1. NH Patient Safety Culture Survey (AHRQ) Beth Hercher, QI Specialist Patient Safety Team April 2009 Patient Safety Restraint Collaborative Learning Session 2

2. Acronyms AHRQ Agency for Healthcare Research and Quality NH SOPS Nursing Home Survey of Patient Safety

3. “The right care for every person, every time.” CMS Vision Statement for the National Healthcare Quality Improvement Program

4. S afe T imely E ffective Efficient Equitable P atient-centered The Institute of Medicine The “Right Care”

5. “How we do things here” Unique challenges, but similar to all other Nursing Homes in TN –Opportunities for Improvement –Aspects of brilliance! Administrative and Medical Leadership commitment to quality and safety Data for learning, not judgment Organization-wide, systematic approaches to improvement Foundation: Organizational Culture

6. Teamwork/Quality Improvement Is… An Attitude!!! –Professional life –Personal life

7. Examples of Teamwork/QI “Attitude” We’re good people and care about what we do We need (re)education and (re)training Our processes need to be improved We need to be held accountable, not “judged” (words, tone of voice, body language, facial expression) Process and outcome data is for learning, not judgment Together Everyone Accomplishes More Our differences are our strengths

8. Why Teamwork/Continuous Quality Improvement (CQI)? It’s good business! –Eliminate waste –Improve work flow –Manage time –Improve the work environment –Design systems to avoid mistakes –Enhance the producer/customer relationship Taken from: “The Improvement Guide,” Langley and Nolan et al, 1996

9. Team Member Responsibilities Understand/“own” the goals (be engaged) Offer perspectives and ideas/work for consensus Participate in meetings, discussions, decisions, and activities Follow through on action items, tasks, etc. Share knowledge, skills, experience, expertise Respect other team members’ opinions; avoid negative comments Build team cohesiveness through participation

10. Safety Culture Definition The safety culture of an organization is the product of individual and group values, attitudes, perceptions, competencies, and patterns of behavior that determine the commitment to an organization’s health and safety management.

11. Organizations with Positive Safety Culture Characterized by communications founded on mutual trust Shared perceptions of the importance of safety Confidence in the efficacy (capacity) of preventive measures

12. Nursing Home Survey on Patient Safety Culture Developed by Agency for Healthcare Research and Quality (AHRQ) Designed specifically for nursing home staff Asks for their opinions about the culture of patient safety in nursing homes

13. The Survey Used for: Diagnostic tool to assess patient safety culture Intervention to raise staff awareness for patient safety issues Mechanism to evaluate the impact of patient safety improvement initiatives Track changes in patient safety culture over time

14. NH Patient Safety Culture Dimensions 42 Items assess the following 12 dimensions of patient safety culture: 1.Communication openness 2.Compliance with procedures 3.Feedback and communication about incidents 4.Handoffs 5.Management support for resident safety 6.Nonpunitive response to mistakes

15. NH Patient Safety Culture Dimensions, cont. 7.Organizational learning – continuous improvement 8. Overall perceptions of resident safety 9. Staffing 10. Supervisor/Manager expectations and actions promoting resident safety 11. Teamwork 12. Training and skills Resident safety “grade” (Excellent to Poor) Overall recommendation of nursing home to friends

16. Final formatted survey Survey User’s Guide providing instruction on data collection and analysis Microsoft Excel data entry and analysis tool NH SOPS Toolkit

17. Westat has designed a data entry and analysis tool to display results from the new nursing home survey –Input individual survey data –Create graphs and tables to display your survey results overall and by various demographics –Analyze which patient safety culture dimensions may need additional attention –Share the results with others in your organization. All results are printable. SOPS Nursing Home Data Entry and Analysis Tool

18. Tool is meant for a single nursing home with a minimum of 5 respondents Can upload the tool directly into the upcoming nursing home data submission system Each tool will handle data entry of up to 2,500 individual survey responses You must have at least Microsoft Excel 2002 or higher to use the tool This tool uses Excel macros. Make sure your firewall accepts macros before downloading SOPS Nursing Home Data Entry and Analysis Tool, cont.

19. Home Page

20. Data Entry Only enter data in green cells

21. Item Level Results Item results will be displayed only where there are more than 2 respondents answering an item

22. SOPS Nursing Home Data Entry and Analysis Tool, cont. Composite Level Scores are the average percent of positive responses for each patient safety culture area. Composite level scores are not calculated when an item in a composite has less than 3 respondents.

23. Composite Level Results Comparative results are based on 40 pilot nursing homes

24. Composite Level Comparative Results

26. Recommendations to Friends Comparative Results

27. TeamSTEPPS: Team Strategies and Tools to Enhance Performance and Patient Safety Developed by the Agency for Healthcare Research and Quality and the Department of Defense Purpose: To enhance performance and patient safety

28. TeamSTEPPS, cont. Emphasis: Teamwork and communication Communication and teamwork skills are essential to providing quality care and preventing medical errors

29. Communication Satisfaction surveys show that greatest areas of concern involve some form of communication breakdown

30. Two broad categories of communication among providers: Between your facility and an outside provider Within your facility

31. Communication within your facility When contacting medical staff for orders Reporting off at shift change Upon being assigned a new patient Times when good communication is crucial:

32. Communication within your facility, cont. When the patient has had a change in condition When there has been a change in the Plan of Care Times when good communication is crucial:

33. Streamlining Communication Consistent format Easy way to organize information Way to assure all important information is communicated

34. Streamlining Communication, cont. Effective communication is: Complete Clear Brief Timely

35. SBAR Streamlining Communication, cont.

36. T EAM STEPPS 05.2 Mod 3 05.2 Page 36 Essentials

37. Next Steps May-June 2009-Baseline Survey Conduct paper survey tool Response feedback entered into data analysis tool July 31, 2009 Data analysis tool submitted to QSource

38. Next Steps, cont. May-June 2010-Re-measurement Re-administer paper survey tool Response feedback entered into data analysis tool July 31, 2010 Data analysis tool submitted to QS ource

39. Thank You! Patient Safety Team 1.800. 528.2655 Beth Hercher Laurie Gyscek Susan duLaney Barbara Meadows This presentation and related materials were developed by QSource, the Medicare Quality Improvement Organization for Tennessee, under contract with the Centers for Medicare & Medicaid Services (CMS), a division of the Department of Health and Human Services. Contents do not necessarily reflect CMS policy. QSOURCE-TN-109.62-2008-16