Welcome to the Leadership for Safety Webinar Safety Attitude Questionnaire:
Unit-Level Results on Teamwork and Non-Punitive Response to Error
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Agenda for Today’s Webinar
• Unit-level COS results from San Francisco General Hospital, and UT Tyler
• Unit by unit COS data, resilience, and readiness for change• Run chart “poster session”• Next month’s focus: Just Culture – How to know whether
to hold an individual to account for a safety mishap.
Who is on Today’s Call?
Leadership Summit staff
Guest speakers on today’s call
Kimberly Horton, DHA, MSN, FNP, RN, FACHE
San Francisco General Hospital and Trauma Center
Regional Medical Center at Memphis
Cook County Health & Hospitals System John H. Stroger, Jr. Hospital
Truman Medical Centers TMC- Hospital Hill TMC- Lakewood
Los Angeles County Department of Health Services
Harbor-UCLA Med CenterLAC+USC Healthcare NetworkRancho Los Amigos National Rehab. Center
Maricopa Medical Center
Univ. Medical Center of El Paso
UT-Health Science Center at Tyler
LSU-HCSD Interim Bogalusa
Contra Costa Regional Med. Center
Santa Clara Valley Health and Hospital System
Harris County Health System Ben Taub GeneralLBJ Hospital Quentin Mease
St. Luke’s Regional Medical Center
MetroHealth
Alameda County Medical Center
San Mateo Medical Center
St. Luke’s Meridian Medical Center
St. Luke’s Treasure Valley
Provident Hospital
Jim Reinertsen, MD
Jill Steinbruegge, MD, PhD
Bianca Perez, PhD
Arielle Gorstein
David Coultas, MD, FACP
Bart Hill, MD, MPA
Sue Currin, MS, RN
Alfred Connors, MD
Thomas Holton, MS, RN
University of Texas – TylerComparative Results By Unit
Teamwork Across Units Unit 1 2012 Unit 1 2010 Difference
Unit 2 2012
Unit 2 2010 Difference Unit 3 2012 Unit 3 2010 Difference Unit 4 2012 Unit 4 2010 Difference Unit 5 2012 Unit 5 2010 Difference
1. Hospital units do not coordinate well with each other.
Database36 36 43 39 44 43 48 46 41 39
Your Hospital 33 45 -12 33 55 -22 35 14 21 100 60 40 75 65 10
2. There is good cooperation among hospital units that need to work together.
Database48 46 57 53 58 56 63 60 55 54
Your Hospital 33 55 -22 56 64 -8 50 43 7 80 80 0 75 52 23
3. It is often unpleasant to work with staff from other hospital units.
Database 50 49 63 62 61 60 64 64 56 55 Your
Hospital 58 45 13 75 73 2 47 53 -6 80 80 0 92 71 21
4. Hospital units work well together to provide the best care for patients.
Database 58 56 66 63 66 65 71 69 65 63 Your
Hospital 58 64 -6 63 36 27 57 47 10 100 100 0 92 62 30
Teamwork Within Units Unit 1 2012 Unit 1 2010 Difference
Unit 2 2012
Unit 2 2010 Difference Unit 3 2012 Unit 3 2010 Difference Unit 4 2012 Unit 4 2010 Difference Unit 5 2012 Unit 5 2010 Difference
1. People support one another in this unit.Database 84 84 89 89 85 84 92 92 83 83
Your Hospital 92 73 19 100 100 0 82 81 1 100 100 0 100 78 22
2. When a lot of work needs to be done quickly, we work together as a team to get the work done.
Database 86 86 90 90 81 81 90 89 86 86
Your Hospital
85 73 12 100 100 0 85 75 10 100 100 0 100 87 13
3. In this unit, people treat each other with respect.
Database 74 74 80 80 77 76 88 87 73 73 Your
Hospital 77 50 27 100 100 0 85 75 10 100 100 0 100 74 26
4. When one area in this unit gets really busy, others help out.
Database 67 67 77 77 64 62 77 75 65 65 Your
Hospital 69 36 33 67 67 0 52 56 -4 100 100 0 100 52 48
Nonpunitive Response to Error Unit 1 2012 Unit 1 2010 Difference
Unit 2 2012
Unit 2 2010 Difference Unit 3 2012 Unit 3 2010 Difference Unit 4 2012 Unit 4 2010 Difference Unit 5 2012 Unit 5 2010 Difference
1. Staff feel like their mistakes are held against them.
Database 43 43 46 46 46 46 64 64 48 49 Your
Hospital 58 36 22 33 45 -12 38 25 13 80 100 -20 50 39 112. When an event is reported, it feels like the person is being written up, not the problem.
Database 38 38 43 41 44 42 62 61 46 46 Your
Hospital 62 36 26 33 27 6 45 6 39 40 60 -20 50 43 7
3. Staff worry that mistakes they make are kept in their personnel file.
Database 28 27 31 30 32 31 52 50 35 34 Your
Hospital 31 36 -5 25 18 7 15 6 9 80 20 60 42 48 -6
Unit by Unit COS data, Resilience, and Readiness for Change
7
9
From Bryan Sexton
Key Domain One: TeamworkDriven by Answers to Six Questions
1. Nurse input is well received in this clinical area.
2. In this clinical area, it is difficult to speak up if I perceive a problem with patient care.
3. Disagreements in this clinical area are resolved appropriately (i.e., not who is right, but what is best for the patient).
4. I have the support I need from other personnel to care for patients.
5. It is easy for personnel here to ask questions when there is something that they do not understand.
6. The physicians and nurses here work together as a well-coordinated team.
10
A poor teamwork score (less than 60% reporting positive teamwork)…
• Results from persistent interpersonal dysfunction on the unit
• Predicts operational outcomes e.g. staff turnover, delays, etc.
Needs a specific leadership response: If teamwork score is low, find out which of the questions is
dragging the score down and address that issue specifically
Key Domain Two: Safety ClimateDetermined by scores on seven questions:
1. I would feel safe being treated here as a patient.
2. Medical errors are handled appropriately in this clinical area.
3. I know the proper channels to direct questions regarding patient safety in this clinical area.
4. I receive appropriate feedback about my performance.
5. In this clinical area, it is difficult to discuss errors.
6. I am encouraged by my colleagues to report any patient safety concerns I may have.
7. The culture in this clinical area makes it easy to learn from the errors of others.
Poor safety climate scores (<60%)…• Predict poor clinical outcomes, and high staff injury
rates• Result from perceived lack of commitment to safety by
leadership• Leadership response: demonstrate eagerness to learn
about safety problems, and willingness to do something about them
Key Support Domain: Resilience (Burnout)Determined by scores on four questions:
1. I feel fatigued when I get up in the morning and a have to face another day on the job
2. I feel burned out from my work 3. I feel frustrated by my job 4. I feel I am working too hard on my job
Leadership Response:
For units with HIGH resilience, you can go ahead with a new initiative even if safety or teamwork scores are low (but you will need to address the
specifics of why these scores are low)
For units with low resilience AND low teamwork/safety climate scores, you must first deal with the burnout issues before you can hope to accomplish
ANY change initiative.
The MetroHealth System
Run charts for 2010, 2011, 2012 for VAP, CLBSI, and CAUTI
16
Catheter Related Bloodstream Infections (CLBSI), 2010 to 2012
0
10
20
30
40
50
60
Num
ber o
f inf
ectio
ns
ICU 14 23 10Non-ICU 40 28 25
2010 2011 2012
2.91*2.58*
1.86*
*infections per 1000 catheter days
17
Total Hospital Acquired Catheter Related Bloodstream Infections (ICU and non-ICU, 2010 to 2012)
2
0
4 4 4
14
4
1
8 8
4
1
5
3 3
5
2 2
8
7
5
3
6
2
4 4
3
9
1
6
1
2
1 1
3
0123456789
101112131415
Jan-10
Feb-10
Mar-10
Apr-10
May-10Jun-10
Jul-10
Aug-10
Sep-10
Oct-10
Nov-10
Dec-10Jan
-11
Feb-11
Mar-11
Apr-11
May-11Jun-11
Jul-11
Aug-11
Sep-11
Oct-11
Nov-11
Dec-11Jan
-12
Feb-12
Mar-12
Apr-12
May-12Jun-12
Jul-12
Aug-12
Sep-12
Oct-12
Nov-12
Dec-12
18
Ventilator Associated Pneumonia (VAP)2010 to 2012
0
10
20
30
40
50
60
Num
ber o
f inf
ectio
ns
VAP 51 51 35
2010 2011 2012
4.81* 4.69*
4.14*
*pneumonias per 1000 ventilator days
Ventilator Associated Pneumonia2011 to 2012
4
1
2
5 5
7 7
5
4
7
3
1
7
5
4
5
6
5
3
6
5
2
0
3
2
3
7
1
3
4
3 3
4 4
1
0
1
2
3
4
5
6
7
8
Jan-10
Feb-10
Mar-10
Apr-10
May-10
Jun-10Jul-1
0
Aug-10
Sep-10
Oct-10
Nov-10
Dec-10
Jan-11
Feb-11
Mar-11
Apr-11
May-11
Jun-11Jul-1
1
Aug-11
Sep-11
Oct-11
Nov-11
Dec-11
Jan-12
Feb-12
Mar-12
Apr-12
May-12
Jun-12Jul-1
2
Aug-12
Sep-12
Oct-12
Nov-12
Dec-12
Infe
ction
s/M
onth
19
20
Catheter Associated Urinary Tract Infection (CAUTI) 2010 to 2012
0
20
40
60
80
100
120
140
160
180
Num
ber o
f Inf
ectio
ns
CAUTI 167 119 76
2010 2011 2012
8.71*
4.12*
3.11*
*infections per 1000 catheter days
21
Catheter Associated Urinary Tract Infections (CAUTI)(ICU and non-ICU)
33
20
2726
23
29
31 31
36
24
28
23
19
7
13
11
6
10
8
16
4
7
10
76
10
16
7
34
8
5
34
9
0
5
10
15
20
25
30
35
40
Jan-10
Feb-10
Mar-10
Apr-10
May-10Jun-10
Jul-10
Aug-10
Sep-10
Oct-10
Nov-10
Dec-10Jan
-11
Feb-11
Mar-11
Apr-11
May-11Jun-11
Jul-11
Aug-11
Sep-11
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Nov-11
Dec-11Jan
-12
Feb-12
Mar-12
Apr-12
May-12Jun-12
Jul-12
Aug-12
Sep-12
Oct-12
Nov-12
Dec-12
Infe
ction
s/M
onth
Change in CAUTI definition
Total BSI, VAP, UTI 2011 to 2012
118
75
51
35
51
35
0
50
100
150
200
250
2011 2012
CAUTI CLBSI VAP
34% reduction 2011 to 2012
23
Total BSI, VAP and CAUTI 2011 to 2012
34
16
22
25
15
18
23
30
16
13
18
1314
17
26
22
7
16
12
17
9
1213
0
5
10
15
20
25
30
35
40Ja
n-11
Feb-
11
Mar
-11
Apr
-11
May
-11
Jun-
11
Jul-1
1
Aug
-11
Sep
-11
Oct
-11
Nov
-11
Dec
-11
Jan-
12
Feb-
12
Mar
-12
Apr
-12
May
-12
Jun-
12
Jul-1
2
Aug
-12
Sep
-12
Oct
-12
Nov
-12
Total VAP, CLBSI, & CAUTI Linear (Total VAP, CLBSI, & CAUTI)
Next Month:Tuesday February 12th 8am PT/9am MT/10am CT/ 11am ET
Just Culture1. Have a brief conversation with the chief nurse, or the head of HR,
and ask the following questions: Did we initiate disciplinary action against any staff member (nurse, pharmacist,
physician, nursing assistant…) because of a safety mishap in the last year? If yes…by what method did we decide that this was a problem with the individual?
What is our method for determining individual culpability for safety mishaps? 2. Be prepared to discuss what you’ve learned about your
organization and how it decides when to hold people to account for their safety behaviors. Just Culture Algorithm, HR protocols, or other document
THANK YOU FOR JOINING US!
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