patient safety culture measurement and improvement [email protected] fleming saint mary’s...
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Patient Safety Culture Measurement and Improvement
Mark Fleming
Saint Mary’s University
Objectives
Understand the nature and importance of culture and relationship with patient safety
• Evaluate current culture – Measure, track, monitor culture
• Develop a strategic plan for safety culture measurement and improvement
• Implement culture improvement strategies – Identify barriers to improvement
We can't solve problems by using the same kind of thinking we used when we created them
Albert Einstein
Importance of culture
• “Health care organizations must develop a culture of safety such that an organization's care processes and workforce are focused on improving the reliability and safety of care for patients.” (p. 14; IOM, 1999)
• “The biggest challenge to moving toward a safer health system is changing the culture from one of blaming individuals for errors to one in which errors are treated not as personal failures, but as opportunities to improve the system and prevent harm.” (p. 79; Crossing the Quality Chasm, 2001)
Norms andBehaviour
PatientSafety
Patient Safety Interventions
Patient Safety Culture
Enabler/Barrier
Culture and patient safety
Patient safety culture A culture of safety can be defined as
an integrated pattern of individual and organizational behaviour, based upon shared beliefs and values, that continuously seeks to minimize patient harm that may result from the processes of care delivery (Kizer, 1999).
Patient safety culture elements Leadership commitment to safety Organizational resources for patient safety Priority of safety versus production Effectiveness and openness of communication Openness about problems and errors Organizational learning Frequency of unsafe acts
(Singer et al. 2003)
Measurement and Improvement Organizational level
Major system wide change process requiring significant resources
Step change in patient safety outcomes Unit level
Focused intervention Incremental improvement
1. Investigate
Build expertise in safety culture Form small assessment and improvement
team Select appropriate instrument
Agency for Health Care Research and Quality Hospital survey on patient safety (79 items) (Sorra &
Nieva, 2004) Safety Attitudes Questionnaire
SAQ (60 items) (Sexton & Thomas 2003) York University
Modified Stanford (32 items) (Ginsburg et al, 2009)
York University Modified Stanford
Based on PSCI and Capital Health questionnaire Organizational leadership for safety Unit leadership for safety Perceived state of safety Shame and repercussions Learning
Good psychometrics (alpha’s .66-.86) Currently used by Accreditation Canada Large Canadian data set
2. Initiate
Obtain Informed senior leadership support Involve health care staff
Planning and implementation of assessment Keep staff informed about progress
3. Implement
Collect data Interpret results Feedback results to staff
Org
anisat
iona
l lea
ders
hip
Unit le
ader
ship
Perce
ived
sta
te o
f saf
ety
Sham
e an
d re
perc
ussion
s
Lear
ning
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
5.0
Overall average for each factor
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
5.0 Organisational leadership Items
Organ
isatio
nal le
ader
ship
Unit l
eade
rship
Perc
eive
d stat
e of
safe
ty
Sham
e an
d re
perc
ussio
ns
Lear
ning
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
5.0
Comparsion between units
OncologyCardiac surgeryGynecologyDay surgeryICUENTEmergencyOrthopedicsCCU Diagnostic Imaging Overall
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
5.0Organisational leadership by Unit
Unit level assessment and improvement Conduct safety culture survey (e.g. MSI ) Group exercise
Representative group of frontline caregivers 30 – 60 minutes to complete
Helps to make sense out of culture survey results and create actions for improvement
Normalizes patient safety culture conversations
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
5.0
Organisational leadership items for Emergency dept
4. Improve
Involve cross section of staff in development of improvement plan
Implement an improvement plan Monitor the implementation of plan Evaluate effectiveness of plan Assess change in culture
Patient Safety Culture Improvement Tool (PSCIT)
Perceptions are based in reality i.e. perceptions of leadership commitment reflect
their interactions with leaders Organisations and units with different cultures have
different practices Safety culture improvement involves system
change e.g. perceptions of leader commitment is
improved through training and evaluating safety leadership practices
Patient safety culture elements
Leadership Senior Manager Clinical Manager Physician
Risk analysis Workload management Sharing and learning Resource management
Example element
How to use the audit Self assessment of systems supporting the
safety culture Completed by unit or department to assist in
identifying opportunities to improve Completed by senior management team to form
basis for improvement workshop
Improving patient safety culture
Leadership Judged by actions not words
Solution focused approach Assess current culture Work at team level to develop local action plan Implement changes Reassess culture
Health care specific challenges Unclear management control Limited acceptance of need to change
Taking Action Culture is shared by group members Groups consist of individuals Culture change requires individuals to change
their values, beliefs and behaviour Cultural change can begin at the:
Organizational level Unit level Individual level
So what are you going to do to change the culture?
Summary Creating a culture of patient safety is crucial The culture determines what behaviours are
acceptable and unacceptable Patient safety culture consists of a number of
dimensions It is important to understand the current
culture before trying to change it Cultural change can be conducted at the
organisational or unit level
References Kizer, K. W. 1999. Large system change and a culture of
safety. In: Enhancing Patient Safety and Reducing Errors in Health Care. Chicago, IL: National Patient Safety Foundation
Ginsburg L, Gilin D, Tregunno D, Norton P G, Flemons W. and Fleming M (2009) Advancing measurement of patient safety culture Health Services Research Vol 44 no 1 pp205-223
Sexton JB, Paine LA, Manfuso J, Holzmueller CG, Martinez EA, Moore D, Hunt DG, & Pronovost PJ.(2007) A check-up for safety culture in "my patient care area". Joint Commission journal on quality and patient safety. Nov;33(11):699-703, 645
Fleming, M. and Wentzell, N. (2008) Patient Safety culture improvement tool: development and guidelines for use. Healthcare Quarterly Volume 11 Special issue pp10-15
Jackson, J. Sarac, C. and Flin R. (2010) Hospital safety climate surveys: measurement issues Current Opinion in Critical Care , 16:632–638