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Improving Patient Safety Culture Using the AHRQ Hospital Survey

Theresa Famolaro, MPS Westat

Westat1650 Research Blvd. Rockville, MD 20850

TheresaFamolaro@westat.com 301-738-3547

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Objectives

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

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Shared by staff

Beliefs, values & norms

What is Patient Safety Culture?

“The way we do things around here”

Exists atmultiplelevels:System

Organization

Department

Unit

What is• Rewarded• Supported• Expected

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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

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Background Hospital Survey on Patient Safety Culture

(HSOPS) Developed by Westat, funded by AHRQ Survey development process:

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

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HSOPS Patient Safety Culture Dimensions 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 units12. Teamwork within units

Patient safety “grade” (Excellent to Poor) Number of events reported in past 12 months

777

HSOPS Comparative Database

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HSOPS Comparative Database

2012 Report 1,128 U.S. hospitals, 567,703 respondents

Average # respondents per hospital = 503 staff 650 trending hospitals

Survey modes Paper 21% Web 66%, In 2007 was 25% Both 13%

Average hospital response rate = 53% Paper 61% Web 51% Both 49%

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Hospital Work Areas

Medicine 12% (62,688)

Surgery 10%

Many areas/no specific area 8% ICU 7% Radiology 6% Emergency 6% Lab 5%

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Staff Positions & Patient Contact

Nursing 35% (191,402)

Technicians (EKG, Lab, Radiology, etc) 11% Management, administration 8% Unit assistant/clerk/secretary 6% Physicians, PAs, NPs 6%

76% had direct interaction with patients

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Hospital Strengths

12

Hospital Middle Composite Scores

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Hospital Areas for Improvement

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30%

45%

20%

4% 1%0%

20%

40%

60%

80%

100%

Excellent Very Good Good Poor Failing

Patient Safety Grade

151515

55%

27%

12%4% 2% 1%

0%

20%

40%

60%

80%

100%

None 1 to 2 3 to 5 6 to 10 11 to 20 21 ormore

Number of Events Reported

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How Do I Compare My Results?

• Compare Percent Positive Results

• Compare Results by Hospital and Respondent Characteristics

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Improving Patient Safety Culture

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Step #2: Communicate & Discuss Results

Step #4:Communicate

Plans & Deliverables

Step #6 and 7:Track Progress

& Evaluate Impact and Share

Step #1:Understand Your Results

Step #3:Create Focused

Action Plans

Step #5: Implement Action Plans

Action Planning for Improvement

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Actions Taken by Trending Hospitals

Types of Action TakenTrending Hospitals

Number PercentImplemented 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%

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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

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Improving Patient Safety Resource List

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

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What is the AHRQ Health CareInnovations Exchange?

Publicly accessible, searchable database of over 2,300 health policy and service delivery innovations and QualityTools

Successes and attempts Innovators’ stories and lessons learned Expert commentaries Learning and networking opportunities

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Evidence for Patient Safety Initiatives

• March 2013 AHRQ Report 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 initiativeso Team training in health care

o 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-based-reports/ptsafetyuptp.html

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TeamSTEPPS®

• Developed by Department of Defense (DoD) and AHRQ

• Teamwork training for health care professionals

• Focuses on organizational culture of safety

• Involves a three-phased process A pretraining assessment for site readiness Free training for onsite trainers and health care

staff Implementation and sustainment

• Comprehensive curriculum

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Success with TeamSTEPPS®

Northshore Long Island Jewish Health System• Implemented TeamSTEPPS® first in pilot unit

• Administered AHRQ Hospital Survey at baseline and after TeamSTEPPS® training

• Significant improvement in ALL survey results (2007 to 2010) Nonpunitive response to error +15.9% Staffing +15.8% Teamwork within units +11.9% Overall perceptions of safety +11.8% 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.

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Leadership WalkroundsTM

• Developed by Allan Frankel, MD, Director of Patient Safety at Partners HealthCare

• 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

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Success With Leadership WalkroundsTM

Massachusetts hospitals (7)• WalkroundsTM 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

Used SAQ survey 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.

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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

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

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Success With Just Culture Training

Aurora Healthcare System

• HSOPS survey 2005

Aurora hospitals, in 2005, Nonpunitive response to error: 33%

• Implemented David Marx Just Culture Training

• HSOPS survey 2008

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.

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Future AHRQ SOPS Activities

• AHRQ Hospital Survey on Patient Safety Culture Comparative Database Next Comparative Database Report, Spring 2014 Next Hospital Data Submission, June 2015

• Revise Hospital Survey (Version 2.0)

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Resources

• AHRQ Hospital Survey on Patient Safety Culture: http://www.ahrq.gov/professionals/quality-patient-safety/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

• TeamSTEPPS®: http://teamstepps.ahrq.gov/• Leadership WalkroundsTM:

http://www.hret.org/quality/projects/patient-safety-leadership-walkrounds.shtml

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Questions?

SafetyCultureSurveys@westat.com, 1-888-324-9749

DatabasesOnSafetyCulture@westat.com, 1-888-324-9790