1. Patient Safety Culture and Resilience
May 2016

2. UNC Medical Center Survey Details
We use the Agency for Healthcare Research and Quality Medical Office Survey on Patient Safety Culture
Administered Sept 20 to Oct 17, 2015 in 63 unique out-patient areas
Overall Response Rate – 76%
Add your clinic response rate #taking survey/number staff who could have taken the survey X 100 =XX% response rate.

3. Survey Dimensions Teamwork Patient Care Tracking/Follow-up
Organizational Learning
Overall Perceptions of Patient Safety and Quality
Staff Training
Leadership Support for Safety
Communication About Error
Communication Openness
Office Processes and Standardization
Work Pressure and Pace
Resilience
42 Questions for the 12 numbered dimensions and 8 additional questions for Resilience and Stress Recognition dimensions.
Resilience and Stress Recognition are dimensions measured on the other nationally recognized safety culture survey called the “Safety Assessment Questionnaire or SAQ”. This is the survey used at Duke.
RESILIENCE (EMOTIONAL EXHAUSTION/INNOVATION FATIGUE) RESULTS
Definition
Resilience is a function of your ability to cope, and the availability of resources related to health and well being. Here it is measured using the emotional exhaustion subscale of the Maslach Burnout Inventory.
Items (all items are reverse scored so that a higher score is better)
I feel fatigued when I get up in the morning and a have to face another day on the job
I feel burned out from my work
I feel frustrated by my job
I feel I am working too hard on my job
Intervention
Resilience is the “pace-ometer,” for a work setting, as it tells you the pace and intensity of interventions and efforts that are likely to be successful and sustainable. If resilience is high, taking on significant teamwork or safety related interventions is reasonable if this unit falls below 60% on either teamwork climate or safety climate. However, if this unit falls below 60% on teamwork and/or safety climate, and the resilience score is also below 60%, then an initial focus on resilience and work-life balance is important as a first step.

4. Overall Survey Results Comparison 2013 v 2015

5. 2013 ALL CLINICS Survey Results
Teamwork
Office Processes/ Standardization
N=889
Staff Training
Organizational Learning
Communication about Error
Perceptions of Patient Safety and Quality
Leadership Support
Patient Care Tracking/Follow-up
Communication Openness
This slide displays the overall results from 2013.
Percentiles come from the 2012 AHRQ Medical Officer Survey on Patient Safety Culture Benchmark Database. These percentiles are calculated using all respondents to the benchmark database, in other words, includes for example hospital based, community based, big, small, etc.
Dimension 10th %tile 25th%tile 50th %tile 75th%tile 90th%tile
Teamwork 68% 78% 86% 94% 98%
Patient Care Tracking/Follow-up 65% 75% 84% 92% 96%
Organizational Learning 59% 69% 78% 88% 95%
Perceptions of Pt Safety and Quality 58% 68% 78% 87% 94%
Staff Training 50% 63% 75% 84% 92%
Leadership Support for Safety 45% 57% 67% 78% 87%
Communication about Error 49% 56% 66% 77% 88%
Communication Openness 43% 54% 64% 76% 86%
Office Processes and Standardization 39% 53% 65% 76% 86%
Work Pressure and Pace 21% 33% 46% 59% 74%
Work Pressure and Pace
90th Percentile
75th Percentile
25th Percentile
10th Percentile
Average

6. 2015 Clinics Survey Results
Communication about Error
Organizational Learning
Leadership Support
Office Processes/ Standardization
N=708
Perceptions of Patient Safety and Quality
Staff Training
Work Pressure and Pace
Patient Care Tracking/Follow-up
Teamwork
Communication Openness
Percentiles come from the 2012 AHRQ Medical Officer Survey on Patient Safety Culture Benchmark Database. These percentiles are calculated using all respondents to the benchmark database, in other words, includes for example hospital based, community based, big, small, etc.
Instructions to customize for your results: Move your dimension box on the see-saw to match the %tile. Your dimension is at the % if it is the same or less than the %tile value and higher than the lower %tile value. For example if your teamwork score is 97% you group is in the 75th %tile. 75% of all others have lower scores and 24% of all others have better scores. Think of this as getting “graded on the curve”. See the Work Pressure and Pace dimension below. The highest 90th %tile score is 74% which you would think is about a “C” grade but since nationally it is hard to find a clinic without work pressure and pace challenges this is graded on the curve and a 74% is an “A”! Add your N=XX.
Dimension 10th %tile 25th%tile 50th %tile 75th%tile 90th%tile
Teamwork 68% 78% 86% 94% 98%
Patient Care Tracking/Follow-up 65% 75% 84% 92% 96%
Organizational Learning 59% 69% 78% 88% 95%
Perceptions of Pt Safety and Quality 58% 68% 78% 87% 94%
Staff Training 50% 63% 75% 84% 92%
Leadership Support for Safety 45% 57% 67% 78% 87%
Communication about Error 49% 56% 66% 77% 88%
Communication Openness 43% 54% 64% 76% 86%
Office Processes and Standardization 39% 53% 65% 76% 86%
Work Pressure and Pace 21% 33% 46% 59% 74%
90th Percentile
75th Percentile
25th Percentile
10th Percentile
Average

7. Resilience

8. Resilience Goal = >60% Resilience Average 60 % Item
Percent Positive
I feel burned out from my work
66% disagreed with this statement.
I feel I am working too hard on my job
54% disagreed with this statement.
I feel fatigued when I get up in the morning and have to face another day on the job
61% disagreed with this statement.
I feel frustrated by my job
60% disagreed with this statement.
Resilience Average
60 %
Modify this to match your survey results. For each item add strongly disagree and disagree to get the percent positive. Average these four number to get the Resilience average. 60 or greater indicates enough reserves to bounce back from stressors or deal with short and long term stress.
Goal = >60%
60 or greater indicates enough reserves to bounce back from stressors or deal with short and long term stress.

9. Tools to Enhance Resilience
Apply practical strategies such as the 3:1 ratio, 3 Good Things, active constructive responding and Signature Strengths as simple strategies that increase their own well-being.

10. Resilience: Definition
Definition: a function of your ability to cope, and the availability of resources related to health and well-being ~ J. Bryan Sexton, PhD Definition: the ability to resist, absorb, recover from or successfully adapt to adversity or a change in conditions. ~ Department of Homeland Security Definition: the process of adapting well in the face of adversity, trauma, tragedy, threats or significant sources of stress — such as family and relationship problems, serious health problems or workplace and financial stressors. It means "bouncing back" from difficult experiences. ~ American Psychological Association

11. Resilience in the Workplace
While some people have natural coping skills, “we know that resilience can be developed , and you can give people the resources to build within them the power to bounce back from adversity,” says Fred Luthans, management professor emeritus at the University of Nebraska who is co-author of “Psychological Capital and Beyond,” a book about applying positive psychology science at work, and who is developing webinars on resilience training.

12. Borrowed from Duke Patient Safety Center and WISER materials

13. Tool: Three Good Things
As an extension of the concept of being grateful, there is a simple exercise you can do daily to note the good things in your life.
It is simply called ‘Three Good Things” Where you list the three good things that you experienced in one day
Say: As an extension of the concept of being grateful, there is a simple exercise you can do daily to note the good things in your life. It is simply called ‘Three Good Things” Where you list the three good things that you experienced in one day

14. The Science Behind Three Good Things
The ‘Father of Positive Psychology’, Marty Seligman, and Tracy Steen from the University of Pennsylvania found that by reflecting on positive experiences for a couple of minutes just before bedtime, we savor good moments from earlier that day.
From this structured focus, research found improvements in resilience, sleep quality, work-life balance, and even depression.
Say: Marty Seligman, considered the “father of positive psychology” and Tracy Steen from the University of Pennsylvania found that by reflecting on positive experiences for a couple of minutes just before bedtime, we savor good moments from earlier that day. From this structured focus, research found improvements in resilience, sleep quality, work-life balance, and even depression.

15. The Science Behind Three Good Things
Say: In this study, 59 people (represented by the black column) practiced Three Good Things every day for one week and were outscoring the placebo control group on an happiness survey up to six months afterward.
In this study, 59 people (represented by the black column) practiced Three Good Things every day for one week and were outscoring the placebo control group on an happiness survey up to six months afterward.
- Seligman, Steen, Park & Peterson, 2005

16. Want to learn more about 3 Good Things?
Bite Sized Resilience: Three Good Things
Enroll in the next cohorts scheduled for:
May , 2016
Say: “If you would like, you can become part of a research project that Duke is conducting through their Patient Safety Center. Here is the URL you can use.” This is an easy way to try out practicing 3 good things. If you sign up you’ll complete a quick consent, a very short well-being survey, and then for the 2 wks selected you’ll get an every evening at 7PM inviting you to submit you 3 good things for the day. You’ll be asked to take the well-being survey again at the end and then again in 6 months. Bryan Sexton told me that after he was here over 300 people from UNC signed up and participated. I just recently participated myself. I had done it once 3 years ago. Both 3 yrs ago and recently I had a very positive experience.

17. Tool: Gratitude
Robert Emmons, the world’s leading scientific expert on gratitude, argues that gratitude has two key components.
It’s an affirmation of goodness. We affirm that there are good things in the world, gifts and benefits we’ve received.
We recognize that the sources of this goodness are outside of ourselves. We acknowledge that other people—or even higher powers, if you’re of a spiritual mindset—gave us many gifts, big and small, to help us achieve the goodness in our lives.

18. The Science Behind Gratitude
Based on the work of Robert Edmonds from UC Davis, his research suggests that a conscious focus on “blessings” or gratitude may have positive emotional and interpersonal benefits because it builds psychological, social and spiritual resources.

19. Tool: Signature Strengths
24 universal strengths found across cultures, nations, religions and politics. “They are moral strengths – strengths that we value in and of themselves.”
Martin Seligman, 2012
Say: Do you find life exhausting and frustrating? Or is it easy and exhilarating? The difference between the two experiences may hinge on something simple: whether or not your life is aligned to your signature strengths.
Dr. Martin Seligman, considered the father of positive psychology, came up with a structured opportunity to examine what we like doing and are good at, and to be deliberate about using our strengths in new and more frequent ways.
When you use your strengths, you feel engaged and invigorated, and you feel like what you are doing has more meaning to you personally. By deliberately choosing to do what we already do well, especially to deal with difficult tasks, we get into a “flow” and see improvements in resilience and depression.

20. Tool: Active Constructive Responding
Active constructive responding is the most effective way to respond, giving both the deliverer of good news and the listener a positive outcome. Reacting positively, being interested, and caring about the news of others. Active constructive responding helps develop and maintain strong personal relationships. If you retrain yourself to offer active and constructive responses to the people in your life, you will find yourself feeling more positive as well as receiving positive feedback from others.
You already have one of the tools – supportive team mates. You work in an area with high perception of positive Teamwork scores on the Patient Safety culture survey. You can strengthen the resilience building of you teamwork by practicing “Active constructive Responding” is about reacting positively, being interested and caring about the news of others. Role play – how was your weekend good and bad responding.