CULTURE OF SAFETY SURVEYS

TAKING THE PULSE OF YOUR ORGANIZATION

Tatum O’Sullivan, RN, MHSA, CPHRM

Ambulatory Risk & Patient Safety Manager

North Shore Physicians Group

tkosullivan@partners.org

OBJECTIVES

Purpose of the Survey

Options

Frequency of Surveys

Benefits of Survey

Pitfalls & Challenges

Helpful Hints

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

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.

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

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

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Section # of Questions

Example

Patient Safety & Quality Issues

9 A patient was unable to get an appointment within 48 hours for an acute/serious problem? Daily, Weekly, Monthly, Several times in past 12 months, Once in past 12 months, Not in past 12 months, Don’t know

Information Exchange with Other Settings

5 Office has had problems exchanging accurate, complete and timely information with other medical offices? Daily, Weekly, Monthly, Several times in past 12 months, Once in past 12 months, Not in past 12 months, Don’t know

Working in your Medical Office

15 When someone in this office gets really busy, others help out? SD, D, Neither agree or disagree, A, SA, Don’t know

Communication & Followup

12 Providers in this office are open to staff ideas about how to improve office processes? Never, Rarely, Sometimes, Most of the time, Always, Don’t know

Leadership Support

4 They place a high priority on improving patient care processes? SD, D, Neither agree or disagree, A, SA, Don’t know

Your Medical Office

7 When there is a problem in our office we see if we need to change the way we do things? SD, D, Neither agree or disagree, A, SA, Don’t know

Overall Ratings 6 Overall, how would you rate your medical office on being patient-centered? Poor, Fair, Good, Very good, Excellent

AHRQ Safety & Culture Survey

AHRQ 12 DOMAINS

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)

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

TIMELINE

PRENOTIFICATION LETTERDear 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

FREQUENCY OF SURVEYS

At a minimum every 2 years

Items to Consider: Assess operations and leadership changes

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

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

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

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

USEFUL LINKS AHRQ http://www.ahrq.gov/professionals/quality-pat

ient-safety/patientsafetyculture/index.html

SAQ https://med.uth.edu/chqs/surveys/safety-attit

udes-and-safety-climate-questionnaire/

Pascal Metrics http://www.pascalmetrics.com/products_servi

ces/

The Patient Safety Group https://www.patientsafetygroup.org/survey/home.cfm

HTTPS://NNEPATIENTSAFETY.ORG/

QUESTIONS…COMMENTS…IDEAS