Improving Patient Safety Culture Using the AHRQ Hospital

Improving Patient Safety Culture Using the AHRQ Hospital Survey Theresa Famolaro, MPS Westat 1650 Research Blvd. Rockville, MD 20850 Theresa. Famolaro@westat. com 301 -738 -3547 1 1

Objectives l l Present an overview of the AHRQ Hospital Survey on Patient Safety Culture and its Comparative Database results Discuss ways to improve patient safety culture using your survey results Review success stories of using the survey for patient safety improvement Discuss future survey activities 2 2

What is Patient Safety Culture? “The way we do things around here” Exists at multiple levels: System Beliefs, values & norms Shared by staff Organization Department What is Unit • Rewarded • Supported • Expected 3 3

Why you should do a culture survey? • Raise staff awareness about patient safety • Diagnose and assess patient safety culture • Identify strengths and areas for improvement • Examine change over time • Evaluate the impact of patient safety initiatives • Conduct internal and external comparisons 4 4

Background l Hospital Survey on Patient Safety Culture (HSOPS) l Developed by Westat, funded by AHRQ l Survey development process: Ø Ø Ø l Reviewed literature & existing surveys Interviewed hospital staff Identified key areas of safety culture Developed survey items & pretested Obtained input from researchers & stakeholders Pilot tested in 21 hospitals with 1, 437 respondents Final survey released November 2004 5 5

HSOPS Patient Safety Culture Dimensions l 42 items assess 12 dimensions of patient safety culture 1. Communication openness 2. Feedback & communication about error 3. Frequency of event reporting 4. Handoffs & transitions 5. Management support for patient safety 6. Nonpunitive response to error 7. Organizational learning--continuous improvement 8. Overall perceptions of patient safety 9. Staffing 10. Supv/mgr expectations & actions promoting patient safety 11. Teamwork across units 12. Teamwork within units Patient safety “grade” (Excellent to Poor) l Number of events reported in past 12 months l 6 6

HSOPS Comparative Database 7 7

HSOPS Comparative Database 2012 Report l 1, 128 U. S. hospitals, 567, 703 respondents Average # respondents per hospital = 503 staff Ø 650 trending hospitals Ø l Survey modes Paper 21% Ø Web 66%, In 2007 was 25% Ø Both 13% Ø l Average hospital response rate = 53% Paper 61% Ø Web 51% Ø Both 49% Ø 8 8

Hospital Work Areas l l l l Medicine Surgery Many areas/no specific area ICU Radiology Emergency Lab 12% (62, 688) 10% 8% 7% 6% 6% 5% 9 9

Staff Positions & Patient Contact Nursing 35% (191, 402) l Technicians (EKG, Lab, Radiology, etc) 11% l Management, administration 8% l Unit assistant/clerk/secretary 6% l Physicians, PAs, NPs 6% l l 76% had direct interaction with patients 10 10

Hospital Strengths 11

Hospital Middle Composite Scores 12

Hospital Areas for Improvement 13

Patient Safety Grade 14 14

Number of Events Reported 15 15

How Do I Compare My Results? • Compare Percent Positive Results • Compare Results by Hospital and Respondent Characteristics 16 16

Improving Patient Safety Culture 17 17

Action Planning for Improvement Step #1: Understand Your Results Step #2: Communicate & Discuss Results Step #3: Create Focused Action Plans Step #4: Communicate Plans & Deliverables Step #5: Implement Action Plans Step #6 and 7: Track Progress & Evaluate Impact and Share 18 18

Actions Taken by Trending Hospitals Types of Action Taken Trending Hospitals Number Percent Implemented SBAR (Situation-Background-Assessment. Recommendation) 190 65% Made changes to policies/procedures 180 62% Improved compliance with Joint Commission National Patient Safety Goals 171 59% Conducted chart audits 166 57% Improved error reporting system 158 54% Improved fall prevention program 156 53% Implemented patient safety walkrounds 136 47% 19 19

Examine Culture at the Unit Level • Culture clusters in units • Provide results to each unit • Empower units to identify areas to improve • Implement patient safety initiatives at the unit level • Measure improvement at the unit level 20 20

Improving Patient Safety Resource List Improving Patient Safety in Hospitals: A Resource List for Users of the AHRQ Hospital Survey on Patient Safety Culture 21 21

What is the AHRQ Health Care Innovations Exchange? l Publicly accessible, searchable database of over 2, 300 health policy and service delivery innovations and Quality. Tools l Successes and attempts l Innovators’ stories and lessons learned l Expert commentaries l Learning and networking opportunities 22 22

Evidence for Patient Safety Initiatives • March 2013 AHRQ Report Ø Ø Ø Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices Lists Top 41 Patient Safety Improvement Strategies Non-clinical initiatives o o Team training in health care Interventions to promote a culture of safety Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices. March 2013. Agency for Healthcare Research and Quality, Rockville, MD. http: //www. ahrq. gov/research/findings/evidence-basedreports/ptsafetyuptp. html 23 23

Team. STEPPS® • Developed by Department of Defense (Do. D) and AHRQ • Teamwork training for health care professionals • Focuses on organizational culture of safety • Involves a three-phased process Ø A pretraining assessment for site readiness Ø Free training for onsite trainers and health care staff Ø Implementation and sustainment • Comprehensive curriculum 24 24

Success with Team. STEPPS® Northshore Long Island Jewish Health System • Implemented Team. STEPPS® first in pilot unit • Administered AHRQ Hospital Survey at baseline and after Team. STEPPS® training • Significant improvement in ALL survey results (2007 to 2010) Ø Nonpunitive response to error +15. 9% Ø Staffing +15. 8% Ø Teamwork within units +11. 9% Ø Overall perceptions of safety +11. 8% Ø Organizational learning +11. 7% Thomas, L. and Galla, C. Building a culture of safety through team training and engagement. BMJ Qual ity and Safety. 2013; 22: : 425– 434. 25 25

Leadership Walkrounds. TM • Developed by Allan Frankel, MD, Director of Patient Safety at Partners Health. Care • Face-to-face visits by leaders on units • Leaders discuss patient safety issues with clinical staff and physicians • Many concerns related to equipment, facilities, & communication • Concerns entered into a database, addressed by severity • Demonstrates leadership commitment to patient safety 26 26

Success With Leadership Walkrounds. TM Massachusetts hospitals (7) • Walkrounds. TM training at each site • Weekly Walkrounds from August 2002 -April 2005 • Initially 7 hospitals, only 2 hospitals complied • Assessed culture at baseline and 18 months later Ø Used SAQ survey Ø Showed significant increase in scores for 2 hospitals Frankel, Al. et al. Revealing and resolving patient safety defects: The impact of leadership. Walkrounds on frontline caregiver assessments of patient safety. Patient Safety and Medical Errors. Health Serv Res 2008 December; 43(6): 2050– 2066. 27 27

Just Culture • Nonpunitive Response to Error lowest composite in hospital database (2007 -2012) • Improving Patient Safety in Hospitals: A Resource List for Users of the AHRQ Hospital Survey on Patient Safety Culture Ø Ø Ø Nonpunitive Response to Error: The Fair and Just Principles of the Aurora Health Care Culture Patient Safety and the "Just Culture": A Primer for Health Care Executives Patient Safety and the "Just Culture": A Presentation by David Marx, J. D. Improving Patient Safety in Hospitals: A Resource List for Users of the AHRQ Hospital Survey on Patient Safety Culture. August 2010. Agency for Healthcare Research and Quality, Rockville, MD. http: //www. ahrq. gov/professionals/quality-patient-safety/patientsafetyculture/hospital/resourcelist/hospimpptsaf. html 28 28

Success With Just Culture Training Aurora Healthcare System • HSOPS survey 2005 Ø Aurora hospitals, in 2005, Nonpunitive response to error: 33% • Implemented David Marx Just Culture Training • HSOPS survey 2008 Ø Nonpunitive Response to error: 40% Leonhardt, K. (2008). Nonpunitive Response to Error” The Fair and Just Principles of the Aurora Culture. Presented at CAHPS®/SOPS User Group Meeting 2008. Scottsdale, Arizona. 29 29

Future AHRQ SOPS Activities • AHRQ Hospital Survey on Patient Safety Culture Comparative Database Ø Ø Next Comparative Database Report, Spring 2014 Next Hospital Data Submission, June 2015 • Revise Hospital Survey (Version 2. 0) 30 30

Resources • AHRQ Hospital Survey on Patient Safety Culture: http: //www. ahrq. gov/professionals/quality-patientsafety/patientsafetyculture/hospital/index. html • AHRQ Innovations Exchange: www. innovations. ahrq. gov • Making Health Care Safer II: An Updated Critical Analysis of the Evidence for Patient Safety Practices: http: //www. ahrq. gov/research/findings/evidence-based -reports/ptsafetyuptp. html • Team. STEPPS®: http: //teamstepps. ahrq. gov/ • Leadership Walkrounds. TM: http: //www. hret. org/quality/projects/patient-safetyleadership-walkrounds. shtml 31 31

Questions? Safety. Culture. Surveys@westat. com, 1 -888 -324 -9749 Databases. On. Safety. Culture@westat. com, 1 -888 -324 -9790 32 32