1. Rural Organizational Safety Culture Change (ROSC) Identified Participant Group (IPG)

2. What is ROSC?  National initiative of the CMS 8th Scope of Work: 2005–2008  Specific for CAHs and rural hospitals  Focus: Organizational change to create a culture of patient safety  Measurable results

3. What are the basic components of ROSC?  Assessment of the current patient safety culture via the Hospital Survey On Patient Safety Culture (HSOPSC)—Spring 2006  Analyze/interpret results for interventions— Summer 2006  Determine/initiate/implement interventions— Summer 2006 onward  Remeasure to determine improvement— late Summer 2007

4. What is an IPG?  An IPG is a group of hospitals that have agreed to work with the CMS-contracted Quality Improvement Organization (QIO) to accelerate quality improvement.  To participate, each hospital’s CEO must have signed the participation agreement that recognized the strong role of hospital leadership.

5. Why did CMS include IPGs in its 8th SoW?  Prior pace of quality improvement was too slow  Need to accelerate improvement  CMS believes that IPGs will lead by example  Need for organizational culture change  Need to achieve transformational change

6. What is meant by organizational culture change?  Senior leadership orients the organization to quality  Staff empowerment and teamwork

7. What is meant by transformational change? Transformation: (1) Alters the culture of the institution by changing select underlying assumptions and institutional behaviors, processes, and products. (2) Is deep and pervasive, affecting the whole institution. (3) Is intentional. (4) Occurs over time.

8. Nationally, how many hospitals are participating in ROSC? 364 hospitals CAHs—245 Rural—119 Total—364

9. Why were six hospitals selected in Arizona?  CMS indicated a minimum and maximum number of hospitals to be included in each IPG, except ROSC.  ROSC had a minimum of six hospitals to be included, no maximum.  HSAG chose the minimum number of hospitals in order to focus its resources.

10. Which are the six Arizona ROSC Hospitals?  Benson Hospital  Copper Queen Community Hospital  Southeast Arizona Medical Center  Northern Cochise Community Hospital  Mt. Graham Regional Medical Center  Wickenburg Community Hospital

12. Who comprises the HSAG ROSC Team? Judith Richard, RN, MS, CPHQ ROSC Lead jrichard@azqio.sdps.org jrichard@azqio.sdps.org 602.665.6116 Suzanne K. Powell, RN, BSN, MBA, CPHQ, CCM Director, Acute Care/QI Program spowell@azqio.sdps.org 602.665.6109 Howard C. Pitluk, MD, MPH, FACS Medical Director hpitluk@hsag.com 602.665.6143 Charlie A. Chapin, MS, CHCA Director, Decision Support cchapin@azqio.sdps.org 602.665.6107 Larry Cooper, MA Director, Health Education & Publications lcooper@hsag.com lcooper@hsag.com 602.745.6309 Herb Rigberg, MD Chief Executive Officer hrigberg@hsag.com 602.264.6382 Suzette Googins, BA Administrative Assistant II sgoogins@azqio.sdps.org 602.745.6299 HSAG Services Advisory Group Web: http://acute.hsag.comhttp://acute.hsag.com Main Phone: 602.264.6382 Fax: 602.241.0757 Andrea B. Silvey, PhD, MSN Chief QI Officer asilvey@azqio.sdps.org asilvey@azqio.sdps.org 602.665.6135

13. Who comprises each hospital ROSC team?  Senior leaders (CEO, COO, CNO, CFO)  Directors (DON, pharmacy, lab, radiology)  Managers  Clinical champion  Communications  Others______________________

14. How will HSAG and hospital ROSC teams communicate with each other?  E-mail  Individual phone calls  HSAG visits to hospitals  Group teleconferences  Group meetings  ROSC4AZ E-mail List

15. What is the first step? Each hospital will obtain baseline results using the Hospital Survey On Patient Safety Culture (HSOPSC).

16. What is the HSOPSC?  Survey from hospital staff’s perspective  It can be completed by all types of staff, from housekeeping and security to nurses and physicians.

17. What is the purpose of the HSOPSC?  Assess safety culture of a hospital as a whole or for specific units  Identify areas of success  Identify areas for improvement  Provide a means for staff members to express their perspectives, thoughts, and opinions  Track change over time  Evaluate impact of interventions

18. What are the HSOPSC dimensions?  Overall perception of safety  Frequency of events reported  Supervisor/manager expectations and actions promoting patient safety  Organizational learning  Teamwork within units  Communication openness  Feedback and communication about error  Nonpunitive response to error

19. HSOPSC Dimensions (continued)  Staffing  Hospital management support for patient safety  Teamwork across hospital units  Hospital handoff and transition  Patient safety “grade”  Number of events individuals have reported in the last 12 months

20. HSOPSC Dimensions (continued)  Completion time 10–15 minutes  Total of 51 survey items  3 to 4 items per dimension  Area for comments

21. Survey Background  QuIC: Quality Interagency Coordination Task Force that consists of representatives from 11 federal agencies  AHRQ: Agency for Healthcare Research and Quality is the lead federal agency charged with conducting and supporting research to improve patient safety and health care quality for all Americans.  Westat: A statistical survey research corporation that serves agencies of the U.S. government, as well as businesses, foundations, and state and local governments. The HSOPSC was sponsored by the Medical Errors Workgroup of the QuIC, funded by AHRQ, and developed by Westat.

22. What was involved in the survey development process?  A review of the literature and existing safety culture tools  Interviews with hospital staff  Cognitive testing  Input/comment from researchers and health care stakeholders  Pilot-tested with over 1,400 respondents from 21 hospitals

27. How are hospitals to use the HSOPSC User’s Guide? Let’s Review

28. Why was a Web-based survey chosen in lieu of paper?  Inexpensive  Fewer human resources needed  Easy to administer and complete  No copying, data entry, or major data clean-up  Ease of repeated use for hospitals

29. What are the concerns with the Web-based survey?  Computer access  Low response rate  Difficult to follow up with nonresponders  Time to log onto computer and complete the survey Each of these will be discussed in the Survey Preparation section

30. Survey Preparation

31. What is needed for hospitals to administer the survey? Determine Population vs. Sample Arizona chose “hospital population,” i.e., all employees in the hospitals, including physicians, nurse practitioners, and physician assistants who practice at the hospital.

32. What else is needed for hospitals to administer the survey? Methodologies for Survey  Announcement  Incentives to obtain a high response rate  Instructions  Administration  Reminders/Follow-up

33. Announcement  Newsletter article from the CEO  Flyer (signed by CEO)  Message from the CEO  Posters  Communication book  Staff meetings  Letter sent to employees’ homes

34. Incentives for a High Response Rate  CEO message, support, and involvement  Hospital-wide incentive (goal and reward)  Prize drawing  Results will be shared with all staff  Improvement interventions will be implemented

35. Instructions for Survey Administration  Instructions Script  Modifiable for each hospital

36. Administration via Web-Based Survey  HSAG will send the hospital’s ROSC Team Leader an e-mail message and link to the survey.  The ROSC Team Leader will send the e- mail message and link to all hospital employees.

37. Survey Reminders / Follow-Up  Roster of all employees by department in alphabetical order (last name)  Staff members will inform their manager of survey completion and have their name checked off the list  Managers will periodically remind those whose name is not checked off the list

38. Concerns About a Web-based Survey  Computer access: Centralized computer, and paper tool as needed (see Instructions Script)  Low response rate: Incentives and CEO involvement  Difficult to follow up with nonresponders: Name check-off list  Time to log on and complete survey: Message that insufficient time to complete one’s work is a patient safety issue and needs to be conveyed. That is the purpose of the survey that is completely supported by senior leadership.

39. How will hospitals know the results? As soon as HSAG has the responses, in the determined time frame, it will perform data clean-up and analysis and will write a report to send to the hospital’s CEO.

40. When will hospitals know the results?  With all of May 2006 be devoted to data collection and clean up, this baseline report is planned to be sent to the CEO by the end of June.  The hospital CEO will share results with the ROSC team for hospital-wide dissemination and next steps.

41. Questions? Comments?

42. Tomorrow’s Next Step  Meet with your ROSC Team to update and decide on methodology.  See Methodology Example, Timeline, Flyer, Script, and Poster for hospital- specific modifications.

43. Follow-up Activities  Hospitals to contact Judith Richard at HSAG with problems, barriers, challenges, progress, questions or concerns, and requests.  HSAG to subscribe and send a welcome message to those signed up for the ROSC4AZ E-mail List.  HSAG to send survey link by the end of April.

44. Today’s Next Step  Team Development Form  ROSC4AZ E-mail List Form  Evaluation Form  Be safe driving home.

45. Contact Information Judith Richard, RN, MS, CPHQ ROSC Lead Health Services Advisory Group (602) 665-6116 jrichard@azqio.sdps.org

46. www.hsag.com This material was prepared by Health Services Advisory Group, the Medicare Quality Improvement Organization for Arizona, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication No. AZ-8SOW-1C-032306-01