1. Jill A. Marsteller, PhD,MPP August 10, 2011 CSTS: The Cardiovascular Surgical Translational Study Assessing Culture

2. Slide 2 What is patient safety culture? The safety culture of an organization is the product of individual and group values, attitudes, perceptions, competencies, and patterns of behavior that determine the commitment to, and the style and proficiency of, an organization's health and safety management. Organizations with a positive safety culture are characterized by communications founded on mutual trust, by shared perceptions of the importance of safety, and by confidence in the efficacy of preventive measures –AHRQ definition

3. Slide 3 Hospital Survey on Patient Safety Culture Survey assessing 12 dimensions of patient safety culture Westat developed the HSOPS from funding provided by AHRQ Used across the US and in over 20 countries internationally Validated instrument: Pilot tested and reliability and factor structure assessed Culture measures are intuitive and effective for communication and linking to actions

4. Slide 4 Why measure Patient Safety Culture? Data will increase your understanding of employees’ perceptions of patient safety culture within their respective units, hospitals; across professional roles Differences exist by role in perceptions of safety A strong culture of patient safety encourages providers and hospital administrators to consciously work to reduce errors and mitigate hazards within their units and hospitals A weak patient safety culture DIScourages actions supporting safety and teamwork

5. % of respondents within an ICU reporting good safety climate Safety Climate- Culture of Safety Survey

6. Slide 6 Culture of Safety- Michigan Teamwork Climate Across Michigan ICUs

7. Slide 7 % of respondents within an ICU reporting good safety climate Safety Climate Across Michigan ICUs Culture of Safety- Michigan

8. "Needs Improvement“ Statewide Michigan CUSP ICU Results Less than 60% of respondents reporting good safety climate =“needs improvement” Statewide in 2004 84% needed improvement, in 2006 41% Non-teaching and Faith-based ICUs improved the most Safety Climate item that drives improvement: “I am encouraged by my colleagues to report any patient safety concerns I may have”

9. Slide 9 Hospital Survey on Patient Safety Culture Communication openness (Staff freely speak up if they see something that may negatively affect a patient and feel free to question those with more authority) Feedback and communication about error (Staff are informed about errors that happen, given feedback about changes implemented, and discuss ways to prevent errors ) Frequency of event reporting (Mistakes of the following types are reported: – Mistakes caught and corrected before affecting the patient – Mistakes with no potential to harm the patient, and – Mistakes that could harm the patient, but do not ) Handoffs and transitions (Important patient care information is transferred across hospital units and during shift changes)

10. Slide 10 Hospital Survey on Patient Safety Culture Management support for patient safety (Hospital management provides a work climate that promotes patient safety and shows that patient safety is a top priority) Nonpunitive response to error (Staff feel that their mistakes and event reports are not held against them and that mistakes are not kept in their personnel file) Organizational learning – continuous improvement (Mistakes have led to positive changes and changes are evaluated for effectiveness) Overall perceptions of patient safety (Procedures and systems are good at preventing errors and there is a lack of patient safety problems) Staffing (There are enough staff to handle the workload and work hours are appropriate to provide the best care for patients)

11. Slide 11 Hospital Survey on Patient Safety Culture Supervisor/manager expectations & actions promoting patient safety (Supervisors/managers consider staff suggestions for improving patient safety, praise staff for following patient safety procedures, and do not overlook patient safety problems) Teamwork across units (Hospital units cooperate and coordinate with one another to provide the best care for patients) Teamwork within units (Staff support each other, treat each other with respect, and work together as a team) Patient safety “grade” (Excellent to Poor) Number of events personally reported in the past 12 months

12. Slide 12 2011 HSOPS results Areas of strength for most hospitals – Teamwork Within Units (average 80 percent positive response) – Supervisor/Manager Expectations & Actions Promoting Patient Safety (average 75 percent positive response – Patient Safety Grade On average, most respondents within hospitals gave their work area or unit a grade of either "A-Excellent" (29 percent) or "B-Very Good" (46 percent) on patient safety. Areas of weakness for most hospitals – Nonpunitive Response to Error (average 44 percent positive response) – Handoffs and Transitions (average 45 percent positive response) – Number of Events Reported —On average, most respondents within hospitals (54 percent) reported no events in their hospital over the past 12 months. Data from 1,032 U.S. hospitals. Sorra J, Famolaro T, Dyer N, et al. Hospital Survey on Patient Safety Culture: 2011 User Comparative Database Report. AHRQ Publication No. 11-0030, April 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/qual/hospsurvey11/

13. Slide 13 LENS Hospital Survey on Patient Safety Measure (No. of Items in Scale)nMeanSD % of Positive Responses Outcome Measures Frequency of Event Reporting (3) 157 3.311.0048.61 overall perceptions of safety (4) 1573.57.8066.24 Safety Culture Dimensions (Unit level) Supervisor/manager expectations & actions promoting safety (4) 1553.59.7266.18 Organizational Learning (3) 1573.64.6866.59 Teamwork within Hospital Units (4) 1583.81.7173.52 Communication Openness (3) 1583.43.7351.49 Feedback and Communication About Error (3) 1583.34.7946.93 Nonpunitive Response To Error (3) 1563.00.8037.74 Staffing (4) 1583.39.9257.54 Hospital Management Support for Patient Safety (3) 1583.56.9065.82 Safety Culture Dimensions (Hospital-wide) Teamwork Across Hospital Units (4) 1583.39.7654.44 Hospital Handoffs & Transitions (4) 1583.13.7839.87

14. Slide 14 Safety Culture Composite Scores by Roles Domains Attending Surgeons (n=17) Surgical Support Team (n=11) Anesthesia Team (n=47) Nurses (n=41) Perfusionists (n=22) Other Clinical Staff (n=5) Overall Perceptions of Safety 94%86%57%65%60%50% Frequency of Events Reported 55%39%42%62%26%60% Supervisor/Manager Expectations & Actions Promoting Patient Safety 72%82%62%67%64%75% Organizational Learning-- Continuous Improvement 78%79%57%67%60%73% Teamwork Within Units88%84%78%69%73%70% Preliminary data

15. Slide 15 Domains Surgeons (n=17) Surgical Support Team (n=11) Anesthesia Team (n=47) Registered Nurses (n=41) Perfusionists (n=22) Others (n=5) Feedback & Communication About Error 55%67%41%52%41%47% Nonpunitive Response to Error 36%42%31%48%29%13% Staffing 68%73%54%64%43%35% Hospital Management Support for Patient Safety 88%82%59%69%52%87% Teamwork Across Hospital Units 84%77%42%57%55%35% Hospital Handoffs & Transitions 68%43%28%43%35%20% Safety Culture Composite Scores by Role Preliminary data

16. Slide 16 What can we do about low culture scores? Safety Culture “check up” Select items where your unit/area did not perform well Convene focus groups of all provider roles to discuss in confidence what is going on that leads to specific low measures Brainstorm concrete actions that can be taken to improve each area Implement 2-3 actions each Reassess with your own mini-questionnaire

17. Slide 17 Action Items Encourage high participation on HSOPS survey (shoot for 100%!) Provide specific time to complete survey (show your commitment!) Display, publicize your unit/ area results (strengths and areas for improvement) Begin work on problem areas Report on progress