1. HSOPS & Culture Debriefing1 DRAFT Pending AHRQ Approval ARMSTRONG INSTITUTE FOR PATIENT SAFETY AND QUALITY SALLIE WEAVER, PHD NASIR ISMAIL, MS, Doctoral Candidate Remeasuring Safety Culture: The Follow Up HSOPS Survey

2. HSOPS & Culture Debriefing2 DRAFT Pending AHRQ Approval Polling Question #1 Surgeon Quality improvement practitioner Infection preventionist OR nurse OR technician Anesthesiologist OR manager Educator Other What is your current role?

3. HSOPS & Culture Debriefing3 DRAFT Pending AHRQ Approval Polling Question #2 Have you presented the HSOPS results to your unit staff/management? Yes No

4. HSOPS & Culture Debriefing4 DRAFT Pending AHRQ Approval Learning Objectives 1.Describe the value of HSOPS data 2.List steps to complete the HSOPS survey 3.Increase HSOPS response rate 4.Download and debrief HSOPS report

5. HSOPS & Culture Debriefing5 DRAFT Pending AHRQ Approval Can my hospital still take the survey if we have not completed a baseline survey? YES

6. HSOPS & Culture Debriefing6 DRAFT Pending AHRQ Approval Cohort 3 HSOPS Follow-Up Schedule Survey period opens: Oct 14 th, 2014 12:00 pm ET Survey period closes: Dec 2 nd, 2014 5:00 pm ET

7. HSOPS & Culture Debriefing7 DRAFT Pending AHRQ Approval Agenda Why should you complete the HSOPS Survey? How do you complete the HSOPS survey? How can you increase the response rate? How do you download the HSOPS final report? Why should you debrief that report?

8. HSOPS & Culture Debriefing8 DRAFT Pending AHRQ Approval Why Should You Complete HSOPS Survey? Measures safety culture within the units of hospital What does Safety Culture mean? – Perceived priority of safety relative to other goals – Attitudes, beliefs, perceptions, and values related to safety within an organization Hospital Survey On Patient Safety Culture (HSOPS)

9. HSOPS & Culture Debriefing9 DRAFT Pending AHRQ Approval Core Aspects of Safety Culture 1 Draft-Pending AHRQ Final Approval 9 CULTURE OF SAFETY Communication patterns and language Feedback, reward and corrective action practices Formal and informal leader actions and expectations Teamwork processes (backup behavior) Resource allocation practices Error-detection and correction systems

10. HSOPS & Culture Debriefing10 DRAFT Pending AHRQ Approval Safety Culture Is Related To Outcomes 2,3,4,5,6,7,8 Patient outcomes Patient care experience Infection rates, sepsis Postoperative hemorrhage Respiratory failure, accidental puncture or laceration Treatment errors Clinician outcomes Incident reporting Burnout and turnover

11. HSOPS & Culture Debriefing11 DRAFT Pending AHRQ Approval HSOPS Dimensions 1.Supervisor / manager expectations and actions promoting patient safety 2.Organizational learning- continuous improvement 3.Teamwork within unit 4.Communication openness 5.Feedback and communication about error 6.Nonpunitive response to error 7.Staffing 8.Hospital management support for patient safety 9.Teamwork across hospital units 10.Hospital handoffs and transitions

12. HSOPS & Culture Debriefing12 DRAFT Pending AHRQ Approval HSOPS Sample Questions 10 COMPOSITE SCORES (DIMENSIONS)SAMPLE QUESTION 1. Supervisor/manager expectations & actions promoting patient safety B1. My supervisor/manager seriously considers staff suggestions for improving patient safety. 2. Organizational learning- continuous improvement A9. Mistakes have led to positive changes here. 3. Teamwork within unitA1. People support one another in this unit. 4. Communication openness C4. Staff feel free to question the decisions or actions of those with more authority. 5. Feedback & communication about error C1. We are given feedback about changes put into place based on event reports.

13. HSOPS & Culture Debriefing13 DRAFT Pending AHRQ Approval HSOPS Sample Questions 10 COMPOSITE SCORES (DIMENSIONS)SAMPLE QUESTION 6. Nonpunitive response to error A8. Staff feel like their mistakes are held against them. (negatively worded) 7.StaffingA2. We have enough staff to handle the workload. 8.Hospital management support for patient safety F8. The actions of hospital management show that patient safety is a top priority. 9.Teamwork across hospital units F4. Cooperation is good among hospital units that need to work together. 10.Hospital handoffs & transitions F5. Important patient care information is often lost during shift changes. (negatively worded)

14. HSOPS & Culture Debriefing14 DRAFT Pending AHRQ Approval HSOPS Sample Questions 4 OUTCOME VARIABLESEXAMPLE QUESTION 1. Overall perceptions of safetyA15.Patient safety is never sacrificed to get more work done. 2. Frequency of event reportingD1.When a mistake is made, but is caught and corrected before affecting the patient, how often is this reported? 3. Patient safety grade (of hospital unit) E1.Please give your work area/unit in this hospital an overall grade on patient safety. 4. Number of events reported in the last 12 months G1.In the past 12 months, how many event reports have you filled out and submitted?

15. HSOPS & Culture Debriefing15 DRAFT Pending AHRQ Approval Inviting Staff To Complete The HSOPS Survey 1.Collect the email addresses of ALL clinicians and staff (including physicians) that worked in the unit at least 3 months Option 1 https://armstrongresearch.hopkinsmedicine.org/susp.aspx 2.Compile email addresses into an Excel spreadsheet 3.Your team’s survey coordinator then uploads the Excel spreadsheet file into the SUSP online data portal

16. HSOPS & Culture Debriefing16 DRAFT Pending AHRQ Approval Inviting Staff To Complete The HSOPS Survey 1.Some clinical areas prefer to submit surveys via a central computer located in within the unit 2.Request a work area id 3.Set up a computer workstation in the clinical area 4.Instruct staff to use the provided link and ID Contact susp@jhmi.edu for more information.susp@jhmi.edu Contact susp@jhmi.edu for more information.susp@jhmi.edu Option 2: Alternate Work Area ID Method

17. HSOPS & Culture Debriefing17 DRAFT Pending AHRQ Approval

18. HSOPS & Culture Debriefing18 DRAFT Pending AHRQ Approval Polling Question What was your response rate on the initial HSOPS survey? 80-100% 60-80% 40-60% 20-40% 0-20% Unit did not complete 1 st HSOPS survey What did you do to motivate team members to participate?

19. HSOPS & Culture Debriefing19 DRAFT Pending AHRQ Approval Increasing Your Response Rate Set a goal Make a plan! Flyers & posters

20. HSOPS & Culture Debriefing20 DRAFT Pending AHRQ Approval Checking Response Rate and Getting Reports Check response rates anytime using the HSOPS App Download HSOPS report after survey period closes on Dec 2, 2014

21. HSOPS & Culture Debriefing21 DRAFT Pending AHRQ Approval HSOPS REPORTS AVAILABLE AFTER SURVEY PERIOD CLOSES DEC 2 ND, 2014 These reports will provide a comparison of your team’s baseline HSOPS data to your current HSOPS data

22. HSOPS & Culture Debriefing22 DRAFT Pending AHRQ Approval HSOPS Reports

23. HSOPS & Culture Debriefing23 DRAFT Pending AHRQ Approval What Is Debriefing? Debriefing is a semi-structured conversation among frontline clinicians that a facilitator leads Encourages open communication, transparency, and interactive discussion – across all levels of the work area – between disciplines Engages clinicians and staff in generating and implementing their ideas about how to create an effective safety culture in their work area Debrief survey results with all your team members

24. HSOPS & Culture Debriefing24 DRAFT Pending AHRQ Approval Making HSOPS Data Meaningful Data are data. Debriefing turns data into information. Debriefing accelerates improvement. 1 Units that did not debrief survey results only achieved 2.2% reduction in infection rates Units that used semi- structured debriefing of culture survey achieved 10.2% reduction in infection rates YES NO Work units that debrief around safety culture perform better

25. HSOPS & Culture Debriefing25 DRAFT Pending AHRQ Approval Making HSOPS Data Meaningful Share culture results with everyone on the unit during a survey debriefing – Bring together team members from your work area – Follow your debriefing plan Have facilitator take notes and recognize recurring themes Encourage open, honest discussion about making the culture of your work area the best it can be Using the CUSP Culture Check-Up Tool

26. HSOPS & Culture Debriefing26 DRAFT Pending AHRQ Approval Making HSOPS Data Meaningful Focus on identifying system issues that the group can work on improving together instead of as individuals – Don’t use it to point fingers at specific individuals Use the tool to structure meetings and guide conversation Complete all steps in the tool as a group Using the CUSP Culture Check-Up Tool

27. HSOPS & Culture Debriefing27 DRAFT Pending AHRQ Approval HSOPS debriefings with CUSP Culture Check-Up Tool What is Purpose of Tool? Understand the unit culture Use teammates’ feedback to predict and avoid barriers Use feedback to leverage the team’s strengths Who Should Use Tool? Safety culture debriefing facilitators Helps guide the discussion and record group decisions Making HSOPS Data Meaningful

28. HSOPS & Culture Debriefing28 DRAFT Pending AHRQ Approval Steps in CUSP Culture Check-Up Tool 1.Identify general strengths and weaknesses of your unit culture 2.Get specific about behaviors and attitudes that contribute to those strengths and weaknesses 3.Select opportunities for growth 4.Develop a strategy for addressing growth opportunities 5.Put plan into action 6.Evaluate results and share progress during SUSP team meetings

29. HSOPS & Culture Debriefing29 DRAFT Pending AHRQ Approval Tip: Download the Culture Check-Up Tool at www.ahrq.gov/professionals/education/curriculum- tools/cusptoolkit/toolkit/culturecheckup.html www.ahrq.gov/professionals/education/curriculum- tools/cusptoolkit/toolkit/culturecheckup.html Tip: Download the Culture Check-Up Tool at www.ahrq.gov/professionals/education/curriculum- tools/cusptoolkit/toolkit/culturecheckup.html www.ahrq.gov/professionals/education/curriculum- tools/cusptoolkit/toolkit/culturecheckup.html Culture Check-Up Tool Culture Check-Up Tool is a document used by debriefing facilitator to guide conversation and improvement planning Download from AHRQ Web site

30. HSOPS & Culture Debriefing30 DRAFT Pending AHRQ Approval Culture Check-Up Tool https://armstrongresearch.hopkinsmedicine.org/susp

31. HSOPS & Culture Debriefing31 DRAFT Pending AHRQ Approval Culture Check-Up Tool

32. HSOPS & Culture Debriefing32 DRAFT Pending AHRQ Approval Culture Check-Up Tool

33. HSOPS & Culture Debriefing33 DRAFT Pending AHRQ Approval 33 Brainstorming culture discussion items STATEMENT TO BE DISCUSSED Unit Safety Assessment Score % What does this statement mean to you? How accurately does the unit score reflect your experience on this unit? Share examples. How would it look (what behaviors or processes would we see) in this unit if 100% of staff responded “agree strongly” with this item? Identify at least one action item to improve unit results. What are the next steps and how will we accomplish them? Culture Check-Up Tool

34. HSOPS & Culture Debriefing34 DRAFT Pending AHRQ Approval Debriefing Plan Highlights DECISION POINTS FOR PROJECT TEAM DEBRIEFING PLAN How many debriefing sessions will be held? Who will facilitate each debriefing session? When will debriefing(s) be held? Who is responsible for taking notes and recording ideas from each session? If you conduct more than one debriefing session, who is responsible for collating notes and ideas for improvement from the different sessions? How will the CUSP team ensure there is followup on the action items from the debriefing session(s)?

35. HSOPS & Culture Debriefing35 DRAFT Pending AHRQ Approval Next Steps 1.Prepare your surgical services team members for survey – Why important? – How was baseline HSOPS feedback used? 2.Log on to the project website: – https://armstrongresearch.hopkinsmedicine.org/susp.aspx https://armstrongresearch.hopkinsmedicine.org/susp.aspx 3.Upload survey participants for participating work area(s) 4.Check response rate weekly and aims for ≥ 60% response 5.Download report after survey closes (after Dec 2, 2014) – Based on your survey debriefing plan, share with project team, leadership and frontline staff members

36. HSOPS & Culture Debriefing36 DRAFT Pending AHRQ Approval Project Resources https://armstrongresearch.hopkinsmedicine.org/susp Project webinars, tools, data portal

37. HSOPS & Culture Debriefing37 DRAFT Pending AHRQ Approval References 1.Schein E. Organizational culture and leadership, 4 th edition. San Francisco, CA: Jossey-Bass. 2010. 2.Huang DT, Clermont G, Kong L, Weissfeld LA, Sexton JB, Rowan KM, Angus DC. Intensive care unit safety culture and outcomes: a US multicenter study. Int J Qual Health Care. 2010 Jun;22(3):151-61. PMID: 20382662. 3.MacDavitt K, Chou SS, Stone PW. Organizational climate and health care outcomes. Jt Comm J Qual Patient Saf. 2007 Nov;33(11 Suppl):45-56. PMID: 18173165. 4.Mardon RE, Khanna K, Sorra J, Dyer N, Famolaro T. Exploring relationships between hospital patient safety culture and adverse events. J Patient Saf. 2010 Dec;6(4):226- 32. PMID: 21099551. 5.Singer SJ, Falwell A, Gaba DM, Meterko M, Rosen A, Hartmann CW, Baker L. Identifying organizational cultures that promote patient safety. Health Care Manage Rev. 2009 Oct-Dec;34(4):300-11. PMID: 19858915.

38. HSOPS & Culture Debriefing38 DRAFT Pending AHRQ Approval References 6.Sorra J, Khanna K, Dyer N, Mardon R, Famolaro T. Exploring Relationships Between Patient Safety Culture and Patients' Assessments of Hospital Care. J Patient Saf. 2012 Jul 10. [Epub ahead of print]. 7.Sorra JS, Nieva VF. Hospital Survey on Patient Safety Culture. (Prepared by Westat, under Contract No. 290-96-0004). AHRQ Publication No. 04-0041. Rockville, MD: Agency for Healthcare Research and Quality. September 2004. 8.Weaver SJ. A configural approach to patient safety climate: The relationship between climate profile characteristics and patient safety. Doctoral dissertation. University of Central Florida. 2011. 9.Vigorito MC, McNicoll L, Adams L, Sexton B. Improving safety culture results in Rhode Island ICUs: lessons learned from the development of action-oriented plans. Jt Comm J Qual Patient Saf. 2011 Nov;37(11):509-14. PMID: 22132663.

39. HSOPS & Culture Debriefing39 DRAFT Pending AHRQ Approval https://armstrongresearch.hopkinsmedicine.org/susp.aspx Your survey coordinator can download a copy of your aggregate survey report (PDF) from the SUSP Project website

40. HSOPS & Culture Debriefing40 DRAFT Pending AHRQ Approval Select “My Reports” from the “My Network” drop down menu Finding Your HSOPS Report

41. HSOPS & Culture Debriefing41 DRAFT Pending AHRQ Approval 1. Project: Select “SUSP” 2. Tool: Select “HSOPS for SUSP” 1. Project: Select “SUSP” 2. Tool: Select “HSOPS for SUSP” Finding Your HSOPS Report

42. HSOPS & Culture Debriefing42 DRAFT Pending AHRQ Approval 3. Network: Select your Unit Typing the first letter of its name will bring you to that part of the alphabetized list 4. Report: Select “HSOPS Report” Choose HSOPS Report with most recent dates 3. Network: Select your Unit Typing the first letter of its name will bring you to that part of the alphabetized list 4. Report: Select “HSOPS Report” Choose HSOPS Report with most recent dates Finding Your HSOPS Report

43. HSOPS & Culture Debriefing43 DRAFT Pending AHRQ Approval The same HSOPS Report can also be downloaded from your HSOPS App Dashboard Finding Your HSOPS Report

44. HSOPS & Culture Debriefing44 DRAFT Pending AHRQ Approval Who completed the survey? (Pages 2-4) Your HSOPS Report

45. HSOPS & Culture Debriefing45 DRAFT Pending AHRQ Approval Survey response rate (Page 4) Your HSOPS Report

46. HSOPS & Culture Debriefing46 DRAFT Pending AHRQ Approval Interpreting composite scores The big picture view Higher scores are better Interpreting composite scores The big picture view Higher scores are better Composite score (Pages 6-7) Your HSOPS Report

47. HSOPS & Culture Debriefing47 DRAFT Pending AHRQ Approval Questions (Page 8-25) % Positive = Green % Neutral = Yellow % Negative = Red Your HSOPS Report

48. HSOPS & Culture Debriefing48 DRAFT Pending AHRQ Approval Tip: For positively worded items, more GREEN is better. Questions provide opportunity for deeper dive Your HSOPS Report

49. HSOPS & Culture Debriefing49 DRAFT Pending AHRQ Approval Questions (Pages 8-25) Tip: For negatively worded items, more RED is better. Your HSOPS Report

50. HSOPS & Culture Debriefing50 DRAFT Pending AHRQ Approval Tip: For negatively worded items, more RED is better. Your HSOPS Report Questions provide opportunity for deeper dive