Fostering a Culture of Quality & Safety at Providence Health Care

1. Fostering a Culture of Quality & Safety at Providence Health Care November 16, 2012 Meghan MacLeod Quality Improvement Specialist Dr Adrienne Melck General Surgeon & NSQIP Surgeon Champion

2. Overview • Quality, Safety & Care Experience at PHC • Quality Improvement in the Surgical Program • OR Culture Survey • Teamwork & Communication

3. PHC Quality & Safety Structure Board Quality & Performance Improvement Cte of the Board Senior Leadership TeamCouncil for Excellence Medical Advisory CteCouncil for Excellence Quality, Patient Safety & Clinical Risk Management Committee Infection Control Standards Committee Program/Service Quality & Safety Ctes (7) Other Ctes

4. Surgical Program Quality Improvement Structure Unit Leadership Teams MSJ Periop MSJ Surgical Ward SPH Surgical Wards SPH Periop Performance metrics Strategic priorities Surgical Quality Committee Working Groups Mortality ReviewUrinary Tract InfectionsColorectal Surgery (ERAS)Surgical Safety Checklist OR Culture Survey

5. OR Culture Survey • Sponsored by BC Surgical Quality Action Network (SQAN) • Pascal Metrics (over 500 hospitals across Canada / US) • 14 hospitals currently participating in BC • 7 domains • Teamwork climate, safety climate, job satisfaction, stress recognition, working conditions, perceptions of senior management, perceptions of local management • Each with 4-7 questions • Reports by facility, work area & discipline • Benchmark reports, summary reports, raw rates, bar graphs, scatter plots, heat maps ….

6. Survey Response Rates

7. PHC Overall Results Goal Zone 61 49 Danger Zone 44 42 42 Average Percent Positive 32 29 27 Perceptions of Local Mgmt Perceptions of Senior Mgmt Safety Climate Job Satisfaction Teamwork Climate Stress Recognition Working Conditions

8. Area Results within BC: Teamwork Climate Goal Zone Danger Zone Average Percent Positive

9. Area Results by Provider: Safety Climate Proportion of respondents reporting “high” or “very high” agreement

10. Communication & Collaboration Surgeons with each other: 82% 68% 79% 46% 34% Nurses with each other: 69% Anesthesiologists with each other: 100% 72% 79% % of OR caregivers reporting “high” or “very high” levels of communication & collaboration with other members of the OR team.

11. Qualitative Comments

12. Culture Survey Working Group • First Steps • Understand data • Questions! • (eg, Local vs. senior mgmt) • Share right away • Mass email with tidbits of data & plan going forward • Present high level data • PHC QPSCRM Cte • Surgical Business Cte • All Party Rounds • Dept meeting Membership • NSQIP Surgeon Champions • Anesthesia Lead • Program Director • Nursing Operations Leaders • OR Nursing Supervisor • Business Analyst • Quality Improvement Specialist

13. Sharing & Acting on Results • Engage in dialogue with each area/department & care provider (Surgeon, Nurse, Anesthesiologist, Porter, etc) • Clarify meaning of responses • (eg, Perceptions of Senior Management) • Uncover important issues • Determine Staff priorities for change

14. Emerging Themes • Performance feedback • Staff recognition • Communication with management • Closing the loop on incident reporting

15. Next Steps • Developing trust • This is not “just another survey” • We are taking responses/data to heart & committing to do what is doable • Addressing priority issues • Communication • Feedback • System transparency • Readminister survey • Link with Surgical Safety Checklist and other Working Groups

16. Thoughts onTeamwork & Communication, Quality, Safety & Care Experienceat PHC