TEAMWORK AND COMMUNICATION IN SURGERY INITIATIVE

SAFETY ATTITUDES QUESTIONNAIRE AND HEALTH BENCH DEMO

November 18, 2011

Outline• Why Teamwork and Communication?

Dr. Craig Bosenberg Clinical Lead for Surgical Checklist and SSI, BC Patient Safety & Quality Council

•Logistics Marlies van Dijk Quality Leader, BC Patient Safety & Quality Council

• Safety Culture, SAQ, and Health Bench Demo Dr. Maleek Jamal

Vice President, Client Development, Pascal Metrics

Why Teamwork and Communication?

Step-by-Step Breakdown

Timeline for Culture Survey

Initial wave deadline:November 30, 2011

Cost?No. of Sites Bronze Silver

5 to 10 $3,900 $5,500

11 to 15 $3,750 $5,300

16 to 20 $3,600 $5,100

21 to 26 $3,200 $4,600

Readiness elements: •Leadership support and guidance (CEO and Board)•Champions from all three disciplines (surgery, anesthesia and nursing)•Resources to implement interventions

Readiness elements: •Leadership support and guidance (CEO and Board)•Champions from all three disciplines (surgery, anesthesia and nursing)•Resources to implement interventions

Dr. Maleek Jamal

Safety Culture, SAQ, and Health Bench Demo

Makary et al. 2006 American College of Surgeons

PASCAL METRICS AND THE SAFETY PASCAL METRICS AND THE SAFETY ATTITUDES QUESTIONNAIREATTITUDES QUESTIONNAIRE

DR. ALLAN FRANKEL

10

Pascal serves ~800 hospitals and healthcare systems, has over 13,000 clinical areas in its industry-leading patient safety

culture dataset

What is culture?

“The way we do things around here.”– Shared perceptions about what is good, right, important, valued,

rewarded, supported, and expected – Culture is shaped by:

• Policies, practices, and procedures• The values and personalities of people in the organization• Leadership

– We can talk about specific pieces of culture, for example:• Safety climate: To what extent is safety of patients a priority?• Teamwork climate: To what extent is collaboration valued and

supported?

12

Why does culture matter?

13

1. Nosochomial Infections

2. Readmissions

3. Medication errors

4. Wrong site surgeries / RFBs

5. Patient satisfaction

6. Nurse turnover & absenteeism

7. AHRQ Patient Safety Indicators

8. Nurse satisfaction

9. VAPs and BSIs

10.Malpractice claims

...and more.

Useful References for Culture-to-Outcomes Linkage:

• Jain et al. (2011) New Eng J Med• Hansen et al. et (2011) Health Ser

Res• Leonard & Frankel (2011) Book• Curry et al. (2010) Ann Int Med• Singer et al. (2009) Health Ser Res• Pettker et al. (2009) Am J Obs / Gyn• Vogus & Sutcliffe (2010) Acad

Manag Persp.• Frankel & Leonard (2006) Health Ser

Res• Hoffman et al. (2006) Personnel

Psych• Sexton et al. (2006) BMC

Safety Culture: Leading indicator of key clinical, operational, and financial outcomes

14

Culture can be measuredA survey instrument can most effectively distinguish between a “healthy”

culture and an “unhealthy” culture when:– A valid instrument is used– All members of a unit are invited to complete the survey

• Including people of different roles ensures that each role’s piece of the patient care stream is taken into account

– The survey response rate is high (at least 60%)• A high response rate usually indicates that data are

representative of everyone’s perceptions

15

A Framework for Excellence:Examine a Patient – Examine a Unit

Culture of Safety

Learning Organization

1. Leaders who facilitate and mentor teamwork, improvement, respect and psychological safety

2. Teams who know the game plan and agree upon specific behaviors

3. Accountability that supports psychological safety because employees believe that they’ll be treated fairly

4. A Continuous Learning Process that generates reliable care by applying best evidence and minimizing variation,

5. Uses Measurement transparently, continuously, owned by frontline providers, and

6. Applies Formal Improvement Methods to generate quality and mitigate and eliminate defects.

16

Nurses are the ‘Canaries in the Mine’ Nurse perceptions of care are leading indicators of harm

✓ Strong correlation of sentinel events with <50% RN perceptions of care

No BSI = 5 months or more with no

Blood Stream Infection

17

✓ Strongest predictor of clinical excellence: caregivers feel comfortable speaking up if they

perceive a problem with patient care

Michigan Keystone Initiative: Teamwork Climate Across ICUs Predicts Infection

Attribution: Doug Salvador, Maine Med Ctr

Maine Medical Center

Quarterly cumulative SSI rate for all surgical procedures included in surveillance plan per 100 surgical procedures

Attribution: Doug Salvador, Maine Med Ctr

Maine Medical Center

20

The usefulness of the survey is dependent on

- Knowing which data to display- Knowing how to display the data- Knowing how to make the data actionable

OR/SPD

SPDPACU/SACU

ResidentsPreSurgical Eval

SACU

PACU

OR ORPACUSPD

Hospital AHospital BHospital CResidents

Debriefing culture data locally

- CONFIDENTIAL-23 © 2011 Pascal Metrics

• Local debrief sessions target improvement at the clinical area level

• Sessions empower caregivers to “own the data”

• Use the DEBRIEFer tool available via Pascal HealthBench

• Tools >> DEBRIEFer

Change in s

urv

ey s

core

s

ICUs with DeBRIEFer

Reflected on SAQ scores and took action1. Increased SAQ scores in 5 of 6 domains2. Achieved 10.2% decrease in BSI

(infection) rates3. Achieved 15.2% decrease in VAP rates

ICUs without DeBRIEFer

Did not reflect on SAQ scores nor take action

1. Decreased SAQ scores in 5 of 6 domains

2. No significant decrease in BSI (infection) rates

3. Experienced 4.8% increase in VAP rates✓ Silver-level Debriefing drives outcomes and performance

improvement

* * *

* *

Value of Silver-level?

Questions?

IMPLEMENTING THE SURVEY IN BC: IMPLEMENTING THE SURVEY IN BC: LOGISTICSLOGISTICS

MARLIES VAN DIJK

Canadian Context – Patient Safety ToolsAccreditation CanadaModified Stanford tool

BC Culture Initiative: Safety Attitudes Questionnaire

Quota set for number of employees organizationally wide

Aiming for 80% of staff in Operating Rooms and Surgical units

Starting unit level reporting in November 2011

Unit level and can compare yourself to 1000 ORs in the US/Canada

Positively framed questionsExample: - At work, my opinions seem to count- In my area, it is easy to speak up if I feel there is a problem related to safety

Positive and negative framed questionsExample:- In this work setting, if I perceive a problem it is difficult to speak up- In this work setting it is difficult to discuss errors

No specific questions on how nurses and physicians as a team

2 specific questions- Nurse input is well received in this work setting- The physicians and nurses work as a well coordinated team

Up to local sites/HA’s to interpret and support action

• Support to interpret and plan action at a local level across the province for interested sites

• 2 day workshop in March 2012

Survey Process?1. Subscription Model – BCPSQC

2. Organizational Mapping, 2-3 weeks long• Subscription Manager (10-15% of time)

3. Survey Administration, 4-6 weeks long• Survey Lead (10-15% of time)

4. Data Scrub and Analytics, 4 weeks long

5. Leadership Briefing & Analytics and Action, *

6. Improvement and Debriefing, 9 months long

Cost?

No. of Sites Bronze Silver

5 to 10 $3,900 $5,500

11 to 15 $3,750 $5,300

16 to 20 $3,600 $5,100

21 to 26 $3,200 $4,600

Readiness elements: •Leadership support and guidance (CEO and Board)•Champions from all three disciplines (surgery, anesthesia and nursing)•Resources to implement interventions

Readiness elements: •Leadership support and guidance (CEO and Board)•Champions from all three disciplines (surgery, anesthesia and nursing)•Resources to implement interventions

Pascal Metrics OptionsBronze Levelo Survey Administrationo Safety Culture Analytics and Reporting

- Executive Summary and One Page Reports;- Basic Benchmarking; and- Downloadable Data Spreadsheets.

o 2 Leadership briefings

Pascal Metrics OptionsSilver Levelo Survey Administrationo Safety Culture Analytics and Reporting

- Interactive Analytics, Views and Tools including Heat Maps, Scatter Plots, Spike Charts, Drill Down Tables- DeBRIEFER Plus to develop, track, execute and communicate improvement plans;- Executive Summary and One Page Reports;- Basic Benchmarking; and- Downloadable Data Spreadsheets.

o 5 Leadership briefings

Timeline for Culture Survey

Initial wave deadline:November 30, 2011

Next Steps

• Expression of Interest• Surgical Quality Action Network (SQAN) will be

recruiting sites till November 30, 2011• Please email Marlies van Dijk at mvandijk@bcpsqc.ca

with any questions or to register for the survey.