1. Safe & Reliable Healthcare Allan Frankel MD Michael Leonard, MD Terri Christensen RN, COO Joshua Proulx, CTO Maleek Jamal, PhD, CSO Duke Patient Safety Center J. Bryan Sexton PhD

2. A Brief History: Safety Culture and Workforce Engagement Assessment of safety culture and of workforce engagement in healthcare settings have historically been conducted separately, under the umbrellas of departments of quality and human resources, respectively. This separation is happenstance, a result of two fields advancing at different times in isolation of each other. We integrate into a single instrument scales and items from safety culture and workforce engagement because they both look at culture and their components are inextricably entwined.

3. The Integrated SCORE Safety, Communication, Operational Reliability and Engagement Survey Highly diagnostic and actionable questions target explicit improvements that drive measurable, sustainable cultural, clinical, financial and operational results Powerful psychometrics The opportunity to customize questions to generate longitudinal data benchmarks Comprehensive end-to-end survey offering with best-in- breed analytics and reporting Full mobile functionality for survey, reporting and analytics platform

4. SCORE Survey Domains Safety Culture/Resilience Learning Environment Local Leadership/Management Resilience/ Burnout Teamwork Safety Climate Work / Life Balance Work Force Engagement Job Demands Job-related Uncertainty Intentions to Leave Workload Resources Growth Opportunities Participation in Decisions Advancement

5. Validity: Cronbach’s Alpha Safety Culture/Resilience.935 Learning Environment.973 Local Leadership.915 Resilience/ Burnout.805 Teamwork.861 Safety Climate.835 Work / Life Balance Work Force Engagement Job Demands.881 Job-related Uncertainty.873 Intentions to Leave.847 Workload Resources.907 Growth Opportunities.856 Participation in Decisions.873 Advancement

6. Learning Environment Taking the survey…….

7. 7 UNMINDFUL “We show up, don’t we?” Chronically Complacent UNMINDFUL “We show up, don’t we?” Chronically Complacent REACTIVE “Safety is important. We do a lot every time we have an accident” REACTIVE “Safety is important. We do a lot every time we have an accident” SYSTEMATIC Systems being put into place to manage most hazards SYSTEMATIC Systems being put into place to manage most hazards PROACTIVE “We methodically anticipate”— prevent problems before they occur PROACTIVE “We methodically anticipate”— prevent problems before they occur GENERATIVE Organizational Culture “Genetically- wired” to produce safety GENERATIVE Organizational Culture “Genetically- wired” to produce safety Learning Environments Attribution: Prof. Patrick Hudson, Univ. Leiden

8. Perceptions of Local Leadership Effective and visible leadership providing support and feedback to the front line is an essential component of a high performance culture.

9. Local Management/Leaders

10. Resilience and Burnout Caring for the caregiver is mandatory. Burnout creates cynicism, leading to disengaged employees and, in the clinical setting, to poorer patient care. Burnout also takes a toll on healthcare providers, making them more susceptible to illness. Some studies indicate that as many as 4 out of 10 caregivers have symptoms of burnout.

11. Teamwork and Safety Legacy domains evaluate the willingness of providers to speak up about concerns (psychological safety), the ability of disciplines to coordinate with each other (teamwork behaviors), the effectiveness of leaders to create a climate perceived as trustworthy and just, and the perception of reliability in the workplace.

12. Work-life Balance Work-life balance evaluates how workplace policies and expectations affect work productivity and personal/family well-being. Important insights can be gained by examining the relationship between work-life balance, burnout and engagement.

13. Engagement How engaged are your caregivers and employees? Do you have highly motivated caregivers who are willing to go above and beyond to propel your organization to become a highly reliable and operationally excellent 21st century healthcare provider? Uses a job-demands resource model approach to measure engagement.

17. SCORE Survey Preparation…What next? (c) 2013

18. SCORE Survey Setup Two steps to setting up the SCORE survey Work Setting mapping – Obtaining a list of the various work settings (units) that will be surveyed, along with the expected number of responses per work setting. Choosing a survey distribution method – Determining which method of survey distribution will work best for your organization: One link per survey One link per work setting Emailed invites for each respondent Identify work setting administrators to receive daily response rate updates (c) 2013

19. SCORE Survey Distribution Methods One link per survey – Safe & Reliable will give you one link to distribute to your organization. Each respondent picks their work setting in question #1. This is typically the easiest distribution method. One link per work setting – Safe & Reliable will give you one link per work setting. You can then have each unit or work setting administrator forward that link to the members of their group. This method only works well if your unit administrators will reliably forward the link the first time and will periodically send follow-up emails. Emailed invites for each respondent – You will provide a list of email addresses along with the name and work setting for each potential respondent. Safe & Reliable will work with you to ensure that the emails will not be filtered as spam by your email servers. (c) 2013

20. Survey Go Live Prior to survey launch we will send you a link to review so that you can confirm the following: The work setting (unit) list is correct The position types are appropriate for your work settings The survey link is accessible on your network The survey loads properly in your organization’s default browser (c) 2013

21. The End in Mind: SCORE Report Platform

22. Illinois Hospital Association SCORE Timeline (c) 2013 March April May to September November Informational call March 24, 2016 Confirm participation by April 14, 2016 Survey set-up Webinars ID Primary Points of Contact (POC) & Work Setting Administrators (WSA) Select administration option Map work settings (due 2 weeks prior to chosen “Go-Live” date) Determine “Go Live” date Prepare, Publicize, Strategize Complete “Test” survey Survey Launch at each site based on chosen “Go-Live” date (Phase I: May 1 – June 30, 2016: Phase II: July 1 - September 30, 2016) Daily response rate updates to POCs & WSAs Survey remains LIVE striving for adequate response rates (up to 6 weeks total survey time) Survey remains LIVE (if necessary) striving for adequate response rates (all surveys will close no later than November 14, 2016) Report Center Training Webinars Leadership Brief & Action Planning Webinars for; Data is accessible by sites 3-4 weeks following Survey Close.

23. Next Steps Identify your main points of contact for the survey (Executive Sponsors / Survey Mapping Leads) Build your internal strategy to prepare, strategize & publicize –template letters to potential survey respondents. Determine survey distribution method. Send in mapping document Review provisioned survey and position type list (c) 2013

24. Email: josh@safeandreliablecare.com at any point throughout the survey process.josh@safeandreliablecare.com Questions? (c) 2013