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

2. 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 GP Practices
WEAHSN 11 GP Practices
EEAHSN wards
Mental Health Trust

3. 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

4. The path we have trodden….

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

6. 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

7. 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.

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

9. 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

10. 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

11. 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

12. 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

13. 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

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

15. 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

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

17. 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.

18. Questions

19. Thank you!