How to Use the JHAH Online PortalA training call for HSOPS coordinators

November 4, 2014

Lauren Benishek, PhD

& Sallie Weaver, PhD

Armstrong Institute for Patient Safety and Quality

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You enable JHAH teams’ success

At the end of this webinar, you should be able to:• Define safety culture

• Describe why safety culture is important for improvement efforts

• Identify best practices for measuring safety culture

• Complete the HSOPS administration process

A BRIEF OVERVIEW OF SAFETY CULTURE

Part I

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The Armstrong Institute Model to Improve Care

Comprehensive Unit based Safety Program

(CUSP)

1. Educate staff on science of safety

2. Identify defects

3. Recruit executive to adopt unit

4. Learn from one defect per quarter

5. Implement teamwork tools

Translating Evidence Into Practice

(TRiP)

1. Summarize the evidence in a checklist

2. Identify local barriers to implementation

3. Measure performance

4. Ensure all patients get the evidence

• Engage• Educate• Execute• Evaluate

Reducing CLABSI

• Emerging Evidence

• Local Opportunities to Improve

• Collaborative learning

Technical Work Adaptive Work

Pre-Work: Measure clinician and staff perceptions of safety culture (HSOPS Survey)

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The JHAH Model to Improve Care

Comprehensive Unit based Safety Program (CUSP)

Pre-work: Measure clinician and staff perception of safety culture (HSOPS survey)

1.Educate staff on science of safety

2.Identify defects

3.Assign executive to adopt unit

4.Learn from one defect per quarter

5.Implement teamwork tools

1. Wash your hands

2. Use chlorhexidine wipes

3. Use full barrier precautions

4. Avoid the femoral site

5. Ask every day if lines can be removed

Central line associated bloodstream infections

(CLABSI)

Technical Work Adaptive Work

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Safety Culture Matters

• Safety culture is related to outcomes– Patient outcomes

– Clinician outcomes

• Safety culture influences the effectiveness of other safety and quality interventions– Can enhance or inhibit effects of other interventions

• Safety culture can change through intervention– Best evidence so far is for culture interventions that

use multiple components

Huang et al., 2010; Mardon et al., 2010; MacDavitt et al., 2007; Singer et al., 2009; Sorra et al., 2012; Weaver, 2011.

Haynes et al., 2011; Morello et al., 2012; Van Nord et al., 2010; Weaver et al., in press

Culture

Behavior on the Job

Outcomes-Patient & Family

Safety

- Care Provider Safety

Priority of safety relative to other goals as collectively perceived by unit members

Culture is the context that defines expectations and guides team members’ behaviors, attitudes, & perceptions on the job

• What will I get praised for?• What will I get reprimanded for?

• Culture is continually evolving and can be changed

• Multi-pronged approach best

What is Safety Culture?

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What Are the Core Aspects of Safety Culture…

Culture of

Safety

Communication patterns & language

Feedback, reward, and corrective

action practices

Formal and informal leader

actions & expectations

Teamwork processes

(e.g., back-up behavior)

Resource allocation practices

Error-detection and correction

systems

MEASURING SAFETY CULTURE

Part II

Why Measure Safety Culture

• Many hospitals globally measure safety culture using some type of survey

• Results help guide improvement efforts

• Regular efforts are valuable in understanding what helps or hinders your efforts to improve

• Use reliable and valid survey instrument

• Hospital Survey on Patient Safety (HSOPS)

What is the Hospital Survey on Patient Safety (HSOPS)?

• Sponsored by the Agency for Healthcare Research & Quality• US federal agency charged with conducting and supporting research

to improve patient safety and care

• Measures all six aspects of safety culture

• Armstrong Institute in partnership with CeCity developed an online HSOPS application (“the HSOPS App”)• Allows participants to complete the survey online and survey

coordinators to access detailed reports of results

• Takes about 10-15 minutes to complete

• Participants are asked to choose 1 to 5 for each of 42 questions1 Strongly Disagree 2 Disagree 3 Neither Agree nor Disagree 4 Agree 5Strongly Agree

1 Never 2 Rarely 3 Sometimes 4 Most of the time 5 Always

HSOPS Scoring

Safety culture is not about what any one person thinks – it’s shared.

• Scores represent the % of positive responses– % who gave a score of 4 or 5

1 Strongly Disagree 2 Disagree 3 Neither Agree nor Disagree 4 Agree 5Strongly Agree

1 Never 2 Rarely 3 Sometimes 4 Most of the time 5 Always

HSOPS ADMINISTRATIONPart III

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Effective surveys…

1. Are confidential and anonymous• No way to link responses with email address or other individual

information • Results reported at unit-level• Critical that the survey coordinator, project team, and leadership

focus on survey as a tool for learning and improvement

2. Have a clear reason and motivation to complete them• Must be clear to staff why you are asking them to complete this

survey, what will happen with results, and what will be done based on their input

3. Are publically supported by both formal and informal unit leaders • If leaders and colleagues view the survey as important and worthy

of their time, frontline staff will be more motivated to contribute their input

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HSOPS Coordinator Responsibilities

• HSOPS Survey Coordinator– Leads HSOPS administration at your ICU level– Encourages staff to respond to the survey

• JHAH ICU HSOPS planning period: November 4 - November 9

• JHAH ICU HSOPS survey open period: November 9 to 22, 2014

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You now have access to the HSOPS app

• You can only access the HSOPS app with a JHAH portal username and password

• We sent all HSOPS coordinators listed on the CUSP/CLABSI team registration form an email with temporary log-in information

• Try logging in using these instructions:

Log in here: https://armstrongresearch.hopkinsmedicine.org/Default.aspx 

Use these credentials:Username: Your complete email address

(e.g. john.smith@hospital.org)Default Password: Your last name and first initial, capitalized

(e.g. John Smith would use “SmithJ”)

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Survey coordinators will use the HSOPS App to…

1. Collect new HSOPS data– Send invitation emails to survey participants– Emails contain a unique link that participants will click

on to complete the survey

2. Check on your unit’s response rate– Goal = 60% response rate – Stretch goal = 80% response rate or higher

3. Download a pdf report that summarizes survey results for your unit– Reports will be available after the survey closes

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JHAH Portal Main page Bookmark it!

https://armstrongresearch.hopkinsmedicine.org/Default.aspx

• Select My Tools

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Locating the HSOPS App

• Click ‘HSOPS for Johns Hopkins Aramco Healthcare’– If you are coordinating more than one ICU, you’ll see each HSOPS

‘app’ listed. Make sure you click the correct ‘app’

Accessing the HSOPS App

Click Manage

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HSOPS Administration method 1: Sending surveys out using staff e-mail

1. Determine whom to survey

2. Compile email lists (Pre-op, OR, PACU)

3. Click “Send Emails”

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HSOPS Administration method 1: Sending surveys out using staff e-mail

4. Upload a list of survey participant email addresses for participating work area(s)

5. The app will send each study participant an email which contains a unique link to the survey.

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Is your email list up to date?

Make sure your list is up to date, check for:

• Staff on administrative or extended sick leave, • Staff who appear in more than one staffing

category or hospital area/unit, • Staff who have moved to another hospital

area/unit, • Staff who no longer work at the hospital, and • Other changes that may affect the accuracy of

your list email addresses

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HSOPS Administration method 1: Sending surveys out using staff e-mail

6. Check survey response rate weekly

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HSOPS Administration method 2: Setting up HSOPS survey work station

For staff who do not have email addresses

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HSOPS Administration method 2: Setting up HSOPS survey work station

For staff who do not have email addresses

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HSOPS Administration method 2: Setting up HSOPS survey work station

For staff who do not have email addresses

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HSOPS Administration method 2: Setting up HSOPS survey work station

For staff who do not have email addresses

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Aim for a response rate of 60% or higher

• Response rate = Number of respondents who completed the online survey divided by the total number of unit members who were invited to complete the survey

• Safety culture reflects the shared perceptions among unit members – Response rate of 60% is minimum necessary for a

relatively representative sample– Important for validity and reliability of your results

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When the survey period closes: Access Your HSOPS Report

• Available after JHAH ICU Survey “Closes” on November 22, 2014

• Download aggregate report to obtain results of the HSOPS for your work area, including charts and graphs

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Sample Final Report

Percent positive = GreenPercent neutral = YellowPercent negative = Red

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Next Step: Create a Debriefing Plan for your Survey Results

Debriefing is…• A semi-structured conversation among frontline

clinicians and staff that is usually led by a designated facilitator

Purpose…• Encourage open communication, transparency, and

interactive discussion about the survey results across all levels

• To engage clinicians and staff in generating and implementing their ideas about how to create an effective safety culture in their work area

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Next Step: Create a Debriefing Plan for your Survey Results

We’re here to help!

Learn how and what tools to use to debrief your results with frontline staff.

Debrief Training Webinar:

Tuesday, December 2 @ 3pm AST

Schedule your debrief session for:

January 11, 2014 (Armstrong Institute staff will be there in person)

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HSOPS Tools & Resourceshttps://armstrongresearch.hopkinsmedicine.org/JHAH/CLABSI/HSOPS.aspx

• Planning and PreparingHSOPS User Guide

• Debriefing & using your HSOPS results for meaningful change

Example results report

Debriefing plan template

Culture check up tool

Improving patient safety in hospitals: resource list

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References

• 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.

• 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].

• 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.

• van Noord I, de Bruijne MC, Twisk JW. The relationship between patient safety culture and the implementation of organizational patient safety defences at emergency departments.. Int J Qual Health Care. 2010 Jun;22(3):162-9.

• 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.

• Weaver, S. J., Dy, S., Lubomski, L., & Wilson, R. Promoting a culture of safety. In R.M. Watcher, P.G. Shekelle, P. Pronovost (Eds.). Making healthcare safer: A critical analysis of the evidence of patient safety practices (AHRQ report # TBD). Rockville, MD. In press.