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Re-measuring Safety Culture:

The Follow-up HSOPS Survey

Sallie Weaver, PhD

Kristina Weeks, MSH, DrPH (c)

Nasir Ismail, MS, PhD(c)

ARMSTRONG INSTITUTE FOR PATIENT SAFETY AND QUALITY

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Polling Question #1

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What is your current role?

Surgeon

Quality improvement practitioner

Infection preventionist

OR nurse

OR technician

Anesthesiologist

OR manager

Other

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Polling Question #2

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Have you presented the HSOPS results to your unit staff/management?

Yes

No

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Learning Objectives

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1. Describe the value of HSOPS data

2. List steps to complete the HSOPS survey

3. Increase HSOPS response rate

4. Download and debrief HSOPS report

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Can my hospital still take the survey if we have not

completed a baseline survey?

YES

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When will the follow-up HSOPS survey be available for Cohort 1 and Cohort 2 teams?

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Survey period opens:

July 1st, 2014

12noonEDT

Survey period closes:

September 3rd, 2014

5pmEDT

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Today’s Agenda

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Why should you complete the HSOPS Survey?

How do you complete the HSOPS survey?

How can you increase the response rate?

How do you download the HSOPS final report?

Why should you debrief that report?

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Why Should You Complete HSOPS Survey?

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Measures safety culture within the units of hospital

What does Safety Culture mean?

– Perceived priority of safety relative to other goals

– Attitudes, beliefs, perceptions, and values related to

safety within an organization

Hospital Survey On Patient Safety Culture (HSOPS)

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Core Aspects of Safety Culture1

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Safety Culture Is Related To Outcomes2,3,4,5,6,7,8

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Patient outcomes

Patient care experience

Infection rates, sepsis

Postoperative hemorrhage

Respiratory failure, accidental puncture / laceration

Treatment errors

Clinician outcomes

Incident reporting

Burnout and turnover

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HSOPS Dimensions

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1. Supervisor / manager expectations and actions promoting patient safety

2. Organizational learning-continuous improvement

3. Teamwork within unit

4. Communication openness

5. Feedback and communication about error

6. Nonpunitive response to error

7. Staffing

8. Hospital management support for patient safety

9. Teamwork across hospital units

10.Hospital handoffs and transitions

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10 Composite Scores

(“Dimensions”)

Sample Question

1. Supervisor/manager expectations & actions promoting patient safety

B1. My supervisor/manager seriously considers staff suggestions for improving patient safety.

2. Organizational learning-continuous improvement

A9. Mistakes have led to positive changes here.

3. Teamwork within unit

A1. People support one another in this unit.

4. Communication openness

C4. Staff feel free to question the decisions or actions of those with more authority.

5. Feedback & communication about error

C1. We are given feedback about changes put into place based on event reports.

HSOPS Sample Questions

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10 Composite Scores

(“Dimensions”)

Sample Question

6. Nonpunitive response to error

A8. Staff feel like their mistakes are held against them. (negatively worded)

7. Staffing A2. We have enough staff to handle the workload.

8. Hospital management support for patient safety

F8. The actions of hospital management show that patient safety is a top priority.

9. Teamwork across hospital units

F4. Cooperation is good among hospital units that need to work together.

10.Hospital handoffs & transitions

F5. Important patient care information is often lost during shift changes. (negatively worded)

HSOPS Sample Questions

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4 Outcome Variables Example Question

1. Overall perceptions of safety

A15. Patient safety is never sacrificed to get more work done.

2. Frequency of event reporting

D1. When a mistake is made, but is caught and corrected before affecting the patient, how often is this reported?

3. Patient safety grade (of hospital unit)

E1. Please give your work area/unit in this hospital an overall grade on patient safety.

4. Number of events reported in the last 12 months

G1. In the past 12 months, how many event reports have you filled out and submitted?

HSOPS Sample Questions

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How Do You Complete The HSOPS Survey?

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1. Collect the email addresses of all clinicians and staff (including physicians) that worked in the unit at least 3 months

2. Enter email addresses into an Excel spreadsheet

3. Upload the Excel spreadsheet file into the SUSP online portal

https://armstrongresearch.hopkinsmedicine.org/susp.aspx

OPTION 1

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1. Some clinical areas prefer to submit surveys via a central pc located in within the unit

2. Request a work area id

3. Set up a workstation in the clinical area

4. Instruct staff to use the provided link and ID

How Do You Complete The HSOPS Survey?

Contact susp@jhmi.edu for more information.

OPTION 2 Alternate Method: Work Area ID

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HSOPS Response Rate

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What was your response rate on the initial HSOPS survey?• 80-100%• 60-80%• 40-60%• 20-40%• 0-20%• Unit did not complete 1st HSOPS survey

Polling Question #3

What did you do to motivate team members to participate?

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How Can You Increase The Response Rate?

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Set a goal

Make a plan!

Flyers & posters

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Checking Response Rate & Getting Reports

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HSOPS Reports

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HSOPS Reports

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Debrief survey results with all your team members

Debriefing is a semi-structured conversation among frontline clinicians and staff that is usually led by a designated facilitator

Encourages open communication, transparency, and interactive discussion– across all levels of the work area

– between disciplines

Engages clinicians and staff in generating and implementing their ideas about how to create an effective safety culture in their work area

What is Debriefing?

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Work units that debrief around safety culture perform better

Data is data. Debriefing turns data into information.

Debriefing accelerates improvement.9

Units who did not debrief survey results achieved2.2% Reduction in Infection Rates

Units who used semi-structured debriefing of

culture survey achieved 10.2% Reduction in

Infection Rates

YES NO

Making HSOPS Data Meaningful

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How do I use the CUSP culture check-up tool?

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Share culture results with everyone on the unit during a survey debriefing– Bring together team members from your work area– Follow your debriefing plan

Take notes and recognize recurring themes

Encourage open, honest discussion about making the culture of your work area the best it can be

Making HSOPS Data Meaningful

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Focus on identifying system issues that the group can work on improving together instead of as individuals.

– Don’t use it to point fingers at specific individuals

Use the tool to structure meetings and guide conversation.

As a group, complete all steps in this worksheet.

Making HSOPS Data Meaningful

How do I use the CUSP culture check-up tool?

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HSOPS debriefings with CUSP culture check-up tool

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What is the Purpose of this Tool?

Understand the unit culture

Use teammates’ feedback to predict and avoid barriers

Use feedback to leverage the team’s strengths

Who Should Use this Tool?

Safety culture debriefing facilitators

Helps to guide the discussion and record group decisions

Making HSOPS Data Meaningful

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1. Identifies general strengths and weaknesses of your unit culture

2. Get specific about behaviors and attitudes that make up those strengths and weaknesses

3. Select opportunities for growth

4. Develop a strategy for addressing growth opportunities

5. Put plan into action

6. Evaluate results and share progress during SUSP team meetings

Steps in CUSP Culture Check-Up Tool

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Tip: Download the Culture Check UpTool at

https://armstrongresearch.hopkinsmedicine.org/susp.aspx

www.ahrq.gov/professionals/education/curriculum-tools/cusptoolkit/toolkit/

culturecheckup.html

Culture Check Up Tool

Culture Check Up Tool is a document used by Debriefing Facilitator to guide conversation and improvement planning

Download from the SUSP portal or the AHRQ website

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Culture Check-up Tool

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https://armstrongresearch.hopkinsmedicine.org/susp

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Culture Check up tool

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Brainstorming culture discussion items

Statement To Be Discussed

Unit Safety Assessment Score %What does this statement mean to you?How accurately does the unit score reflect your experience on this unit? Share examples.How would it look (what behaviors or processes would we see) in this unit if 100% of staff responded “agree strongly” with this item?Identify at least one actionable idea to improve unit results in this area.What are the next steps and how will we accomplish them?

Culture Check Up Tool

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Debriefing Plan Highlights

Decision Points For Project Team Debriefing Plan

How many debriefing sessions will be held?

Who will facilitate each debriefing session?

When will debriefing(s) be held?

Who is responsible for taking notes and recording ideas from each session?

If you conduct more than one debriefing session, who is responsible for collating notes and ideas for improvement from the different sessions?

How will the CUSP team ensure there is follow-up on the action items from the debriefing session(s)?

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What’s Next?

1. Plan debriefing strategy to share results with team

– Be prepared to listen

– Ask for feedback

– Ask teammates to help come up with solutions

2. Gather a small group together and use the “culture debriefing tool” to examine the roots of problem areas and begin to formulate strategies for improvement

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Where to find the old webinars?

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The link: https://armstrongresearch.hopkinsmedicine.org/susp

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Cohort 1 & 2 Project End Date

Project End

August 31, 2014

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Activities Still Open for Participation

Affinity group calls

SUSP webpage (webinars, toolkits, etc.)

SUSP data portal

– HSOPS reports

– SSI reports

Medconcert

SUSP help desk (SUSP@jhmi.edu)

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What Now?

Does your hospital want to continue using the data portal to track your SSI data?

Or rather, do you want Sept 2014- Aug 2015 SSI data to be entered into portal?

If yes, contact your CE to confirm data will continue to be uploaded routinely

If no, your CE will complete one final upload in February 2015 to complete the 2 years of project data

Review the data manual on how to create SSI reports in NHSN and NSQIP

SUSP generating reports using the SSI data registry

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Want To Continue Beyond August 2014?

Does your hospital want to stay involved in SUSP activities (cohorts 3, 4 & 5 project calls, affinity groups, etc.) ?

If yes, contact your CE and let them know your plans to continue your participation and which ones.

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Thank you for your willingness to participate and learn together on how to prevent surgical site infections.

The journey continues…..

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References

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1. Schein E. Organizational culture and leadership, 4 th edition. San Francisco, CA: Jossey-Bass. 2010.

2. Huang DT, Clermont G, Kong L, Weissfeld LA, Sexton JB, Rowan KM, Angus DC. Intensive care unit safety culture and outcomes: a US multicenter study. Int J Qual Health Care. 2010 Jun;22(3):151-61.

3. MacDavitt K, Chou SS, Stone PW. Organizational climate and health care outcomes. Jt Comm J Qual Patient Saf. 2007 Nov;33(11 Suppl):45-56.

4. Mardon RE, Khanna K, Sorra J, Dyer N, Famolaro T. Exploring relationships between hospital patient safety culture and adverse events. J Patient Saf. 2010 Dec;6(4):226-32.

5. Singer SJ, Falwell A, Gaba DM, Meterko M, Rosen A, Hartmann CW, Baker L. Identifying organizational cultures that promote patient safety. Health Care Manage Rev. 2009 Oct-Dec;34(4):300-11.

6. Sorra J, Khanna K, Dyer N, Mardon R, Famolaro T. Exploring Relationships Between Patient Safety Culture and Patients' Assessments of Hospital Care. J Patient Saf. 2012 Jul 10. [Epub ahead of print].

7. Sorra JS, Nieva VF. Hospital Survey on Patient Safety Culture. (Prepared by Westat, under Contract No. 290-96-0004). AHRQ Publication No. 04-0041. Rockville, MD: Agency for Healthcare Research and Quality. September 2004.

8. Weaver SJ. A configural approach to patient safety climate: The relationship between climate profile characteristics and patient safety. Doctoral dissertation. University of Central Florida. 2011.

9. Vigorito MC, McNicoll L, Adams L, Sexton B. Improving safety culture results in Rhode Island ICUs: lessons learned from the development of action-oriented plans. Jt Comm J Qual Patient Saf. 2011 Nov;37(11):509-14.