Measuring safety culture in healthcare organisations

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Measuring safety culture in healthcare
organisations

• Jane Carthey,
• Safety Improvement Specialist,
• NPSA

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NPSA Seven Steps to Patient Safety

• Step One Build a safety culture
• A safety culture is.
• A culture where staff have a constant and active
  awareness of the potential for things to go wrong
• A culture that is open and fair, and one that
  encourages people to speak up about mistakes

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Other definitions

• The shared beliefs and values of staff working in
  an organisation that determine the commitment to
  and quality of an organisations health and
  safety management
• Alternatively.
• The way we do things around here
• Safety culture manifests itself in all safety
  related aspects of the organisation

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• Culture Oh No, not the C word!

• "When I hear the word 'culture' . . . I release
  the safety-catch of my Browning." - HANNS JOHST,
  Schlageter
• "Culture is an instrument wielded by professors
  to manufacture professors, who when their turn
  comes will manufacture professors." - SIMONE
  WEIL, The Need for Roots

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Manchester Patient Safety Framework

• Originally developed for use in primary care
• Tailored from a tool developed for the oil
  industry and used by Shell plc.
• Based on Westrums (1993) theory of
  organisational safety
• Tailoring the tool for use in acute, mental
  health, ambulance settings

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Levels of maturity with respect to a safety
culture
Risk management is an integral part of everything
that we do
We are always on the alert for risks that might
emerge
We have systems in place to manage all like risks
We do something when we have an incident
Why waste our time on safety?
Reactive
Pathological
Calculative
Proactive
Generative
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Pathological
Reactive
Calculative
Proactive
Generative
Commitment to Q
Priority to PS
Causes
Investigation
Learning
Communication
Personnel
Education
Team working
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Pathological
Incidents are seen as bad luck and outside the
organisations control, occurring as a result of
staff errors or patient behaviour. Ad hoc
reporting systems are in place but the
organisation is largely in blissful ignorance
unless serious events occur or solicitors
letters are received. Incidents and complaints
are swept under the carpet if possible. There is
a high blame culture with individuals subjected
to victimisation and disciplinary action
Perceptions of causes of adverse events and near
misses and their identification
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Generative
Organisational failures are noted, although staff
are also aware of their own professional
accountability in relation to errors. It is
second nature for staff to report adverse events
and near misses, as they have confidence in the
investigation process and understand the value of
reporting. Integrated systems allow adverse
events, near misses, complaints and litigation
cases to be analysed together. Staff, patients
and relatives are actively supported from the
time of the incident. The organisation has a high
level of openness and trust.
Perceptions of causes of adverse events and near
misses and their identification
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What can MaPSaF be used for?

• To facilitate self-reflection on the safety
  culture maturity of your healthcare organisation
• To promote recognition that patient safety is a
  complex multidimensional concept
• To stimulate discussion about areas of strength
  and weakness in your patient safety culture
• To highlight differences in perceptions between
  staff groups in the organisation
• To help understand how the organisation with a
  more mature safety culture might look.
• To help evaluate any specific intervention to
  change the safety culture of your organisation

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Examples of using MaPSaF 1

• A team leader wants his/her team to recognise the
  relevance and importance of patient safety
  culture in their daily working lives
• Use MaPSaF to introduce the concept of safety
  culture to the team and facilitate discussion
  about where any problems lie and how things can
  be improved

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Examples of using MaPSaF 2

• An operational management team wants to know more
  about the strengths and weaknesses of the patient
  safety culture in their trust
• Use MaPSaF at a regular meeting to facilitate
  their discussion and identify how to improve the
  safety culture

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What is MaPSaF not for?

• MaPSaF is NOT designed to be used
•  
• For performance management and assessment
  purposes
• To apportion blame if using it indicates that the
  organisations safety culture is not
  significantly mature

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How its used

• Focus groups
• Identify different perceptions between staff
  groups
• Discuss differences
• Develop action plan

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Tailoring of the tool

• Six focus groups
• Took 3 risk dimensions
• Language appropriate to care setting?
• How they would use MAPSAF
• Approved changes

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Piloting MaPSaF versions

• 4 pilots carried out
• Mental health, acute, primary care, ambulance
  trust
• Process of using the framework
• Feedback to team on changes
• Final amendments now being made

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Roll out

• NPSA to roll out later in 2005
• Along with guidance on how to use
• Web site to feedback findings

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A final thought 2005 Indianapolis grand prix
7 teams refused to race and returned to the pit
lane after the parade lap due to safety concerns
with their Michelin tyres
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Only those teams using Bridgestone tyres took
part in the race much to the annoyance of
the fans
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The effects of the incident

• Huge reputation damage to F1
• Huge losses expected in TV revenue and
  sponsorship
• BUT
• A rare victory for safety resulting from a
  proactive response to an identified hazard.
• Work towards achieving a similar culture in the
  NHS

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• Thank you for listening
• Any questions?
• www.npsa.nhs.uk