Have Safety C ulture Data, Will Travel?

1. Have Safety Culture Data, Will Travel? Sallie J. Weaver, PhD Assistant Professor Dept. of Anesthesiology & Critical Care Medicine, and Armstrong Institute for Patient Safety & Quality

2. Roadmap • What is patient safety culture? • Why does it matter? • I have data….but now what? • Some food for thought regarding acting on data Armstrong Institute for Patient Safety and Quality

3. Sounding the Call for a Culture of Safety • “Health care organizations must develop a culture of safety such that an organization’s care processes and workforce are focused on improving the reliability and safety of care for patients” • Joint Commission Leadership Standard: • Leaders create and maintain a culture of safety and quality throughout their organization • NQF Safe Practice #2 • Culture measurement, feedback, and intervention Armstrong Institute for Patient Safety and Quality

4. The Armstrong Institute Model to Improve Care Reducing preventable patient harm Translating Evidence Into Practice (TRiP) Comprehensive Unit based Safety Program (CUSP) Pre-Work:Measure clinician and staff perceptions of safety culture (HSOPS Survey) • Emerging Evidence • Local Opportunities to Improve • Collaborative learning • Summarize the evidence in a checklist • Identify local barriers to implementation • Measure performance • Ensure all patients get the evidence • Engage • Educate • Execute • Evaluate Educate staff on science of safety Identify defects Recruit executive to adopt unit Learn from one defect per quarter Implement teamwork tools Technical Work Adaptive Work

5. What is Safety Culture? • Perceived priority of safety relative to other goals • Culture is the compass team members use to guide their behaviors, attitudes, & perceptions on the job • What will I get praised for? • What will I get reprimanded for? • What is the “right” thing to do? Armstrong Institute for Patient Safety and Quality

6. What Are Core Aspects of Safety Culture… Armstrong Institute for Patient Safety and Quality

7. Why Safety Culture Matters • Safety culture is related to outcomes • Patient outcomes • Patient care experience • Infection rates, sepsis • Postop. hemorrhage, respiratory failure, accidental puncture/laceration • Treatment errors • Clinician outcomes • Incident reporting, burnout, turnover • Safety culture influences the effectiveness of other safety and quality interventions • Can enhance or inhibit effects of other interventions • Safety culture can change through intervention • Best evidence so far for culture interventions that use multiple components Armstrong Institute for Patient Safety and Quality

8. CUSP & Safety Culture • Safety Culture is typically measured “Pre-CUSP”: Before interventions begin • Provides a baseline to diagnose barriers and facilitators that can impact improvement efforts • Then can be measured 12-18 months following start of improvement efforts • Use reliable and valid survey instrument • Hospital Survey on Patient Safety (HSOPS) • CUSP is the intervention that you will use to help you improve culture results Armstrong Institute for Patient Safety and Quality

9. Part II I have my daTa…but now what?

10. Prepare your Elevator Speech:What is the Hospital Survey on Patient Safety (HSOPS)? • Suite of survey tools = SOPS • Hospital • Medical office • Nursing home • Background & Frame of Reference: • Sponsored by: Agency for Healthcare Research & Quality • US federal agency charged with conducting and supporting research to improve patient safety and care quality • Developed by Westat, public release in 2004 • Participants are asked to choose 1 to 5 for each question: 1Strongly Disagree 2Disagree 3 Neither Agree nor Disagree 4 Agree 5Strongly Agree 1Never 2 Rarely3 Sometimes 4 Most of the time 5 Always Armstrong Institute for Patient Safety and Quality

11. HSOPS Questions & Composite Scores

12. HSOPS Questions & Composite Scores –continued- • Plus background questions about respondents Armstrong Institute for Patient Safety and Quality

13. HSOPS Scoring • Scoring guidelines created by AHRQ • Scores represent the % of positive responses • % who gave a score of 4 or 5 • 1Strongly Disagree 2Disagree 3 Neither Agree nor Disagree 4 Agree 5Strongly Agree • 1Never 2 Rarely3 Sometimes 4 Most of the time 5 Always Armstrong Institute for Patient Safety and Quality

14. Your medical center Your medical center Your medical center Your medical center Your medical center Your medical center Your medical center Your medical center Your medical center • Interpreting Composite Scores: • The big picture view • Higher is better Armstrong Institute for Patient Safety and Quality

15. Questions provide a deeper dive: • For positively worded items, more green is better 15 Armstrong Institute for Patient Safety and Quality

16. Your medical center Your medical center Your medical center Your medical center Your medical center Your medical center Your medical center Your medical center Your medical center • Interpreting Composite Scores: • The big picture view • Higher is better Armstrong Institute for Patient Safety and Quality

17. Questions provide a deeper dive: • For negatively worded items, more RED is better Armstrong Institute for Patient Safety and Quality

18. Next Steps: Creating a Debriefing Plan • Debriefing is… • A semi-structured conversation among frontline clinicians and staff that is usually led by a designated facilitator • Purpose… • Encourage open communication, transparency, and interactive discussion about the survey results • Across all levels • To engage clinicians and staff in generating and implementing their ideas about how to create an effective safety culture in their work area Armstrong Institute for Patient Safety and Quality

19. Some points to cover in your debriefing plan Armstrong Institute for Patient Safety and Quality

20. Keep in mind…Culture Change can seem Hard Because Culture has Three Layers… (Schein, 2010; Scorzoni, 1982) Behaviors, norms, processes enacted on the job, feedback & reward systems Espoused values, goals, philosophies, formal policies Underlying assumptions Armstrong Institute for Patient Safety and Quality

21. Keep in mind…Culture Change can seem Hard Because Culture has Three Layers… (Schein, 2010; Scorzoni, 1982) Behaviors, norms, processes enacted on the job Safety climate surveys focus diagnostic measurement here Espoused values, goals, philosophies, formal polices Underlying assumptions Armstrong Institute for Patient Safety and Quality

22. Keep in mind…Culture Change can seem Hard Because Culture has Three Layers… (Schein, 2010; Scorzoni, 1982) Behaviors, norms, processes enacted on the job Espoused values, goals, philosophies, formal policies • Deeper levels addressed by: • Debriefing • Involvement of unit members • Leaders who model the values and align assumptions Underlying assumptions Armstrong Institute for Patient Safety and Quality

23. Culture Change Can Seem Hard Because it Involves both Unlearning and Re-Learning Lewin, 1951; Schein, 2009 Armstrong Institute for Patient Safety and Quality

24. Changing Culture in Practice: National CLABSI ProjectExample • Baseline HSOPS survey Target non-punitive response to error • What did they do? • Clarified the language and definitions of events, errors, glitches with all unit clinicians & staff • Education campaign to define and differentiate process errors (e.g., expected behavior not clear, not known) from intentional violations • Created shared mental model about expected safety behavior, as well as what to report, when, and when/how to follow-up • Follow up…hot off the presses! Non-punitive response, communication openness, supervisor support Armstrong Institute for Patient Safety and Quality

25. In Sum • Review the survey report for your unit • Can be helpful to distill the report down into 3-5 key slides • Decide when, how, and where to debrief your teammates (and leaders) on these results • Be prepared to listen • Ask for feedback • Ask teammates to help come up with solutions • Gather a small group together and use the “culture debriefing tool” to examine the roots of problem areas and begin to formulate strategies for improvement • Next call with Jill Marsteller & Mike Rosen Aug 9 Armstrong Institute for Patient Safety and Quality

26. Thank you! Sallie J. Weaver, PhD ACCM, and Armstrong Institute for Patient Safety and Quality Sjweaver@jhu.edu