Safer Culture, Better Care Matt Hill, Consultant Anaesthetist & Regional Patient Safety Lead Jo Pendray, Improvement Lead 29 March 2017

Profile of work South West 41 work settings 7 Acute Trusts 3 Mental Health Trusts 15 GP practices 1 Care Home Repeated in 2 so far….. National (PiSCES) Haelo 7 GP Practices WEAHSN 11 GP Practices EEAHSN 6 wards Mental Health Trust

Introduce yourself to your group Think of one word to describe the culture in your work team Share with your group Write your word on the flipchart

The path we have trodden….

Preparation is key Promotion Learning opportunity Local understanding Champion Commitment Improvement skills and knowledge Senior buy in

Survey Domains Domain What does it measure? Learning Environment The ability of a work setting to self-reflect, identify problems and solve them, learn from excellence Local Leadership The level of confidence that respondents have in the support they receive from their local leaders including positive feedback Burnout & Work Life Balance The degree of cynicism, emotional exhaustion and frustration that respondents feel Teamwork How effectively different disciplines coordinate their efforts and whether they work in a psychologically safe environment Safety Climate The degree to which mindfulness and psychological safety exist in the work setting Learning Env – also strengths and opportunities for improvement and learning.. Local Leadership – Perceptions of feedback overall – another hallmark of a learning culture. Burnout & Work Life Balance – low scores can usually be linked to absenteeism, poor staff retention, low staff morale, poor performance, disturbed sleep and all affect clinical outcomes of patients Teamwork also includes dealing with difficult colleagues and effectiveness of communication internally and externally Safety Climate also assesses how safe staff would feel to be treated in their work setting as a patient

This example of the teamwork domain shows a number of aggregated scores from those who have taken part in the survey in the South West and it clearly shows that people perceive patient care is put first and that teamwork is strong – the issues come with communication breakdowns and dealing with difficult colleagues, which to some extent reflects the complexities of negotiating the healthcare system as a whole. Dealing with difficult colleagues within a work setting we will cover later.

Exercise Look at the domain results and draw how the results make you feel…..

Local Leadership Domain In this work setting, local leadership... is available at predictable times. % 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 38 Safe and Reliable Healthcare

Teamwork Domain Safe and Reliable Healthcare care. % 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 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 Safe and Reliable Healthcare

Burnout Domain Safe and Reliable Healthcare Events in this work setting affect the lives of people here in an emotionally unhealthy way % 20 40 60 80 100 People in this work setting are working too hard on their jobs. frustrated by their jobs exhausted from their work. burned out from their work. (151) 61 75 77 83 78 Safe and Reliable Healthcare

Safety Climate Domain Safe and Reliable Healthcare My suggestions about quality would be acted upon if I expressed them to management % 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 85 58 36 68 Safe and Reliable Healthcare

Enablers Voluntary engagement Right information Clarity and understanding of roles Good local promotion Staff engaged with process Psychological safety with the survey & work place Meaningful debriefing process Opportunity for learning

Barriers Lack of psychological safety Staff not engaged Management lack of information Management anxiety Mandating participation   Perception that survey results are judgement or inspection

Psychologically safe teams know that…… Work is uncertain and frame it as a learning problem Leaders say “I may miss something. I need to hear from you” Leaders model curiosity and ask more questions Dr Amy Edmondson, Harvard Business School Professor

Engage – Connect - Commit South West Debriefing Community Community of people trained in debriefing Training available 22 June Facilitation & debriefing opportunities

Effective behaviours Structured communication eg SBAR Critical language Clarity in everything Identify shared goals Plan forward Reflect back Celebrate success Communicate clearly & openly Brief Debrief Teams with a healthy and safe culture are those who maximise the efficacy of teamwork by starting with shared goals and communicating frequently, clearly and positively. Communication and psychological safety are themes which run throughout the survey whether between team members or as part of the relationship between staff and managers. Briefings and debriefings are tools which can be used to highlight actions needed and to reflect on what went well as well as what can be improved. Using language tools such as the SBAR in communicating about patient care in handovers and briefings ensures that there are common expectations about communication and that information is consistent and relevant, which reduces variation and increases safety.

Questions

Thank you! matt.hill1@nhs.net Joanna.Pendray@swahsn.com