Strongly Disagree/
Disagree
1. We are actively doing things to improve
patient safety. (A6)
12
2. Mistakes have led to positive changes
here. (A9)
12
3. After we make changes to improve
patient safety, we evaluate their
effectiveness. (A13)
% Neither
15
73
21
35
% Strongly Agree/
Agree
67
19
46
NOTE: The item letter and number in parentheses indicate the item’s survey location.
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Teamwork Within Units
Survey Items
% Strongly Disagree/
Disagree
1. People support one another in this unit.
(A1)
8 9
2. When a lot of work needs to be done
quickly, we work together as a team to
get the work done. (A3)
9
3. In this unit, people treat each other with
respect. (A4)
4. When one area in this unit gets really
busy, others help out. (A11)
5
% Neither
% Strongly Agree/
Agree
83
16
75
17
24
78
15
61
NOTE: The item letter and number in parentheses indicate the item’s survey location.
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Communication Openness
Survey Items
1.
Staff will freely speak up if they see
something that may negatively affect
patient care. (C2)
2.
Staff feel free to question the decisions
or actions of those with more authority. (C4)
R3.
Staff are afraid to ask questions when
something does not seem right. (C6)
% Never/
Rarely
6
% Sometimes
22
17
% Most of the
time/Always
72
31
72
52
23
R
Indicates reversed-worded items.
NOTE: The item letter and number in parentheses indicate the item’s survey location.
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5
Feedback and Communication About Error
Survey Items
% Never/
Rarely
1.
We are given feedback about changes put
into place based on event reports. (C1)
2.
We are informed about errors that happen
in this unit. (C3)
18
3.
In this unit, we discuss ways to prevent
errors from happening again. (C5)
17
% Sometimes
33
% Most of the
time/Always
34
31
28
33
51
55
NOTE: The item letter and number in parentheses indicate the item’s survey location.
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Nonpunitive Response to Error
Survey Items
R1.
R3.
% Neither
% Strongly Agree/
Agree
Staff feel like their mistakes are held
against them. (A8)
R2.
% Strongly Disagree/
Disagree
When an event is reported, it feels like
the person is being written up, not the
problem. (A12)
Staff worry that mistakes they make are
kept in their personnel file. (A16)
31
17
35
52
16
52
49
14
34
R
Indicates reversed-worded items.
NOTE: The item letter and number in parentheses indicate the item’s survey location.
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Staffing
Survey Items
1.
We have enough staff to handle the
workload. (A2)
R2.
Staff in this unit work longer hours than
is best for patient care. (A5)
R3.
We use more agency/temporary staff
than is best for patient care. (A7)
R4.
We work in “crisis mode” trying to do
too much, too quickly. (A14)
% Strongly Disagree/
Disagree
% Neither
% Strongly Agree/
Agree
70
33
12
19
48
70
19
16
18
14
16
65
R
Indicates reversed-worded items.
NOTE: The item letter and number in parentheses indicate the item’s survey location.
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Hospital Management Support for Patient Safety
Survey Items
% Strongly Disagree/
Disagree
% Neither
1. Hospital management provides a work
climate that promotes patient safety. (F1)
40
17
2. The actions of hospital management
show that patient safety is a top priority.
(F8)
37
23
R3.
Hospital management seems interested
in patient safety only after an adverse
event happens. (F9)
27
12
% Strongly Agree/
Agree
43
40
61
R
Indicates reversed-worded items.
NOTE: The item letter and number in parentheses indicate the item’s survey location.
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Teamwork Across Hospital Units
Survey Items
% Strongly Disagree/
Disagree
1. There is good cooperation among hospital
units that need to work together. (F4)
2. Hospital units work well together to
provide the best care for patients. (F10)
R3.
Hospital units do not coordinate well with
each other. (F2)
R4.
It is often unpleasant to work with staff
from other hospital units. (F6)
21
31
15
26
% Neither
% Strongly Agree/
Agree
48
60
25
19
62
55
23
15
R
Indicates reversed-worded items.
NOTE: The item letter and number in parentheses indicate the item’s survey location.
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Hospital Handoffs & Transitions
Survey Items
R1.
Things “fall between the cracks” when
transferring patients from one unit to
another. (F3)
R2.
Important patient care information is
often lost during shift changes. (F5)
R3.
Problems often occur in the exchange
of information across hospital units. (F7)
R4.
Shift changes are problematic for
patients in this hospital. (F11)
% Strongly Disagree/
Disagree
33
% Neither
% Strongly Agree/
Agree
17
59
29
50
14
18
53
27
53
20
27
R
Indicates reversed-worded items.
NOTE: The item letter and number in parentheses indicate the item’s survey location.
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Respondents comments
‘ I thought I would feel better at Mater Dei Hospital but it is the
opposite. The public is expecting more good service from Mater
Dei Hospital when the same problems that were at St Lukes
Hospital have migrated with us. The main problem is
overcrowding.’
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Comparative Results
Patient Safety Culture Composites
Average % of Database
Hospitals
MDH
MDH
percentile
1.
Teamwork Within Units
79%
75%
25th – 50th
2.
Supervisor/Manager Expectations & Actions Promoting Patient Safety
75%
72%
25th – 50th
3.
Management Support for Patient Safety
70%
37%
< 10th
4.
Organisational Learning – Continuous Improvement
70%
62%
10th – 25th
5.
Overall Perception of Patient Safety
64%
53%
10th – 25th
6
Feedback & Communication About Error
62%
46%
< 10th
7
Communication Openness
62%
65%
50th – 75th
8.
Frequency of Events Reported
60%
29%
< 10th
9.
Teamwork Across Units
57%
49%
25th – 50th
10.
Staffing
55%
35%
< 10th
11.
Handovers & Transitions
45%
44%
50th – 75th
12.
Non Punitive Response to Error
44%
39%
25th – 50th
Institutionalised reporting system
REPORTING and
LEARNING
SYSTEM
Handovers
&
Transitions
Communication
Openness
The way forward

EU roadmap:
High Level Group on Patient Safety recommendations –
a.
b.
Establish effective reporting and learning systems…..
Establish a transparent, open and honest patient safety
culture by clarifying the legal situation on health
professionals’ liability issues and creating an
environment where it is easy to report and there is an
opportunity to learn from mistakes without fear of
punishment.
Leadership in management
‘Leaders as teachers help people restructure
their views of reality to see beyond the
superficial conditions and events into the
underlying causes of problems and therefore
to see new possibilities for shaping the
future.’
Building learning organisations
Peter Senge
Center of excellence
The really critical innovation occurs at the interface
with the customers !
The staff are our main assets at ‘the state of the art’
Mater Dei Hospital.
Managerial responsibility to provide the appropriate
framework to turn knowledge from mistakes’
reporting into value.