Improving Your Practice Safety Culture

Aims

• Why is “safety culture” important?........what does this mean??

• How can we develop our safety culture/does it need developing?

• Using “Safequest”

What is Safety Culture?

“Individual and group values, attitudes, perceptions and patterns of behaviour that determine their commitment to safety management”

The way things are done around here

NHS Education for Scotland 2010

Safety Culture

Why is a strong Safety CultureImportant?

A strong safety culture essential to safe reliable care in any workplace

Positive Safety Culture

• Safety a Priority • Eliminate “shame and blame”• Accept staff will make errors • Build systems to make care safer• Foster a culture where people can speak up• Team training • Organizational learning from errors and near-misses

Francis Report and Culture

• Atmosphere of fear of adverse repercussions

• Lack of openness

• It did not listen sufficiently to its patients and staff or correct deficiencies highlighted

• Above all it failed to tackle an insidious negative culture involving tolerance of poor standards

Developing your Safety Culture

• Understanding its importance• Thinking about it • Measuring your culture• Discussing it and reflecting on results • Focussed action to Improve it

Levels of maturity with respect to a safety culture

A. Why waste our time on

safety?

B. We do something when we have an incident

C. We have systems in

place to manage all identified

risks

D. We are always on

the alert for risks that

might emerge

E. Risk management is an integral

part of everything that we do

Using the SafeQuest Safety Climate Survey work in practice?

Safety Climate Survey• On line• Practice centred• Measurement• Diagnosis• Catalyst for change

Areas of Focus:• Teamwork• Workload

• Communication• Leadership

• Safety systems and learning

Process

PlanDistributeComplete

ReviewDiscussChange

Process

PLAN Plan DO Distribute Complete STUDY Review Discuss

ACT Change

Process

PlanDistribute - ?involve “locality managers”

Complete

Negative Questions

• The Performance of the team is impaired by excessive workload*• When pressure builds up team members are expected to work faster even

if it means taking shortcuts*• Where negative questions* results have been reversed and a high score is

therefore desirable

• Watch out for these ones – can be confusing within report.

What to do with the report?

• Close survey when all have completed

• Download / Print off

• Distribute to all team

• Arrange meeting to discuss findings

Sample Report

• Have a look at the report• What does it show you?

• What questions does it raise?• What questions do you have?

Making the most of your Results

• Identify uptake – is this telling you something?• Identify positive/negative elements of culture • Look in detail at the questions/areas where you might improve • Compare to other practices• Compare between staff groups• Compare with previous results , if repeating • Summarize – Complete QOF summary sheet and Action plan

• Links via Refhelp to HIS site - help facilitate discussion!

Group Discussion

• What would be the benefits and challenges of completing and discussing the safety climate survey

Insights

• “Many of us in the practice staff hadn’t really made the link that us failing to communicate in was a threat to patient safety ….we had a lot of really

good stuff came out of it, a lot of very open discussion”

Increased frequency of staff meetings.At least one doctor to attend staff meeting.Increased communication over a variety of issues.Newsletter/minutes after each meeting.Quarterly meeting involving whole practice.

Positive Change

Quotes from Practice

“ it did sound good, being able to ask questions and get answers straight away from Drs/or receiving instructions etc instead of going through a third party”“beneficial....encouraged to speak out if you think something isn’t right"

Key points

The findings are for your practice teams (consider carefully though)

• “Employees”/NHSB staff etc.

Don’t get too focused on the numbers

Concentrate on how you might use the results to “drive improvements”• Key issue• Emphasis on change/improvement, if needed

Key Points

• It’s a tool, a “snapshot”• Discuss, Reflect and Change as a practice team• Takes time to change

• Important to repeat • Present in QOF

• Specifies 2 x cycles

QOF

• Annually• Practice teams

• Discuss • Action Plan

• Reflection Sheet

Reflection Sheet

• What positive aspects of your team’s safety culture were highlighted in the report and your discussions?

• What aspects of your safety culture do you as a team feel you could improve?

• What steps will you take to improve these aspects of your safety culture?

• What else might you change to improve your safety culture?• Would you like any support or guidance to make changes in your

practice? If so, what would be useful?

Relevant Links……..• http://www.healthcareimprovementscotland.org/our_work/patient_safet

y/spsp_primary_care_resources/safety_climate_survey.aspx• Interpretation guides/FAQs/link to safequest

• http://www.sehd.scot.nhs.uk/pca/PCA2013(M)02guide.pdf• QoF 2013/14 Guidance, section 6ii QI domain

• http://www.refhelp-borders.scot.nhs.uk/• See Primary care/GP contract/Patient safety