Culture of Safety Surveys Taking the Pulse of Your Organization

1. Culture of Safety SurveysTaking the Pulse of Your Organization Tatum O’Sullivan, RN, MHSA, CPHRM Ambulatory Risk & Patient Safety Manager North Shore Physicians Group tkosullivan@partners.org

2. Objectives • Purpose of the Survey • Options • Frequency of Surveys • Benefits of Survey • Pitfalls & Challenges • Helpful Hints

3. Purpose of the Survey • Raise staff awareness about patient safety • Diagnose and assess the current status of patient safety culture (patient safety issues, medical errors, and event reporting) • Identify strengths and areas for patient safety culture improvement • Examine trends in patient safety culture change over time • Evaluate the cultural impact of patient safety initiatives and interventions • Conduct internal and external comparisons

4. Positive Patient Safety Culture (PSC) • Guides discretionary behavior of healthcare professionals towards viewing patient safety as a highest priority • Defined as individual/group values, attitudes, perceptions, competencies, & patterns of behavior, which determine the commitment to and the style and proficiency of an organization’s health & safety management • Fujita, et.al, (2013). The characteristics of patient safety culture in Japan, Taiwan, and the United States. BMC Health Services Research, 13:20.

5. The Business Case • Joint Commission Requirements • The Joint Commission requires that hospitals measure the culture of safety within the organization using valid and reliable tools (LD.03.01.01, EP 1) • Leap Frog Survey • A general employee satisfaction survey that has a small component of the survey addressing organizational culture does not qualify. A Culture survey must be undertaken at minimum biannually with priority to high-risk areas and other targeted units where the majority of care is provided. • In the Ambulatory Setting it is critical for PCMH and team-based care and is required as part of Primed Status

6. Options for Surveys • The AHRQ Offers 4 Surveys • Hospital Survey on Patient Safety Culture • Medical Office Survey on Patient Safety Culture • Nursing Home Survey on Patient Safety Culture • Pharmacy Survey on Patient Safety Culture—New! • Bryan Sexton • Safety Attitudes Questionnaire – Short Form • Safety Attitudes Questionnaire – Teamwork and Safety Climate • Safety Attitudes Questionnaire – Ambulatory Version • Safety Attitudes Questionnaire – ICU Version • Safety Attitudes Questionnaire – Labor and Delivery Version • Safety Attitudes Questionnaire – Operating Room Version • Safety Attitudes Questionnaire – Pharmacy Version • Safety Climate Survey • Hybrid Versions • https://med.uth.edu/chqs/surveys/safety-attitudes-and-safety-climate-questionnaire/ • http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/index.html

8. AHRQ Safety & Culture Survey - 8 -

9. AHRQ 12 Domains

11. Safety Attitudes Questionnaire • 2 Major Domains • Safety Climate • Teamwork Climate • The original extended version consists of 60 items • The short form version includes only 30 core items, four of which are responded to separately for the hospital and unit level, yielding a total of 34 items • Measures Provider Attitudes about: • Job Satisfaction (5 items) • Perceptions of Management (4 items) • Teamwork (6 items) • Safety Climate (7 items) • Working Conditions (4 items) • Stress Recognition (4 items)

12. What’s the best way to administer? • Paper Form • Requires more manpower and a trusted person for data entry • May not appear as “confidential” to employees • Some believe offers more participation • Electronic Format • Organizing emails/user name and passwords by unit may be cumbersome • Can be done at employee’s leisure • Ability to track response rates (not who completed) in real time

13. Timeline

14. Prenotification Letter Dear Team Member, As part of our commitment to patient safety and quality, Organization X has partnered with Pascal Metrics Inc. to measure patient safety culture and help us identify and prioritize opportunities to improve our culture of safety.  We will conduct the Agency for Healthcare Quality and Research (AHRQ) Medical Office Survey on Patient Safety Culture over the next several weeks.  The survey will help us understand beliefs and attitudes about safety within our organization. This survey is of great importance, because an organization's beliefs about safety in the workplace have been shown to prevent errors and injuries.  I strongly urge you to complete the short survey. Your input is important and honesty is critical.  The survey will be emailed to you from Pascal Metrics in the upcoming days through the beginning of August.  This survey takes approximately eight minutes to complete - and result in reducing patient harm.  Your responses to the questionnaire are completely anonymous and will be processed by Pascal Metrics, an independent, external research company.  We will not be provided individual-level results. Pascal will provide a report summarizing overall patterns of responses, which then can be used to assist our organization in strengthening further our patient safety program and processes. If you should have any questions please don't hesitate to contact our point person: XXXX XXX at 603-442-2244. Please take a few moments and share your perceptions and thank you for your help - our patient safety depends on it. Sincerely, President

15. Frequency of Surveys • At a minimum every 2 years • Items to Consider: • Assess operations and leadership changes

16. Benefits of Survey • Provides objective data to something “subjective” • Can be used as a tool to measure improvement over time • Conveys what the organization’s priorities are to employees • Allows RM the opportunity to interface with staff

17. Pitfalls & Challenges • Too Many Surveys – Survey Fatigue • Employee Satisfaction, Focus Groups, Etc. • Failure to Recognize the Value • Make results available ASAP • Newsletters, Meetings, Email • Develop Action Plans with Leaders/Staff • Compare Results to Previous Years • Selecting the Correct Time Frame • Generally a 4 week window • Avoid Peak Vacation Times • Summer & Holidays

18. Limitations • N/A for all staff • Some questions may not apply to all staff, particularly support staff • Small sample sizes make it difficult to interpret results • Goal is to achieve a minimum of 60% for validity • Challenging when sharing with staff D/T positively and negatively worded questions used • Comments are permitted but can make provide challenges when additional information is needed

19. Using a vendor • Robust survey analysis and reporting • Reports instantly available • Compare your results vs. benchmarks • Web-based survey and analysis • User-generated reports to dissect data how you want • Hospital Survey is available in Spanish • Easy to setup, take and administer • Monitor response rates in real-time • Quick turnaround for starting up • Export results or import previous results • Little to no IT/IS required by hospitals • Hospital defined units/departments • Simplicity - saves time, money and effort

20. Useful Links • AHRQ • http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/index.html • SAQ • https://med.uth.edu/chqs/surveys/safety-attitudes-and-safety-climate-questionnaire/ • Pascal Metrics • http://www.pascalmetrics.com/products_services/ • The Patient Safety Group https://www.patientsafetygroup.org/survey/home.cfm

21. https://nnepatientsafety.org/

22. Questions…Comments…Ideas