Just Culture Collaborative

1. Just Culture Collaborative Jill Hanson and Stephanie Sobczak Certified Just Culture™ Champions WHA

3. Today’s Call • Review the Just Culture Collaborative Plan • Culture of Safety Foundations • What is a “Just Culture” • Readiness Assessment • Resources • Next 30 days

4. Partnership for Patients In addition to the ten core topics, WHA must offer collaborative specific to Culture Change: Just Culture Comprehensive Unit Based Safety Program Leadership Engagement *Transforming Care at the Beside will be offered under the Aligning Forces for Quality grant which continues until at least May 2013.

5. Why Just Culture? From July 2011 WHA survey, 35 hospitals interested in Just Culture WHA Survey of QI Managers, July 2011

6. WHA’s Approach • Two Certified Just Culture™ Champions • Benchmarked other successful collaborative work • Connected with other Just Culture ™ hospitals in Wisconsin • Learn what hospitals are currently doing for incident reporting (incl. RWHC’s Safety Zone) • Work with Outcome Engenuity staff , Fiona Lawton and David Marx as advisors to the project.

7. Poll Question #1 Please describe your hospital’s familiarity with Just Culture: • Our hospital has adopted Just Culture • Our hospital is in process of adopting Just Culture • Only individuals in our hospital know about or have worked in a Just Culture hospital • We understand the general concept behind Just Culture • Not very familiar – have heard of Just Culture

8. What is Just Culture? Concept developed by David Marx (Outcome Engenuity), based on the work of James Reason and others. A systematic approach to understanding adverse events, consistently consoling or coaching employees and fairly applying discipline when indicated.

10. The Key to Becoming a Just Culture Only part of it is the use of the Just Culture Algorithm

11. Poll Question #1 Answers Please describe your hospital’s familiarity with Just Culture: • Our hospital has adopted Just Culture • Our hospital is in process of adopting Just Culture • Only individuals in our hospital know about or have worked in a Just Culture hospital • We understand the general concept behind Just Culture • Not very familiar – have heard of Just Culture

12. The Key to Becoming a Just Culture

13. What’s the Problem? • “The single greatest impediment to • error prevention in health care is • that we punish people for • making mistakes.” • Dr. Lucian Leape • Professor, Harvard School of Public Health • Testimony before Congress on Health Care Quality Improvement

17. Dangerous Shortcuts 84 percent of respondents say that 10 percent or more of their colleagues take dangerous shortcuts and 26 percent say these shortcuts have actually harmed patients. Source: The Silent Treatment study

18. Incompetence 82 percent of respondents say that 10 percent or more of their colleagues are missing basic skills and as a result, 19 percent say they have seen harm come to patients. Source: The Silent Treatment study

19. Disrespect 85 percent of respondents say that 10 percent or more of the people they work with are disrespectful and this undermines the ability or willingness to share concerns and speak up about problems. Source: The Silent Treatment study

20. Makes You Wonder….. What is happening in our hospital?

21. Measuring the Culture of Safety • AHRQ has made available the Hospital Survey on Patient Safety Culture (HSOPS) since 2004. • Comparative Data is available for 2007 – 2010. • The 2010 database has 885 hospitals and 338,607 staff responses. • On average, hospitals submitted 383 completed surveys for a response rate of 56%. • Wisconsin has 50 hospitals that have submitted data for at least two years in succession.

22. Poll Question #2 Does your hospital apply the AHRQ Hospital Survey of Patient Survey on a regular interval (every two years or less)? • Yes • No • Have, but need to do it more frequently

23. Very Different from “Satisfaction” (But much more difficult to “fix”)

25. AHRQ Item Level Data

26. AHRQ Item Level Data

27. AHRQ Item Level Data

28. AHRQ Item Level Data

29. Poll # 2 Answers Does your hospital apply the AHRQ Hospital Survey of Patient Survey on a regular interval (every two years or less)? • Yes • No • Have, but need to do it more frequently

30. Staff Safety Assessment Just two (2) very important questions for any clinical unit: Hospitals enrolled in WHA’s Partners for Patients initiatives have had teams using this assessment, or a variation of it. If this applies to your hospital, speak with your teams about what they learned. Disclaimer information here…

31. Adopting a Just Culture is: • Creating an open, fair and just culture • Creating a systematic, consistent, repeatable approach to incident review, coaching and discipline • Creating a learning culture • Designing safe systems • Managing behavioral choices

34. Adding Value to the Experience Please consider: • Having adopted Just Culture and are experienced – please be willing to share stories of success and challenges. • Planning to adopt Just Culture and are just beginning – please ask questions. • Willing to share examples of wording in policies and procedures – before and after Just Culture adoption. • Consider sharing case examples for learning.

35. More Than An Algorithm! • Aligning policies; Learning how to set and achieve expectations; learning how to make value-supportive decisions • Designing safer systems • Managing behaviors (before needing to use the Algorithm) • Improving learning systems – both predictive and proactive (FMEA) AND reactive (RCA/Investigations) • Embed the justice framework in the organization

36. WHA’s Just Culture Collaborative Approach

37. Constructing Your Team This is the minimum representation recommended. Senior Leadership Middle Manager(s) Human Resources Medical Staff? Legal? Trustees? Front-Line Staff? Quality Improvement ?? Risk Management

38. Readiness Just Culture can’t be implemented from the bottom or the middle. Senior leadership must drive the change and be passionate about the reasons for change. Don’t create another “flavor of the month” – this is too important.

39. Tools to Assess Readiness • Part One: Organizational Assessment A tool to review hospital organizational practices, policies and procedures and how closely they align with Just Culture attributes. • Part Two: Individual Assessment A tool to assess leader’s and manager’s perception of organizational culture.

40. Organizational Culture Assessment A 13 item questionnaire exploring: • Organizational policies • Adverse event investigation • Human resource approaches Completed by the Patient Safety Officer

41. Individual Assessment • This 20 item questionnaire explores the following critical behavioral markers: • Coaching • Reporting • Responses to human error • Responses to reckless behavior • Severity bias • Transparency

42. Individual Assessment • Questionnaire is completed by 10 to 15 leaders within each organization • Organizational Leaders include the following: • Chief Nursing Officer • Medical Officers • Directors or managers of human resources, quality and risk management departments

43. Scoring the Assessments Organizational Readiness Assessment – Scoring Guide • Weighted questions with a maximum of 22 total points Individual Assessment of Organizational Culture • Questions based on five point Likert scale with a maximum of 40 total points per survey taken

44. Where to Find on the WHA Quality Center • Just Culture Page via: • Webinars Getting Started Webinar • References & Toolkits • Just Culture Organizational Readiness Assessment • Just Culture Organizational Readiness Assessment-Scoring Guide • Individual Assessment of Organizational Culture* • *Available on the WHA Quality Center for download or WHA can work with you to develop an on-line individual assessment questionnaire

45. Poll #3 Question Based on today’s information, how likely is your hospital to continue participating in this collaborative? • Very Likely • Not sure yet • Not Likely  Answers will be shared next month

46. The Next 30 Days • Tools available on WHA Quality Center: • Just Culture Resources • Recorded Webinars • Discussion Area

47. Thank You! Any Questions? Jill Hanson and Stephanie Sobczak Certified Just Culture™ Champions WHA