NH Patient Safety Culture Survey (AHRQ)

Beth Hercher, QI SpecialistBarbara Meadows, QI SpecialistPatient Safety Team

October 2009Patient Safety Restraint CollaborativeLearning Session 3

“The right carefor every person,every time.”

CMS Vision Statementfor the National Healthcare Quality Improvement Program

• Safe

• Timely

• Effective

• Efficient• Equitable

• Patient-centered The Institute of Medicine

The “Right Care”

• Final formatted survey• Survey User’s Guide providing instruction on

data collection and analysis• Microsoft Excel data entry and analysis tool

April 2009 Learning Session 2

• May-June 2009 surveys conducted • July 31, 2009 individual data analysis tools

submitted back to QSource• October 2009 presentation of aggregate data

analysis

Timeline

Safety Culture Definition

• The safety culture of an organization is the product of individual and group values, attitudes, perceptions, competencies, and patterns of behavior that determine the commitment to an organization’s health and safety management.

Nursing Home Survey onPatient Safety Culture (NH SOPS)

• Developed by Agency for HealthcareResearch and Quality (AHRQ)

• Designed specifically for nursing home staff• Asks for their opinions about the culture of

patient safety in nursing homes

What the Survey Is Used for:

• Assess patient safety culture• Develop interventions to raise staff awareness

for patient safety issues• Evaluate the impact of patient safety

improvement initiatives• Track changes in patient safety culture over

time

NH Patient SafetyCulture Dimensions

• 42 Items assess the following 12 dimensionsof patient safety culture:

1. Communication openness2. Compliance with procedures3. Feedback and communication about incidents4. Handoffs5. Management support for resident safety6. Nonpunitive response to mistakes

NH Patient SafetyCulture Dimensions, cont.

7. Organizational learning – continuous improvement8. Overall perceptions of resident safety9. Staffing10. Supervisor/Manager expectations and actions

promoting resident safety11. Teamwork12. Training and skills

• Westat has designed a data entry and analysis tool to display results from the new nursing home survey

– Input individual survey data– Create graphs and tables to display your survey

results overall and by various demographics– Analyze which patient safety culture dimensions

may need additional attention– Share the results with others in your organization. All

results are printable.

NH SOPSData Entry and Analysis Tool

Home Page

AHRQ Survey Designed to Measure

1) Two overall patient safety outcomesa. Nursing Home Recommendationb. Rating on Resident Safety

2) Twelve dimensions of culture related to patient safety

Recommendations to Friends Comparative Results

Composite Level Results

Comparative results are based on 40 pilot nursing homes

• Composite results measure the12 different domains of patient safety

• Calculated by averaging the percent positive responses of the items within the domain

• Positive response is the percent of responses that were rated a 4 or 5 (agree/strongly agree)

Definition of Composite Results

• Composite score tells you the average percentage of people who responded positively to the survey items

• Summarize overall how positively people answered the items in each safety culture dimension

Definition of Composite Results, cont.

• 36 IPG facilities conducted survey• Top three opportunities:

– Staffing– Nonpunitive response to mistakes– Communication openness

Baseline Survey

AHRQ Patient Safety Culture Survey: Composite-Level Comparative Results

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JCAHO Sentinel Events

•Administrative and clinical leadership commitment to quality and safety

•Data for learning, not judgment•Organization-wide, systematic

approachesto improvement

•Culture change/teamwork•Conduct informal “RCA” •ASK frontline staff and feed back data

regularly

What You Need to Succeed

Strategies and Tools to Enhance Performance

and Patient Safety

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Are better able to predict the needs of other team members

Provide quality information and feedback Engage in higher level decision-making Manage conflict skillfully Understand their roles and responsibilities Reduce stress on the team as a whole through better

performance

“Achieve a mutual goal through interdependent and adaptive actions”

Effective Team Members

TeamSTEPPS:

• Developed by the Agency for Healthcare Research and Quality and the Department of Defense

• Purpose: To enhance performance andpatient safety

Teamwork Exercise

• Divide up into your facility teams• Decide who will be your team leader

TeamSTEPPS Emphasis:

• Teamwork and communication• Communication and teamwork skills are

essential to providing quality care and preventing medical errors

TEAMSTEPPS 05.2Mod 3 05.2 Page 27

Essentials

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TOPIC

Who is on core team?

All members understandand agree upon goals?

Roles and responsibilitiesunderstood?

Plan of care?

Staff availability?

Workload?

Available resources?

Briefing Checklist

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HuddleProblem solving– Hold ad hoc, “touch-base”

meetings to regain situation awareness

– Discuss critical issues and emerging events

– Anticipate outcomes and likely contingencies

– Assign resources– Express concerns

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DebriefProcess Improvement• Brief, informal information exchange and

feedback sessions• Occur after an event or shift• Designed to improve teamwork skills• Designed to improve outcomes

– An accurate reconstruction of key events– Analysis of why the event occurred– What should be done differently next time

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TOPIC

Communication clear?

Roles and responsibilities understood?

Situation awarenessmaintained?

Workload distribution?

Did we ask for or offerassistance?

Were errors made or avoided?

What went well, what should change, what can improve?

Debrief Checklist

TEAMSTEPPS 05.2Mod 3 05.2 Page 32

Essentials

Scenario Part 1

Mrs. Smith, at 70 yrs old, fell while walking her dog. Following the surgery to repair the hip fracture, it is determined that she will require rehabilitation in the nursing home. The family lives out of state.

What TeamSTEPPS tool would be effective here?

TEAMSTEPPS 05.2Mod 3 05.2 Page 33

Essentials

5 days later…..

While assisting Mrs. Smith, Annie, the new C.N.A., notices a reddened area on the coccyx. She understands from her recent team training that this could be a problem if she doesn’t inform the team.

Using TeamSTEPPS tools, what is Annie’s next step?

TEAMSTEPPS 05.2Mod 3 05.2 Page 34

Essentials

What occurs next is crucial….

The team lead has had several shift problems and is running late. Though she hears Annie’s report, she states “We’ll just leave it for the next shift, get Mrs. Smith dressed and down to the activities room.”

What tool does Annie need?

TEAMSTEPPS 05.2Mod 3 05.2 Page 35

Essentials

When Communication is Crucial

• When the patient has had achange in condition

• When there has been a change in thePlan of Care

• When reporting off at shift change• Upon being assigned a new patient

Streamlining Communication

Effective communication is:• Complete• Clear• Brief• Timely

TEAMSTEPPS 05.2Mod 3 05.2 Page 38

Essentials

SBAR Prep

• Situation – the punch line in 5-10 seconds

• Background – the context, objective data, how did we get here

• Assessment – what is the problem ?

• Recommendation – what do we need to do ?

TEAMSTEPPS 05.2Mod 3 05.2 Page 39

Essentials

SBAR

Excercise

TEAMSTEPPS 05.2Mod 3 05.2 Page 41

Essentials

Next step…reporting out

The team lead recognized Annie’s concerns; they agree to go to the room together and check the reddened area.

The area is deep red, 6cm and the resident reports pain on assessment.

What TeamSTEPPS tool would help the team lead in her communication to the physician?

TEAMSTEPPS 05.2Mod 3 05.2 Page 42

Essentials

Next Steps

May-June 2010Re-administer paper survey toolResponse feedback entered into data analysis

tool

July 31, 2010Data analysis tool submitted to QSource

Thank You!

NH Patient Safety Culture Team Contacts:

Beth Hercher, ext. 2640 Barbara Meadows, ext. 7202

1.800.528.2655

This presentation and related materials were developed by QSource, the Medicare Quality Improvement Organization for Tennessee, under contract with the Centers for Medicare & Medicaid Services (CMS), a division of the Department of Health and Human Services. Contents do not necessarily reflect CMS policy. QSOURCE-TN-109.62-2008-16