Interpreting Safety Culture Survey Data and Using Results for Improvement

Sallie J. Weaver, PhDNasir Ismail, M ScMike Rosen, PhD

Armstrong Institute for Patient Safety and Quality2

Roadmap

1. I have data….but now what?

2. Some food for thought regarding next steps and debriefing survey results

Armstrong Institute for Patient Safety and Quality3

Poll question

• Have you (or your team’s survey coordinator) downloaded or reviewed the HSOPS “aggregate report” for your work area?– Yes– No

Armstrong Institute for Patient Safety and Quality4

Remember: Culture is Local

Overall Perceptions of Patient Safety

Frequency of event reporting

Teamwork Across Units

Handoffs & Transitions

Hospital Management Support for Patient Safety

Nonpunitive Response to Errors

Staffing

Communication Openness

Supervisor/Manager Expectations & Actions Promoting Patient Safety

Feedback & Communication About Error

Organizational Learning—Continuous Improvement

Teamwork Within Unit

Hos

pita

l-Ref

eren

ced

Dim

ensi

ons

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Work Areas in Same Hospital

Work area 2Work area 1

Armstrong Institute for Patient Safety and Quality5

UNDERSTANDING THE HSOPS AGGREGATE REPORT

Part I

Armstrong Institute for Patient Safety and Quality6

7

8

9

100 100 80 80 80%0

10

HSOPS Aggregate Report

11

Armstrong Institute for Patient Safety and Quality12

Who completed the survey: Pg. 2-4

80%(n = 80)

13

Composite Score: Pg. 6-7Scores = Percent positive responses

Interpreting Composite Scores: • The big picture view• Higher is better

14

Composite Score: Pg. 6-7Scores = Percent positive responsesInterpreting Composite Scores: • The big picture view• Higher is better

15

Questions: Pg. 8-25Percent positive = Green Percent neutral = YellowPercent negative = Red

Armstrong Institute for Patient Safety and Quality16

Questions provide a deeper dive:For positively worded items, more green is better

17

Questions: Pg. 8-25

*For negatively worded items, more RED is better

Armstrong Institute for Patient Safety and Quality18

Questions provide a deeper dive:*For negatively worded items, more RED is better

Armstrong Institute for Patient Safety and Quality19

USING THE CUSP CULTURE CHECK-UP TOOL TO DEBRIEF SURVEY RESULTS

Part II

Armstrong Institute for Patient Safety and Quality20

CUSP Culture Check-Up Tool

• What is the Purpose of this Tool?– Understand the culture of the unit– Use teammates’ feedback to predict barriers to change and avoid

them– Use feedback to make the most of the team’s strengths

• Who Should Use this Tool? – Safety culture debriefing facilitators

• Use this tool to help guide the discussion and record group decisions

Armstrong Institute for Patient Safety and Quality21

How Do I Use this Tool?– Share culture results with everyone on the unit

• Bring together team members from your work area• Follow your debriefing plan

– Take notes and recognize recurring themes – Purpose = Open, honest discussion about ideas to make the culture

of your work area the best it can be – Focus on identifying system issues that the group can work on

improving together instead of individuals• NOT used to point fingers at specific individuals

– Use the tool to structure meetings and guide conversation– As a group, complete all steps in this worksheet

CUSP Culture Check-Up Tool

Armstrong Institute for Patient Safety and Quality22

Steps in CUSP Culture Check-Up Tool

• STEP 1: Your team identifies the general strengths and weaknesses of your unit culture.

• STEP 2: Your team identifies the specific behaviors and attitudes that make up those strengths and weaknesses.

• STEP 3: Debriefing facilitator encourages group reflection. Your team chooses opportunities for growth, understanding that cultural strengths can help fix cultural weaknesses.

• STEP 4: Your team identifies a strategy for fixing the opportunities selected in step three.– AHRQ recommends creating ‘safety briefings’ – short updates for frontline teammates

about patient safety issues in the work are. For more ideas, go to: http://www.ahrq.gov/qual/patientsafetyculture/hospimpdim.htm.

• STEP 5: Your team works out the details of putting strategy into action.

• STEP 6: Your team evaluates your plans. Be sure to meet again and check in on progress at your SUSP team meetings

Armstrong Institute for Patient Safety and Quality23

The “Culture Check Up Tool” = Word Document that Debriefing Facilitator can use to guide conversation & improvement planning

Armstrong Institute for Patient Safety and Quality24

Armstrong Institute for Patient Safety and Quality25

Next Steps: Implementing your team’s HSOPS Debriefing Plan

• Debriefing is…– A semi-structured conversation among frontline

clinicians and staff that is usually led by a designated facilitator

• Purpose…1. Encourage open communication, transparency,

and interactive discussion about the survey results

• Across all levels2. To engage clinicians and staff in generating and

implementing their ideas about how to create an effective safety culture in their work area

Armstrong Institute for Patient Safety and Quality26

Some points to cover in your debriefing plan

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?

Where 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 follow-up on the action items from the debriefing session(s)?

Recent Finding #2: CUSP teams that debrief around safety culture perform better

• Data is data– Debriefing turns data into information

• Debriefing accelerates improvement

Units who used semi-structured debriefing

of culture survey 10.2% Reduction in

Infection Rates

Units who did not debrief survey results2.2% Reduction in Infection Rates

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.

Armstrong Institute for Patient Safety and Quality28

Changing Culture in Practice: National CLABSI Project Example

• Baseline HSOPS surveyTarget non-punitive response to error

• What did they do?– Clarified the language and definitions of events,

errors, glitches with all unit clinicians & staff• Education campaign to define and differentiate process

errors (e.g., expected behavior not clear, not known) from intentional violations

• Created shared mental model about expected safety behavior, as well as what to report, when, and when/how to follow-up

• Follow up…hot off the presses!Non-punitive response, communication openness, supervisor support

In Sum

1. Review the survey report for your unit2. Can be helpful to distill the report down into 3-5 key slides 3. Decide when, how, and where to debrief your teammates

(and leaders) on these results• Be prepared to listen• Ask for feedback • Ask teammates to help come up with solutions

4. Gather a small group together and use the “culture debriefing tool” to examine the roots of problem areas and begin to formulate strategies for improvement

29

30

Thank you!