Assessing patient safety using the Manchester Patient Safety Culture framework (MaPSaF) Facilitator: Prof. Dianne Parker University of Manchester and Safety Culture Associates Limited

NHS: Seven Steps to Patient Safety Step One: Build a safety culture A safety culture is….

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A culture where staff have a constant and active awareness of the potential for things to go wrong

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A culture that is open and fair, and one that encourages people to speak up about mistakes

Manchester Patient Safety Framework

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Originally developed for use in primary care by Manchester University

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Based on Ron Westrum’s (1993) theory of organisational safety – “organisational personality”

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Tailored from a tool developed for the oil industry and used by Shell Plc.

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Now piloted and developed for use in acute, mental health, ambulance settings

Characteristics of the pathological organisation Pathological

•Information is hidden •Messengers are “shot” •Responsibilities are shirked •Bridging is discouraged •Failure is covered up •New ideas are actively crushed

Characteristics of the bureaucratic organisation Bureaucratic

•Information may be ignored •Messengers are tolerated •Responsibility is compartmentalised •Bridging is allowed but neglected •Organisation is just and merciful •New ideas create problems

Characteristics of the generative organisation Generative

• Information is actively sought • Messengers are trained • Responsibilities are shared • Bridging is rewarded • Failure causes inquiry • New ideas are welcomed

Expanding the framework

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Reason (1997) revised and added two further levels

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Pathological

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Reactive Calculative or bureaucratic Proactive Generative Additions approved by Westrum (1999)

Levels of maturity with respect to a safety culture A. Why waste our time on safety?

PATHOLOGICAL B. We do something when we have an incident REACTIVE C. We have systems in place to manage all identified risks BUREAUCRATIC D. We are always on the alert for risks that might emerge E. Risk management is an integral part of everything that we do PROACTIVE GENERATIVE

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Dimensions of safety covered Overall commitment to quality Priority given to patient safety Perceptions of the causes of patient safety incidents and their identification Investigating patient safety incidents Organisational learning following patient safety incidents Communication about safety issues Personnel management and safety issues Staff education and training about safety Team working around safety issues

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What can MaPSaF be used for?

To facilitate self-reflection on safety culture maturity of a given healthcare organisation and/or team

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To help a team recognise that patient safety is a complex multidimensional concept

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To stimulate discussion about the strengths, weaknesses and differences of the patient safety culture in a team, between staff groups or in an organisation

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To help understand how an organisation and/or team with a more mature safety culture might look.

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To help evaluate any specific intervention to change the safety culture of your organisation and/or team

What MaPSaF is not:

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A performance management tool for comparing or benchmarking organisations

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A way of apportioning blame if an organisation’s culture is perceived to be not sufficiently mature

Who can MaPSaF be used by ?

Clinical Governance & Risk Committees Professional Groups Directorates & Specialties Boards Multi-disciplinary Teams Wards & Departments

Interactive Session

What is YOUR patient safety culture?

Read through the framework - do this on your own

2. Work in pairs

Discuss your perceptions with the person sitting next to you.

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Explain why you made the choices you did

Short break

We will collate the results from the whole group

3. Whole Group Discussion

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Where did you place yourselves?

Why?

What information did you use to make this decision?

What other information do you need?

Results for Dimensions 1-4

Results for Dimensions 5-9

4. Action Planning

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What are our strengths and weaknesses?

Table discussions of 3-4 key issues Report back to plenary

– Where are we now – Where do we want to get to?

– How do we get there?

– Who needs to be involved to make it happen?

– What next?

Thank you Any Questions?