Safety Attitudinal Survey The University of Texas Attitudes

Safety Attitudinal Survey The University of Texas Attitudes Questionnaire (SAQ) Operating Room version May – June 2014 Friarage Hospital -Sept 2014 Surgical Services- Jan 2015 Clinical & Diagnostic support centre March 2015 Mixed methods for data collection

Several versions that can be used in different teams

What does it measure? • Teamwork Climate: Perceived quality of collaboration between personnel. • Safety Climate: Perceptions of a strong and proactive organisational commitment to safety. • Stress Recognition: Acknowledgement of how performance is influenced by stressors. • Job Satisfaction: Positivity about work experience • Perceptions of Management: Approval of managerial action. • Work Conditions: Perceived quality of the work environment and logistical support.

Resolution: standard / high Figure 1. SAQ factor definitions and example items. Sexton et al. BMC Health Services Research 2006 6: 44 doi: 10. 1186/1472 -6963 -6 -44 Download authors' original image

Culture • The product of individual and group values, attitudes, perceptions, competencies, and patterns of behavior that determine the commitment to, and the style and proficiency of, an organization's health and safety management. (Sorra JS; 2004) • “…. Attitudes, beliefs, perceptions and values that employees share in relation to safety” (Cox and Cox 1991) • “The organisation’s pattern of response to the problems and opportunities it encounters” (Westrum 2004)

Safety Culture vs climate Culture Local (micro) Atmosphere Environment Conditions Surroundings Global (macro) Customs Traditions Society

Overall Satisfaction with level of patient safety 1=strongly disagree, 5 strongly disagree

Domain score by job type

Top 5 performing areas Domain Question TC 13 Briefing operating theatre staff before a surgical procedure is important for patient safety TC 14 Briefings are common in the operating theatre 45 Doctors in the operating theatres here are doing a good job SC 4 I would feel safe being treated here as a patient JS 2 I like my job Trust (n=203) 4. 80 4. 66 4. 52 4. 51 4. 39

Least performing areas Domain Question 27 I have seen others make errors that had the potential to harm patients 33 Stress from personal problems adversely affects my performance JS 41 Morale is high in the operating theatres here Trust (n=203) 2. 51 2. 50 2. 44 2. 37 PM 18 The levels of staffing in our op theatres are sufficient to handle the number of patients 44 I have made errors that had the potential to harm patients 2. 29

Job satisfaction Job Satisfaction Domain 4 J S 2 I like my job 4. 39 J S 2 9 I am proud to work at this hospital 4. 17 J S 1 5 This hospital is a good place to work 4. 11 J S 8 Working in this hospital is like being part of a large family 3. 29 J S 4 1 Morale is high in the operating theatres here 2. 44

Safety Climate D N Question o o m ai n Safety Climate Domain S 4 I would feel safe being treated here as a patient C S 2 I am encouraged to by my colleagues to report any patient safety concerns I may have C 0 S 2 I know the proper channels to direct questions regarding patient safety in the operating theatres C 8 here S 5 Medical errors are handled appropriately in this hospital C S 2 The culture in the operating theatres here makes it easy to learn from the errors of others C 1 S 1 In the operating theatre is it difficult to discuss errors C 2 S 1 I receive appropriate feedback about my performance C 1 S 5 Staff frequently disregard rules or guidelines eg handwashing treatment/protocol/clinical pathways C 6 sterile fields etc that are established for the operating theatres Mea n Sco re 3. 88 4. 51 4. 28 4. 26 4. 21 3. 83 3. 49 3. 24

Quality of collaboration and communication Percentage of staff working in a theate environement reporting a “high” or “very high” level of collaboration with other members of theatre team Staff position being rated Consultant Surgeons Surgical ODPs Perfusionists Consultant Anaesthetics Anaesthetic Trainees Anaesthetic Nurses/ODPs Scrub Nurses Recovery Nurses 73% 53% 47% 43% 81% 59% 35% 76% 31% 100% 80% 100% 67% Surgical ODPs 50% 80% 100% 83% 67% 100% 67% Consultant Anaesthetics 58% 39% 70% 83% 94% 91% 94% 90% Anaesthetic Trainees 57% 50% 58% 0% 93% 92% 93% 57% 93% Anaesthetic Nurses/ODPs 26% 35% 75% 57% 76% 70% 86% 69% 82% Scrub Nurses 61% 45% 62% 40% 5% 52% 61% 68% 48% Recovery Nurses 20% 20% 60% 40% 60% 20% 80% Surgical Trainees Staff position performing Surgical Trainees

Operating Room Teamwork among Physicians and Nurses: Teamwork in the Eye of the Beholder Makary et al J Am Coll Surg. 2006 May; 202(5): 746 -52

Qualitative data Theme Number Staffing 71 Improve teamwork / communication 45 Improve use of safety checklist / briefings 42 Increase training / education 41 Improve work load / work flow 33 improve equipment/facilities 33 Improve policies / procedures and adherence to 14 Improve patient safety feedback and follow up 12 Improve morale 9 Improve management 6 Increase supportive work environment / culture 5 Improve documentation 4 Grand Total 315

Summary • • Its difficult! We do need to be doing this! Beware comparisons! Mixed methods, what we do and what we really do! • Macro vs micro • Learning from other industries.