On the CUSP: STOP BSI The Hospital Survey of Patient Safety ( HSOPS)

WHY Culture?

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Sentinel Event Alert

Issue 40, July 9, 2008 Behaviors that undermine a culture of safety

Intimidating and disruptive behaviors can foster medical errors,( 1 , 2 , 3 ) contribute to poor patient satisfaction and to preventable adverse outcomes,( 1 , 4 , 5 ) increase the cost of care,( 4 , 5 ) and cause qualified clinicians, administrators and managers to seek new positions in more professional environments. ( 1 , 6 ) Safety and quality of patient care is dependent on teamwork, communication, and a collaborative work environment. To assure quality and to promote a culture of safety, health care organizations must address the problem of behaviors that threaten the performance of the health care team.

…

3

Communication Breakdowns are frequently the root cause of… undesirable outcomes

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“Culture” provides context for team success

Engage Educate Execute Evaluate Senior leaders Team leaders Staff

How does this make the world a better place?

What do we need to do?

What keeps me from doing it?

How can we do it with my resources and culture?

How do we know we improved safety?

Pronovost: Health Services Research 2006 Slide 5

Culture Assessment

• • • • Typically “Pre-CUSP” ~ before interventions begin or as soon as possible near the project launch Use validated instrument – HSOPS – SAQ – ? Other CUSP is the intervention we use to help you improve culture results Will provide blinded comparative data for ICUS that administer HSOPS as part of the On the CUSP: Stop BSI project Slide 6

Culture Assessment and On the CUSP: Stop BSI

• • • • DISTINCT process ~ planned for early MAY – Conference Call for State Project Leaders – Conference Call for Hospital Survey Leaders Will use AHRQ HSOPS tool (free) – WESTAT researchers will analyze data and create reports – Participating sites will have full access to AHRQ/HSOPS resources QSRG will facilitate data collection – SURVEY MONKEY QSRG will facilitate use of tools to improve culture Slide 7

“

Hopkins Direct” QSRG rather than MHA

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HSOPS Process

• • REGISTRATION Hospital Identifiers (AHA ID; Medicare Provider #) Hospital Contact Information • • • Survey selection process – – ICU vs whole hospital Web based (HIGHLY recommended) vs Paper ** ICU staffing information ADMINISTRATION • Time parameters REPORT GENERATION Goal: 6-8 weeks after administration is complete Slide 9

HSOPS: A Closer Look

From: Results from the AHRQ Hospital Survey on Patient Safety Culture

Joann Sorra, Ph.D. Westat AHRQ Annual Conference 2008: Promoting Quality…Partnering for Change September 2008 Bethesda, MD Slide 10

Background

 Hospital Survey on Patient Safety Culture (HSOPS)  Developed by Westat, funded by AHRQ  Survey development process:  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  www.ahrq.gov/qual/hospculture Slide 11

HSOPS Patient Safety Culture Dimensions

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 Slide 12

HSOPS Patient Safety Culture Dimensions

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 Slide 13

HSOPS Comparative Database

 AHRQ has funded an HSOPS comparative database  – Annual reports (2007 & 2008) http://www.ahrq.gov/qual/hospsurvey08/  Purposes:  Comparison—of survey results in efforts to establish, improve and maintain a culture of patient safety  Assessment and Learning—in patient safety improvement process (rather than basis for determining punitive actions or external judgment of hospital performance)  Supplemental Information—to help hospitals identify strengths and areas with potential for patient safety culture improvement Slide 14

2008 HSOPS Comparative Database

 519 U.S. hospitals, 160,176 respondents  Average # respondents per hospital = 309 staff  Survey administration    Paper 48% Web Both 27% 25%  Average hospital response rate = 54%    Paper 60% Web Both 44% 52% Slide 15

Hospital Strengths & Areas for Improvement

1. Teamwork Within Units 2. Supervisor/Mgr Support for Patient Safety 3. Management Support for Patient Safety 4. Org Learning--Continuous Improvement 9. Teamwork Across Units 10. Staffing 11. Handoffs & Transitions 12. Nonpunitive Response to Error

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57% 55% 45% 44% 79% 75% 70% 70%

Patient Safety Grade

100% 80% 60% 48% 40% 24% 23% 20% 4% 0% A Excellent B Very Good C Acceptable D Poor

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1% E Failing

Number of Events Reported

100% 80% 60% 52% 40% 20% 0% 28% None 1 to 2 13% 3 to 5 5% 2% 6 to 10 11 to 20 1% 21 or more

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Results by Hospital Characteristics

 Smaller hospitals (49 beds or fewer) scored highest on all dimensions of safety culture  Smallest hospitals (6 – 24 beds) 21% more positive on

Handoffs & Transitions

than largest hospitals (400+ beds)  56% positive vs. 35%  No differences teaching vs. non-teaching  Government hospitals scored higher than non-govt on 

Handoffs & Transitions



Staffing



Teamwork Across Units

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AHRQ: Future Activities

 New Medical Office and Nursing Home surveys on patient safety culture  Same development steps as HSOPS  Pilot tested in 202 medical offices & 40 nursing homes  Toolkit materials similar to HSOPS: » Survey Administration User’s Guides » » » Preliminary Comparative Results from Pilot Tests Microsoft Excel Data Entry & Reporting Tools PowerPoint Survey Feedback Templates  Comparative databases in 2010   Voluntary data submission Free comparative report Slide 20

Long-term AHRQ Support for SOPS

 AHRQ will support all 3 surveys for next 4 years  Three, in-person SOPS User Group Meetings  Combined with CAHPS User Group Meeting  Free registration  December 4-5, 2008 in Scottsdale AZ 

April 2010 in Baltimore MD

 Free technical assistance & national conference calls  SOPS user network  Gathering information about interventions being implementing to address areas for improvement Slide 21

International HSOPS Users

•  International Hospital SOPS comparative database  Focus on countries participating in the World Health Organization’s (WHO) High 5s Patient Safety Initiative http://www.who.int/patientsafety/solutions/high5s/en/index.html

 Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the U.S.

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International HSOPS Users

 24 countries Australia - Bahrain - Belgium - Brazil - Canada - Denmark - El Salvador - France - Germany - Greece - Ireland - Italy - Malta - Netherlands - Norway - Saudi Arabia - Scotland - Serbia - Spain - Sweden - Switzerland - Taiwan - Turkey - United Kingdom Slide 23

To Learn More

• [email protected]

• [email protected]

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On the CUSP: Next Steps

1. Determine what culture tool your hospital/ICU is using – Determine whether your participating units will administer HSOPS as part of this project 2. Respond to email from your state coordinator who will collect participant information for HSOPS survey process 3. Designate a survey coordinator in each unit 4. Survey coordinators will participate in a training call in April 5. Survey administration targeted for MAY Slide 25