Interpreting Safety Culture Survey Data and Using Results for Improvement Sallie J. Weaver, PhD.

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Interpreting Safety Culture Survey Data and Using Results for Improvement

Sallie J. Weaver, PhD

1RoadmapI have data.but now what?Some food for thought regarding next steps and debriefing survey results

Armstrong Institute for Patient Safety and Quality2Poll questionHave you (or your teams survey coordinator) downloaded or reviewed the HSOPS aggregate report for your work area?YesNoArmstrong Institute for Patient Safety and Quality3Overall Pictureusually I put the overall baseline scores in chart for a given project/cohort and show it hereis there a chart like this for VAP that you want to show?Armstrong Institute for Patient Safety and Quality4Remember: Culture is Local

Armstrong Institute for Patient Safety and Quality5Understanding the HSOPS Aggregate ReportPart IArmstrong Institute for Patient Safety and Quality6Armstrong Institute for Patient Safety and Quality7

Survey Coordinators can download HSOPS report(s) from: https://armstrongresearch.hopkinsmedicine.org

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Select the work area that you want to managePre-Op9

100100808080%0HSOPS Aggregate Report10

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Who completed the survey: Pg. 2-4Armstrong Institute for Patient Safety and Quality12

80%(n = 80)

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

Composite scores represent summaries of several areas (aggregate response across several questions to provide a snapshot for the different dimensions of safety culture)Scores represent the % of positive responses: % who gave a score of 4 or 5

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

Be sure to look at high scoring areas (generally 75% positive or higher)Areas with scores less than 50% can be areas for improvement14Questions: Pg. 8-25Percent positive = Green Percent neutral = YellowPercent negative = Red15

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

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Questions: Pg. 8-25 17

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

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Using the CUSP Culture Check-up Tool to Debrief Survey ResultsPart IIArmstrong Institute for Patient Safety and Quality19CUSP Culture Check-Up ToolWhat is the Purpose of this Tool?Understand the culture of the unitUse teammates feedback to predict barriers to change and avoid themUse feedback to make the most of the teams strengths

Who Should Use this Tool? Safety culture debriefing facilitatorsUse this tool to help guide the discussion and record group decisions

Armstrong Institute for Patient Safety and Quality20The Culture Check-up Tool was created to help you use your Safety Culture Assessment results to make patient care safer. It provides a structure for discussing specific actions to improve safety culture and infection prevention practices. Because you are taking your work are culture into account, the improvements you make are more likely to work.

Sometimes, work areas try to improve patient care by making new rules or changing the way teammates do work. Often these changes do not work as well as everyone hoped. This is because the work are culture was not taken into account. Work areas that evaluate their culture before implementing an intervention work better20How Do I Use this Tool?Share culture results with everyone on the unitBring together team members from your work areaFollow your debriefing planTake 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 individualsNOT used to point fingers at specific individualsUse the tool to structure meetings and guide conversationAs a group, complete all steps in this worksheetArmstrong Institute for Patient Safety and Quality21CUSP Culture Check-Up ToolThis tool is designed to be flexible. The tool focuses on work are-level data.

Have a copy of your culture survey results that all team members can see during the meeting. You may want to use a computer and projector to show the results on a screen during the meeting.

21Steps in CUSP Culture Check-Up ToolSTEP 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 meetingsArmstrong Institute for Patient Safety and Quality22STEP 4: Your team identifies a strategy for fixing the opportunities selected in step three. As a guide, the Agency for Healthcare Research and Quality (AHRQ) recommends different strategies depending on your work areas needs. For example, sometimes a safety concern is reported, but teammates do not know if management is working on the problem. If teammates in your work are need better feedback about safety concerns, the 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.

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The Culture Check Up Tool = Word Document that Debriefing Facilitator can use to guide conversation & improvement planningArmstrong Institute for Patient Safety and Quality24

Next Steps: Implementing your teams HSOPS Debriefing PlanDebriefing isA semi-structured conversation among frontline clinicians and staff that is usually led by a designated facilitatorPurposeEncourage open communication, transparency, and interactive discussion about the survey resultsAcross all levelsTo engage clinicians and staff in generating and implementing their ideas about how to create an effective safety culture in their work areaArmstrong Institute for Patient Safety and Quality25Some points to cover in your debriefing planArmstrong Institute for Patient Safety and Quality26

Recent Finding #2: CUSP teams that debrief around safety culture perform betterData is dataDebriefing turns data into informationDebriefing accelerates improvement

Units who used semi-structured debriefing of culture survey 10.2% Reduction in Infection RatesUnits who did not debrief survey results2.2% Reduction in Infection RatesVigorito 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.

Diagnostic data is only the first step (e.g., echo with no reading is just a picture)We debrief oftenbut usually only following events..we ask what went wrong, we look for the root cause--Overlooking outpatient main entrance.just saw a family bringing what looked like their grandfather in for an appointment. There were at least 3 generations together. Gentlemans wife, it looked like his adult daughter, and her young son. In the face of data it is important to remember that the work you are doing is important b/c it impacts the lives of individuals and families. 27Changing Culture in Practice: National CLABSI Project ExampleBaseline HSOPS surveyTarget non-punitive response to error

What did they do?Clarified the language and definitions of events, errors, glitches with all unit clinicians & staffEducation campaign to define and differentiate process errors (e.g., expected behavior not clear, not known) from intentional violationsCreated shared mental model about expected safety behavior, as well as what to report, when, and when/how to follow-up

Follow uphot off the presses!Non-punitive response, communication openness, supervisor support

Armstrong Institute for Patient Safety and Quality2828In SumReview the survey report for your unitCan be helpful to distill the report down into 3-5 key slides Decide when, how, and where to debrief your teammates (and leaders) on these resultsBe prepared to listenAsk for feedback Ask teammates to help come up with solutionsGather a small group together and use the culture debriefing tool to examine the roots of problem areas and begin to formulate strategies for improvement2929Thank you!30