Patient Safety: applying a culture assessment tool in practice

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Patient Safety applying a culture assessment
tool in practice
Assessing ands Transforming the Culture of an NHS
Organisation

• Hilary Merrett
• Quality and Safety Consultancy
• Editor, Clinical Risk

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Agenda

• Patient safety culture what is it and why
  assess for it?
• The basic approach beliefs questionnaires, gap
  analysis and action planning
• Examples of culture assessment tools
• Your organisation a run through the process

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A culture of safety?

• 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

NPSA Seven Steps to Patient Safety
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What makes up a safety culture?

• Commitment to safety articulated at highest level
• Safety perceived to be highest priority
• Financial investment in safe practice
• Incentives aligned to promote safe practice
• Open communication about safety practices
  encouraged
• Unsafe acts rare
• Commitment to organisational learning rather than
  blame

To Err is Human Institute of Medicine, 2000
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Two sides of the safety coin

• Systems design
• Managing behaviours
• our power is the in the systems we build around
  imperfect human beings and in our expectations of
  them within those systems.

WhackaMole the price we pay for expecting
perfection David Marx
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High Reliability organisations

• Don't be tricked by your success
• Defer to your experts on the front line
• Let the unexpected circumstances provide your
  solution
• Embrace complexity
• Anticipate - but also anticipate your limits

Managing the Unexpected Assuring High
Performance in an Age of Complexity (Jossey-Bass,
2001), Karl Weick and Kathleen Sutcliffe
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Why assess for a safety culture?

• A starting point for achieving an improved
  safety culture is to conduct an assessment of the
  current culture of the healthcare organization to
  determine whether and how that culture affects
  the provision of safe patient care. The results
  of the assessment can identify opportunities to
  improve systems and prevent harm.

Healthcare Risk Control ECR Institute 2009
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How does assessment work?

• Building a maturity matrix
• Question areas or Dimensions of safety
• Assessment levels applied to each question /
  dimension
• Process
• Self assessment
• Discussion and consensus forming
• Gap analysis
• Action planning

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Improvement how it can help
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Assessment tools - examples

• Safety Climate Survey
• Patient Safety Maturity Matrix
• Manchester Patient Safety Framework

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Safety Climate Survey ECRI 2009 Professor R
Helmreich (extract)
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The governance of patient safety Maturity Matrix
Good Governance Institute and Datix
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Manchester Patient Safety Framework Dimensions

• 1. Commitment to overall continuous improvement
• 2. Priority given to safety
• 3. System errors and individual responsibility
• 4. Recording incidents and best practice
• 5. Evaluating incidents and best practice
• 6. Learning and effecting change
• 7. Communication about safety issues
• 8. Personnel management and safety issues
• 9. Staff education and training
• 10. Team working

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MaPSaF assessment levels of maturity
E Generative
D Proactive
Risk management is an integral part of everything
that we do
C Bureaucratic
We are always on the alert for risks that might
emerge
B Reactive
We have systems in place to manage all our risks
We do something every time we have an incident
A Pathological
Why waste our time on safety?
Dianne Parker, University of Manchester 2009
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Using MaPSaF

• Developed 2005 by Professor Dianne Parker and
  colleagues at Manchester University
• Originally developed for primary care
• Now versions for primary care, acute, ambulance
  and mental health services
• Works at team and organisational levels
• www.nrls.npsa.nhs.uk/resources/

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Trying it out

• Read first 3 dimensions of framework
• Individually score your organisation from A E
  on evaluation sheet. Note your reasons.
• Discussion on table score by score those from
  same organisation, try to reach a consensus
• Feedback on
• Areas that promoted most debate / difference
• Any obvious steps needed to improve across the
  board

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Key issues

• Do not need external facilitation but be aware of
  political and other sensitivities
• Knowledge of local risk management systems
• Think about patient and public involvement at
  each dimension
• Not to be used for performance management

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And finally .......
In the light of the Francis Inquiry report, does
this equation work in your organisation? What
we say What we do ?