Have Safety Culture Data, Will Travel? Sallie J. Weaver, PhD Assistant Professor Dept. of Anesthesiology & Critical Care Medicine, and Armstrong Institute

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 Armstrong Institute for Patient Safety and Quality 2

Sounding the Call for a Culture of Safety Health care organizations must develop a culture of safety such that an organizations 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 Armstrong Institute for Patient Safety and Quality 3

The Armstrong Institute Model to Improve Care 4 Comprehensive Unit based Safety Program (CUSP) 1.Educate staff on science of safety 2.Identify defects 3.Recruit executive to adopt unit 4.Learn from one defect per quarter 5.Implement teamwork tools Translating Evidence Into Practice (TRiP) 1.Summarize the evidence in a checklist 2.Identify local barriers to implementation 3.Measure performance 4.Ensure all patients get the evidence Engage Educate Execute Evaluate Reducing preventable patient harm Emerging Evidence Local Opportunities to Improve Collaborative learning Technical WorkAdaptive Work Pre-Work: Measure clinician and staff perceptions of safety culture (HSOPS Survey)

Culture Behavior on the Job Outcomes -Patient & Family Safety - Care Provider Safety Perceived priority of safety relative to other goals 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 ? What is Safety Culture? Armstrong Institute for Patient Safety and Quality 5

What Are Core Aspects of Safety Culture Armstrong Institute for Patient Safety and Quality 6 Culture of Safety Communication patterns & language Feedback, reward, and corrective action practices Formal and informal leader actions & expectations Teamwork processes (e.g., back-up behavior) Resource allocation practices Error-detection and correction systems

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 Why Safety Culture Matters Armstrong Institute for Patient Safety and Quality 7

CUSP & Safety Culture Safety Culture is typically measured Pre- CUSP: 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 Armstrong Institute for Patient Safety and Quality 8

I HAVE MY DATABUT NOW WHAT? Part II

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 5 Strongly Agree 1 Never 2 Rarely 3 Sometimes 4 Most of the time 5 Always Armstrong Institute for Patient Safety and Quality 10

HSOPS Questions & Composite Scores 11 10 Composite Scores (Dimensions) Number of Questions Example Question 1. Supervisor/manager expectations & actions promoting patient safety 4B1. My supervisor/manager seriously considers staff suggestions for improving patient safety. 2. Organizational learning-continuous improvement 3A9. Mistakes have led to positive changes here 3. Teamwork within unit4A1. People support one another in this unit. 4. Communication openness3C4.Staff feel free to question the decisions or actions of those with more authority. 5. Feedback & communication about error3C1.We are given feedback about changes put into place based on event reports. 6. Nonpunitive response to error3A8.Staff feel like their mistakes are held against them. (negatively worded) 7.Staffing4A2.We have enough staff to handle the workload. 8.Hospital management support for patient safety 3F8. The actions of hospital management show that patient safety is a top priority. 9.Teamwork across hospital units4F4.There is good cooperation among hospital units that need to work together. 10.Hospital handoffs & transitions4F5.Important patient care information is often lost during shift changes. (negatively worded)

HSOPS Questions & Composite Scores continued- Armstrong Institute for Patient Safety and Quality 12 4 Outcome variablesNumber of Questions Example Question 1. Overall perceptions of safety 4A15.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) 1E1.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 1G1.In the past 12 months, how many event reports have you filled out and submitted? Plus background questions about respondents

HSOPS Scoring Scoring guidelines created by AHRQ Scores represent the % of positive responses % who gave a score of 4 or 5 Armstrong Institute for Patient Safety and Quality 1 Strongly Disagree 2 Disagree 3 Neither Agree nor Disagree 4 Agree 5 Strongly Agree 1 Never 2 Rarely 3 Sometimes 4 Most of the time 5 Always 13

Armstrong Institute for Patient Safety and Quality 14 Your medical center Interpreting Composite Scores: The big picture view Higher is better

Armstrong Institute for Patient Safety and Quality 15 Questions provide a deeper dive: For positively worded items, more green is better 15

Armstrong Institute for Patient Safety and Quality 16 Your medical center Interpreting Composite Scores: The big picture view Higher is better

Armstrong Institute for Patient Safety and Quality 17 Questions provide a deeper dive: For negatively worded items, more RED is 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 18

Some points to cover in your debriefing plan Armstrong Institute for Patient Safety and Quality 19

Keep in mindCulture Change can seem Hard Because Culture has Three Layers (Schein, 2010; Scorzoni, 1982) Armstrong Institute for Patient Safety and Quality 20 1.Behaviors, norms, processes enacted on the job, feedback & reward systems 2.Espoused values, goals, philosophies, formal policies 3.Underlying assumptions

Keep in mindCulture Change can seem Hard Because Culture has Three Layers (Schein, 2010; Scorzoni, 1982) Armstrong Institute for Patient Safety and Quality 21 1.Behaviors, norms, processes enacted on the job 2.Espoused values, goals, philosophies, formal polices 3.Underlying assumptions Safety climate surveys focus diagnostic measurement here

Keep in mindCulture Change can seem Hard Because Culture has Three Layers (Schein, 2010; Scorzoni, 1982) Armstrong Institute for Patient Safety and Quality 22 1.Behaviors, norms, processes enacted on the job 2.Espoused values, goals, philosophies, formal policies 3.Underlying assumptions Deeper levels addressed by: Debriefing Involvement of unit members Leaders who model the values and align assumptions

Culture Change Can Seem Hard Because it Involves both Unlearning and Re-Learning 23 Unfreeze Learn & Rebalance Refreeze Lewin, 1951; Schein, 2009 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 uphot off the presses! Non-punitive response, communication openness, supervisor support Armstrong Institute for Patient Safety and Quality 24

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 25 Armstrong Institute for Patient Safety and Quality

Thank you! Sallie J. Weaver, PhD ACCM, and Armstrong Institute for Patient Safety and Quality [email protected]

Documents

Have Safety Culture Data, Will Travel? Sallie J. Weaver, PhD Assistant Professor Dept. of Anesthesiology & Critical Care Medicine, and Armstrong Institute