Patient Safety Culture in West Virginias Rural Hospitals

1
Patient Safety Culture in West Virginias Rural
Hospitals

• West Virginia Medical Institute
• West Virginia Hospital Association
• WVDHHR State Office of Rural Health
• Quantros Inc.
• Verizon, Inc.

2
Outline for this Presentation

• Background about the project
• Patient Safety Culture its measurement and value
  for evaluating change
• Results from year 1 baseline data

3
Background

• The IOM Report To Err is Human, focused attention
  on patient safety and medical errors
• However, rural West Virginia hospitals did not
  have systems or infrastructure in place to
  improve processes as suggested by IOM
• WVMI saw an opportunity to assist and implemented
  the WV Patient Safety Improvement Program,
  initially with corporate funds
• We received an AHRQ grant 9/2004 to expand the
  scope of the original project

4
Objectives

• AHRQ grant Partnering to Improve Patient
  Safety in Rural West Virginia Hospitals, by
• Offering a free, confidential event reporting
  system protected from legal discovery
• 2. Developing a collaborative network to share
  information and best practices

5
Today

• 26 hospitals are participating in the AHRQ
  project to date, 14 of these are CAH
• Baseline evaluation question What is the
  patient safety culture in West Virginias rural
  hospitals?

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What is Culture?
The way we do things around here

• One attitude opinion
• Everyones attitude culture

aka Climate
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Hospital Wide Culture

• Interesting
• Not the best unit of analysis masks variability
  between work units

8
Safety Climate

• Perceptions of a strong and proactive commitment
  to patient safety in this unit

9
Teamwork Climate

• Perceived quality of collaboration between
  personnel

10
Executive vs Frontline Perceptions

• Executives overestimate
• Teamwork Climate 4X
• Safety Climate 2.5X
• Executive Confidence vs. Executive Accuracy
• Often wrong but rarely in doubt
• Currently no incoming data-streams
• Frontline data fills the gap

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of respondents reporting above adequate teamwork
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Teamwork Disconnect

• RN Good teamwork means I am asked for my input
• MD Good teamwork means the nurse does what I say

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Teamwork Climate Annual Nurse Turnover
 
reporting positive teamwork climate
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Job Satisfaction vs Teamwork Climate

• I like what I do
• I like who I do it with

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The Johns Hopkins Comprehensive Unit-based Safety
Program (CUSP)

• STEP 1 Evaluate culture of safety
• STEP 2 Educate staff on science of safety
• STEP 3 Identify defects
• survey and incident reports
• STEP 4 Assign executive to adopt unit
• STEP 5 Learn from one defect per month
• measure how often we learn from defects
• STEP 6 Evaluate culture

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Survey Measures
The Hospital Survey on Patient Safety Culture is
designed to measure
Four overall patient safety outcomes 1. Overall
perceptions of safety 2. Frequency of events
reported 3. Number of events reported 4. Overall
patient safety grade
The research survey also is intended to measure
Ten dimensions of culture pertaining to patient
safety 1. Supervisor/manager expectations
6. Nonpunitive response to error actions
promoting patient safety 7. Staffing
2. Organizational learning continuous 8.
Hospital management support improvement
for patient safety 3. Teamwork within units
9. Teamwork across hospital units
4. Communication openness 10. Hospital
handoffs transitions 5. Feedback
communications about error
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Survey Methodology

• As part of the AHRQ Patient Safety Project
  participating hospitals were trained in the use
  of the ORM online tool.
• During training the Hospital Survey on Patient
  Safety Culture was administered to those
  present.
• Upon request additional surveys were mailed to
  hospitals to further survey the staff. Overall,
  996 surveys were received from your hospital.

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Demographic Data

• 3. Time worked
• --in the hospital 3.1 Less than 20 hours 27.2
  20 to 39 hours 69.7 40 hours or more
• (hours/week)
• --in the hospital 8 Less than 1 year 31.5 1 to
  5 years 17.7 6 to 10 years
• (years) 13.4 11 to 15 years 11.4 16 to 20
  years 18 21 years or more
• --in their current
• hospital work area 11.9 Less than 1 year 40.1
  1 to 5 years 17.6 6 to 10 years
• (years) 12.4 11 to 15 years 7.9 16 to 20
  years 10.1 21 years or more
• --in their current 5.6 Less than 1 year 23.2
  1 to 5 years 16.2 6 to 10 years
• specialty (years) 15.4 11 to 15 years 13.2 16
  to 20 years 26.4 21 years or more
• 4. Percentage of respondents with direct
  interaction or contact with patients
  69.4

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Overall Perceptions of Safety
Strongly Disagree/ Neither
Strongly Agree/ Disagree
Agree
Survey Items
1. Patient safety is never sacrificed to get
more work done. (A15) 2. Our
procedures and systems are good at preventing
errors from happening. (A18) R3. It is just by
chance that more serious mistakes dont happen
around here. (A10) R4. We have patient safety
problems in this unit. (A17)
R Indicates reversed-worded items. NOTE The
item letter and number in parentheses indicate
the items survey location.
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Frequency of Events Reported
Survey Items

• 1. When a mistake is made, but is caught and
  corrected before affecting the patient, how often
  is this reported? (D1)
• 2. When a mistake is made, but has no potential
  to harm the patient, how often is this reported?
  (D2)
• 3. When a mistake is made that could harm the
  patient, but does not, how often is this
  reported? (D3)

NOTE The item letter and number in parentheses
indicate the items survey location.
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Number of Events Reported
Respondents were asked to indicate the number of
events they had reported in the past 12
months. 1. In the past 12 months, how many event
reports have you filled out and submitted?
(Survey item G1)
1 to 2
3 to 5
6 to 10
Zero or No response
11 to 20
21 or more
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Overall Patient Safety Grade
Respondents were asked to give their work unit
an overall grade on patient safety. 2. Please
give your work area/unit in this hospital an
overall grade on patient safety. (Survey
item E1)
100
80
60
40
20
A Excellent
B Very Good
C Acceptable
D Poor
E Failing
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Supervisor/Manager Expectations Actions
Promoting Patient Safety
Strongly Disagree/ Neither
Strongly Agree/ Disagree
Agree
Survey Items
1. My supervisor/manager says a good word
when he/she sees a job done according to
established patient safety procedures. (B1) 2.
My supervisor/manager seriously considers
staff suggestions for improving patient safety.
(B2) R3. Whenever pressure builds up, my
supervisor/manager wants us to work faster,
even if it means taking shortcuts. (B3) R4. My
supervisor/manager overlooks patient safety
problems that happen over and over. (B4)
R Indicates reversed-worded items. NOTE The item
letter and number in parentheses indicate the
items survey location.
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Organizational LearningContinuous Improvement
Survey Items
Strongly Disagree/ Neither
Strongly Agree/ Disagree
Agree
1. We are actively doing things to
improve patient safety. (A6) 2. Mistakes have
led to positive changes here. (A9) 3. After we
make changes to improve patient safety, we
evaluate their effectiveness. (A13)
NOTE The item letter and number in parentheses
indicate the items survey location.
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Teamwork Within Units
Strongly Disagree/ Neither
Strongly Agree/ Disagree
Agree
Survey Items
1. People support one another in this unit.
(A1) 2. When a lot of work needs to be
done quickly, we work together as a team to
get the work done. (A3) 3. In this unit,
people treat each other with respect. (A4)
4. When one area in this unit gets really
busy, others help out. (A11)
NOTE The item letter and number in parentheses
indicate the items survey location.
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Communication Openness
Survey Items
Never/ Sometimes
Most of the Rarely
time/Always

• 1. Staff will freely speak up if they see
• something that may negatively affect
• patient care. (C2)
• 2. Staff feel free to question the decisions
• or actions of those with more authority. (C4)
• R3. Staff are afraid to ask questions when
• something does not seem right. (C6)

R Indicates reversed-worded items. NOTE The item
letter and number in parentheses indicate the
items survey location.
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Feedback and Communication About Error

Never/ Sometimes
Most of the Rarely
time/Always
Survey Items

• 1. We are given feedback about changes put
• into place based on event reports. (C1)
• 2. We are informed about errors that happen
• in this unit. (C3)
• 3. In this unit, we discuss ways to prevent
• errors from happening again. (C5)

NOTE The item letter and number in parentheses
indicate the items survey location.
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Nonpunitive Response to Error
Strongly Disagree/ Neither
Strongly Agree/ Disagree
Agree
Survey Items

• R1. Staff feel like their mistakes are held
• against them. (A8)
• R2. When an event is reported, it feels like
• the person is being written up, not the
• problem. (A12)
• R3. Staff worry that mistakes they make are
• kept in their personnel file. (A16)

R Indicates reversed-worded items. NOTE The item
letter and number in parentheses indicate the
items survey location.
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Staffing
Survey Items
Strongly Disagree/ Neither
Strongly Agree/ Disagree
Agree
1. We have enough staff to handle the workload.
(A2) R2. Staff in this unit work longer hours
than is best for patient care. (A5) R3. We
use more agency/temporary staff than is best
for patient care. (A7) R4. We work in crisis
mode trying to do too much, too quickly.
(A14)
R Indicates reversed-worded items. NOTE The item
letter and number in parentheses indicate the
items survey location.
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Hospital Management Support for Patient Safety
Survey Items
Strongly Disagree/ Neither
Strongly Agree/ Disagree
Agree
1. Hospital management provides a work climate
that promotes patient safety. (F1) 2. The
actions of hospital management show that patient
safety is a top priority. (F8) R3. Hospital
management seems interested in patient safety
only after an adverse event happens. (F9)
R Indicates reversed-worded items. NOTE The item
letter and number in parentheses indicate the
items survey location.
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Teamwork Across Hospital Units
Survey Items
1. There is good cooperation among hospital
units that need to work together. (F4)
2. Hospital units work well together to provide
the best care for patients. (F10) R3. Hospital
unites do not coordinate well with each other.
(F2) R4. It is often unpleasant to work with
staff from other hospital units. (F6)
R Indicates reversed-worded items. NOTE The item
letter and number in parentheses indicate the
items survey location.
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Hospital Handoffs Transitions
Survey Items
R1. Things fall between the cracks when
transferring patients from one unit to
another. (F3) R2. Important patient care
information is often lost during shift changes.
(F5) R3. Problems often occur in the exchange
of information across hospital units.
(F7) R4. Shift changes are problematic for
patients in this hospital. (F11)
R Indicates reversed-worded items. NOTE The item
letter and number in parentheses indicate the
items survey location.
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Final Notes

• A proposed 2006 JCAHO National Patient Safety
  Goal recommends that Hospitals and Critical
  Access Hospital Programs "Achieve and maintain an
  organization-wide culture of safety."  They
  suggest that "At least annually, use an
  evidence-based test instrument assessment to
  assess the organization's safety culture and
  implement changes, as appropriate, in response to
  findings of the safety culture assessment." 
• If you would like to survey additional employees,
  please let us know and we will continue to update
  your data base.  We intend to repeat this survey
  to see if there have been any changes in the
  patient safety culture at your hospital. 

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Contact Information

• Gail Bellamy, Principal Investigator,
  gbellamy_at_wvmi.org
• Patricia Ruddick, Project Manager,
  pruddick_at_wvmi.org
• David Lomely, Analyst,
• dlomely_at_wvmi.org
• Jean Fisher, Dir. Education Distance Learning
• jfisher_at_wvha.org