measurement and improvement of team safety culture · require a culture firmly rooted in continual...
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Measurement and improvement of team
safety culture
Measurement and improvement of team safety culture
Alison Lovatt, Clinical Network Director Y&H AHSN
Joanna Pendray, Improvement Lead SW AHSN
23 May 2017
The Berwick Report
“Culture will trump rules, standards and control strategies every single time”
“A safer NHS will depend far more on major cultural change than on a new regulatory regime”
“The NHS in England can become the safest health care system in the world…..it will require a culture firmly rooted in continual improvement”
A promise to learn – a commitment to act National Advisory Group on the Safety of patients In England
“Culture has a profound impact on behaviour and the ability to consistently deliver safe care. Safety Culture lives at team level and has to therefore be measured there” M.W Leonard, A. Frankel (2010)
• An effective team is far more able to recognise when things are going wrong
than any one individual.
• A team that works together well is a safe team
• Clinicians’ perception is often that it’s a great team………..
• How positively nursing input is received particularly by Doctors correlates with patient outcomes.
And the Evidence………
What is Safety Culture?
• Shared basic assumptions
• Discovery, creation or development of those assumptions by a defined group
• Group learning of how to cope with its problem of external adaptation and internal integration
• Identification of ways that have worked well enough to be considered valid
• Teaching new members of the group the correct way to perceive, think and feel in relation to any problems
Weick K and Sutcliffe KM. Managing the unexpected. Assuring high performance in an age of complexity. Josey Boss, San Francisco, 2001
What is Safety Culture?
• Collective mindfulness about safety
– Psychological
– Behavioural
– Situational
• Positive perceptions of
– Psychological safety
– Teamwork
– Leadership
A culture of safety
An environment, where everyone regardless of their title or grade, feels safe to speak up. No one is hesitant to voice a concern about a patient or the plan.
When staff do speak up, they are treated with respect and have confidence that leadership will act upon their concerns; a cycle of trust.
Psychological Safety
Measuring safety culture
• Various tools available
• SAQ Safety Attitudes Questionnaire
• SCORE Safety Communication Operational Reliability Engagement
• Measuring safety culture is the starting point!
Survey Domains
Domain Tool What does it measure?
Teamwork SCORE SAQ
How effectively different disciplines coordinate their efforts and whether they work in a psychologically safe environment
Safety Climate SCORE SAQ
The degree to which mindfulness and psychological safety exist in the work setting
Learning Environment
SCORE The ability of a work setting to self-reflect, identify problems and solve them, learn from excellence
Local Leadership SCORE The level of confidence that respondents have in the support they receive from their local leaders including positive feedback
Burnout & Work Life Balance
SCORE The degree of cynicism, emotional exhaustion and frustration that respondents feel
Stress Recognition
SAQ Acknowledgement of how performance is influenced by stressors.
Perceptions of Management
SAQ Approval of managerial action
Working Conditions
SAQ Perceived quality of the work, environment, staffing and equipment
Job satisfaction SAQ Positivity about the work experience
Debriefing
• Open, safe space
• Reflect on what is working well
• Opportunities for improvement
• Use Quality Improvement methodology
Exercise
Look at the domain results
and draw how they
make you feel…..
Improvement
• The insights are critical for organisational improvement
and the ability to drive habitual excellence
• Specific actions can be taken to increase organisational
strengths and address areas of fundamental opportunity
• Survey again!
Some examples : before and after – Raising concerns
February 2016 November 2016
Some examples : before and after – Speaking up
February 2016 November 2016
Effective Behaviours
• Identify shared goals
• Plan forward
• Reflect back
• Communicate clearly & openly
• Celebrate success
• Manage conflict
• Brief
• Debrief
• Structured e.g. SBAR
• Critical language
Principles
• Data belongs to teams not management. Free to use the analysis as they wish.
• Teams must have feedback and a “conversation”
• Point in time. Take at face value don’t need to over analyse, interpret, justify or defend.
• Team decides what to do. Have further support if they want and Management listen.
Value
“SCORE has given us a valuable way of delving down into a deeper layer of understanding and insight...and to continue to develop, grow and thrive but in a more healthy and sustainable way!”
“Sometimes, we are so service focussed that we forget that we are people – staff health and wellbeing is as important as the care we provide… it is crucial to build resilience and sustainability.”
Associate Director, Mental Health Trust
Teamwork Domain
Safe and Reliable Healthcare
% 0
% 20
40 %
60 %
80 %
% 100
Disagreements in this work setting are appropriately
resolved ie not who is right but what is best for the patient
Communication breakdowns are NOT common when this work setting
interacts with other work settings
Communication breakdowns are NOT common in this work setting.
Dealing with difficult colleagues is NOT consistently a challenging part of my
job
The people here from different
disciplines/backgrounds work
together as a well co-ordinated
team
It is easy for personnel here to ask questions when there is
something that they do not understand.
In this work setting, it is NOT
difficult to speak up if I perceive a problem with patient care.
% 63
% 17
33 %
% 37
% 84
91 %
% 73
Local Leadership Domain
Safe and Reliable Healthcare
% 0
20 %
40 %
60 %
80 %
% 100
...communicates their expectations
to me about my performance.
...provides meaningful feedback to
people about their performance.
...provides useful feedback about my performance.
...provides frequent feedback about my performance.
...regularly makes time to pause and reflect with me about my work.
...regularly makes time to provide positive feedback to me about how I am doing.
69 %
48 %
% 37
% 39 % 34
% 34
% 38
In this work setting, local leadership...
is available at predictable times.
7 5
47
44
40
38
33
29
26
25
22
0
0
0 20 40 60 80 100
Receptionist/Secretary
Middle Grade
Sister
Admin
ENP
Porters/CDU/Transfer Team
Consultant
Nurse
Doctor
HCA
ACP
Group B Nurse
Local Leadership Domain
Safe and Reliable Healthcare
Burnout Climate Domain
Safe and Reliable Healthcare
% 0
20 %
% 40
60 %
80 %
% 100
People in this work setting are working too hard on their jobs.
People in this work setting are
frustrated by their jobs People in this work setting are
exhausted from their work.
People in this work setting are burned out from their work. (151)
% 61
75 %
77 % 83 %
78 %
Events in this work setting affect the lives of people here in an
emotionally unhealthy way
Personal Burnout Domain
Safe and Reliable Healthcare
% 0
% 20
% 40
60 %
80 %
% 100
Events in this work setting
affect my life in an
emotionally unhealthy way
I feel I am working too hard on my job
I feel frustrated by my job. I feel fatigued when I get up in the morning and have to face another day on the job.
I feel burned out from my work.
% 45
% 48
57 % 59 %
48 %
Safety Climate Domain
Safe and Reliable Healthcare
My suggestions about quality would be acted
upon if I expressed them to management
0 %
% 20
% 40
60 %
% 80
% 100
The values of the organisations leadership are the same values
that people in this work setting think are important.
In this work setting, it is NOT difficult to discuss errors
I would feel safe being treated here as a patient.
The culture in this work setting makes it easy to learn from the errors of
others
I receive appropriate feedback about my performance
Errors are handled appropriately in this work setting 50 %
46 %
% 60
85 %
58 %
% 36
% 68
