Patient Safety: applying a culture assessment tool in practice

1. Patient Safety: applying a culture assessment tool in practice Hilary Merrett Quality and Safety Consultancy Editor, Clinical Risk Assessing ands Transforming the Culture of an NHS Organisation Hilary Merrett Quality and Safety Consulting

2. Agenda Patient safety culture – what is it and why assess for it? The basic approach – beliefs questionnaires, gap analysis and action planning Examples of culture assessment tools Your organisation – a run through the process Hilary Merrett Quality and Safety Consulting

3. A culture of safety? NPSA – Seven Steps to Patient Safety • A culture where staff have a constant and active awareness of the potential for things to go wrong • A culture that is open and fair, and one that encourages people to speak up about mistakes Hilary Merrett Quality and Safety Consulting

4. What makes up a safety culture? To Err is Human Institute of Medicine, 2000 Commitment to safety articulated at highest level Safety perceived to be highest priority Financial investment in safe practice Incentives aligned to promote safe practice Open communication about safety practices encouraged Unsafe acts rare Commitment to organisational learning rather than blame Hilary Merrett Quality and Safety Consulting

5. Two sides of the safety coin “Whack–a–Mole: the price we pay for expecting perfection” David Marx Systems design Managing behaviours “our power is the in the systems we build around imperfect human beings and in our expectations of them within those systems.” Hilary Merrett Quality and Safety Consulting

6. High Reliability organisations Managing the Unexpected: Assuring High Performance in an Age of Complexity (Jossey-Bass, 2001), Karl Weick and Kathleen Sutcliffe Don't be tricked by your success Defer to your experts on the front line Let the unexpected circumstances provide your solution Embrace complexity Anticipate - but also anticipate your limits Hilary Merrett Quality and Safety Consulting

7. Why assess for a safety culture? Healthcare Risk Control ECR Institute 2009 “A starting point for achieving an improved safety culture is to conduct an assessment of the current culture of the healthcare organization to determine whether and how that culture affects the provision of safe patient care. The results of the assessment can identify opportunities to improve systems and prevent harm.” Hilary Merrett Quality and Safety Consulting

8. How does assessment work? • Building a maturity matrix: • Question areas or Dimensions of safety • Assessment levels applied to each question / dimension • Process: • Self assessment • Discussion and consensus forming • Gap analysis • Action planning Hilary Merrett Quality and Safety Consulting

9. Improvement – how it can help Hilary Merrett Quality and Safety Consulting

10. Assessment tools - examples Safety Climate Survey Patient Safety Maturity Matrix Manchester Patient Safety Framework Hilary Merrett Quality and Safety Consulting

11. Safety Climate Survey – ECRI 2009 Professor R Helmreich (extract) Hilary Merrett Quality and Safety Consulting

12. The governance of patient safety: Maturity Matrix Good Governance Institute and Datix Hilary Merrett Quality and Safety Consulting

13. Manchester Patient Safety Framework: Dimensions 1.Commitment to overall continuous improvement 2. Priority given to safety 3. System errors and individual responsibility 4. Recording incidents and best practice 5. Evaluating incidents and best practice 6. Learning and effecting change 7. Communication about safety issues 8. Personnel management and safety issues 9. Staff education and training 10. Team working Hilary Merrett Quality and Safety Consulting

14. MaPSaF: assessment levels of maturity’ E Generative D Proactive Risk management is an integral part of everything that we do C Bureaucratic We are always on the alert for risks that might emerge B Reactive We have systems in place to manage all our risks We do something every time we have an incident A Pathological Why waste our time on safety? Dianne Parker, University of Manchester 2009

15. Using MaPSaF Developed 2005 by Professor Dianne Parker and colleagues at Manchester University Originally developed for primary care Now versions for primary care, acute, ambulance and mental health services Works at team and organisational levels www.nrls.npsa.nhs.uk/resources/ Hilary Merrett Quality and Safety Consulting

16. Trying it out • Read first 3 dimensions of framework • Individually score your organisation from A – E on evaluation sheet. Note your reasons. • Discussion on table score by score – those from same organisation, try to reach a consensus • Feedback on: • Areas that promoted most debate / difference • Any obvious steps needed to improve across the board Hilary Merrett Quality and Safety Consulting

17. Key issues Do not need external facilitation but be aware of political and other sensitivities Knowledge of local risk management systems Think about patient and public involvement at each dimension Not to be used for performance management Hilary Merrett Quality and Safety Consulting

18. And finally ....... In the light of the Francis Inquiry report, does this equation work in your organisation? What we say = What we do ? Hilary Merrett Quality and Safety Consulting