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DRAFT – final pending AHRQ approval
Re-measuring Safety Culture:
The Follow-up HSOPS Survey
Sallie Weaver, PhD
Kristina Weeks, MSH, DrPH (c)
Nasir Ismail, MS, PhD(c)
ARMSTRONG INSTITUTE FOR PATIENT SAFETY AND QUALITY
DRAFT – final pending AHRQ approval
Polling Question #1
2
What is your current role?
Surgeon
Quality improvement practitioner
Infection preventionist
OR nurse
OR technician
Anesthesiologist
OR manager
Other
DRAFT – final pending AHRQ approval
Polling Question #2
3
Have you presented the HSOPS results to your unit staff/management?
Yes
No
DRAFT – final pending AHRQ approval
Learning Objectives
4
1. Describe the value of HSOPS data
2. List steps to complete the HSOPS survey
3. Increase HSOPS response rate
4. Download and debrief HSOPS report
DRAFT – final pending AHRQ approval5
Can my hospital still take the survey if we have not
completed a baseline survey?
YES
DRAFT – final pending AHRQ approval
When will the follow-up HSOPS survey be available for Cohort 1 and Cohort 2 teams?
6
Survey period opens:
July 1st, 2014
12noonEDT
Survey period closes:
September 3rd, 2014
5pmEDT
DRAFT – final pending AHRQ approval
Today’s Agenda
7
Why should you complete the HSOPS Survey?
How do you complete the HSOPS survey?
How can you increase the response rate?
How do you download the HSOPS final report?
Why should you debrief that report?
DRAFT – final pending AHRQ approval
Why Should You Complete HSOPS Survey?
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Measures safety culture within the units of hospital
What does Safety Culture mean?
– Perceived priority of safety relative to other goals
– Attitudes, beliefs, perceptions, and values related to
safety within an organization
Hospital Survey On Patient Safety Culture (HSOPS)
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Core Aspects of Safety Culture1
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Safety Culture Is Related To Outcomes2,3,4,5,6,7,8
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Patient outcomes
Patient care experience
Infection rates, sepsis
Postoperative hemorrhage
Respiratory failure, accidental puncture / laceration
Treatment errors
Clinician outcomes
Incident reporting
Burnout and turnover
DRAFT – final pending AHRQ approval
HSOPS Dimensions
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1. Supervisor / manager expectations and actions promoting patient safety
2. Organizational learning-continuous improvement
3. Teamwork within unit
4. Communication openness
5. Feedback and communication about error
6. Nonpunitive response to error
7. Staffing
8. Hospital management support for patient safety
9. Teamwork across hospital units
10.Hospital handoffs and transitions
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10 Composite Scores
(“Dimensions”)
Sample Question
1. Supervisor/manager expectations & actions promoting patient safety
B1. My supervisor/manager seriously considers staff suggestions for improving patient safety.
2. Organizational learning-continuous improvement
A9. Mistakes have led to positive changes here.
3. Teamwork within unit
A1. People support one another in this unit.
4. Communication openness
C4. Staff feel free to question the decisions or actions of those with more authority.
5. Feedback & communication about error
C1. We are given feedback about changes put into place based on event reports.
HSOPS Sample Questions
DRAFT – final pending AHRQ approval13
10 Composite Scores
(“Dimensions”)
Sample Question
6. Nonpunitive response to error
A8. Staff feel like their mistakes are held against them. (negatively worded)
7. Staffing A2. We have enough staff to handle the workload.
8. Hospital management support for patient safety
F8. The actions of hospital management show that patient safety is a top priority.
9. Teamwork across hospital units
F4. Cooperation is good among hospital units that need to work together.
10.Hospital handoffs & transitions
F5. Important patient care information is often lost during shift changes. (negatively worded)
HSOPS Sample Questions
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4 Outcome Variables Example Question
1. Overall perceptions of safety
A15. Patient safety is never sacrificed to get more work done.
2. Frequency of event reporting
D1. When a mistake is made, but is caught and corrected before affecting the patient, how often is this reported?
3. Patient safety grade (of hospital unit)
E1. Please give your work area/unit in this hospital an overall grade on patient safety.
4. Number of events reported in the last 12 months
G1. In the past 12 months, how many event reports have you filled out and submitted?
HSOPS Sample Questions
DRAFT – final pending AHRQ approval
How Do You Complete The HSOPS Survey?
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1. Collect the email addresses of all clinicians and staff (including physicians) that worked in the unit at least 3 months
2. Enter email addresses into an Excel spreadsheet
3. Upload the Excel spreadsheet file into the SUSP online portal
https://armstrongresearch.hopkinsmedicine.org/susp.aspx
OPTION 1
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1. Some clinical areas prefer to submit surveys via a central pc located in within the unit
2. Request a work area id
3. Set up a workstation in the clinical area
4. Instruct staff to use the provided link and ID
How Do You Complete The HSOPS Survey?
Contact [email protected] for more information.
OPTION 2 Alternate Method: Work Area ID
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DRAFT – final pending AHRQ approval
HSOPS Response Rate
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What was your response rate on the initial HSOPS survey?• 80-100%• 60-80%• 40-60%• 20-40%• 0-20%• Unit did not complete 1st HSOPS survey
Polling Question #3
What did you do to motivate team members to participate?
DRAFT – final pending AHRQ approval
How Can You Increase The Response Rate?
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Set a goal
Make a plan!
Flyers & posters
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Checking Response Rate & Getting Reports
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HSOPS Reports
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HSOPS Reports
DRAFT – final pending AHRQ approval
Debrief survey results with all your team members
Debriefing is a semi-structured conversation among frontline clinicians and staff that is usually led by a designated facilitator
Encourages open communication, transparency, and interactive discussion– across all levels of the work area
– between disciplines
Engages clinicians and staff in generating and implementing their ideas about how to create an effective safety culture in their work area
What is Debriefing?
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DRAFT – final pending AHRQ approval
Work units that debrief around safety culture perform better
Data is data. Debriefing turns data into information.
Debriefing accelerates improvement.9
Units who did not debrief survey results achieved2.2% Reduction in Infection Rates
Units who used semi-structured debriefing of
culture survey achieved 10.2% Reduction in
Infection Rates
YES NO
Making HSOPS Data Meaningful
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DRAFT – final pending AHRQ approval
How do I use the CUSP culture check-up tool?
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Share culture results with everyone on the unit during a survey debriefing– Bring together team members from your work area– Follow your debriefing plan
Take notes and recognize recurring themes
Encourage open, honest discussion about making the culture of your work area the best it can be
Making HSOPS Data Meaningful
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Focus on identifying system issues that the group can work on improving together instead of as individuals.
– Don’t use it to point fingers at specific individuals
Use the tool to structure meetings and guide conversation.
As a group, complete all steps in this worksheet.
Making HSOPS Data Meaningful
How do I use the CUSP culture check-up tool?
DRAFT – final pending AHRQ approval
HSOPS debriefings with CUSP culture check-up tool
27
What is the Purpose of this Tool?
Understand the unit culture
Use teammates’ feedback to predict and avoid barriers
Use feedback to leverage the team’s strengths
Who Should Use this Tool?
Safety culture debriefing facilitators
Helps to guide the discussion and record group decisions
Making HSOPS Data Meaningful
DRAFT – final pending AHRQ approval
1. Identifies general strengths and weaknesses of your unit culture
2. Get specific about behaviors and attitudes that make up those strengths and weaknesses
3. Select opportunities for growth
4. Develop a strategy for addressing growth opportunities
5. Put plan into action
6. Evaluate results and share progress during SUSP team meetings
Steps in CUSP Culture Check-Up Tool
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DRAFT – final pending AHRQ approval
Tip: Download the Culture Check UpTool at
https://armstrongresearch.hopkinsmedicine.org/susp.aspx
www.ahrq.gov/professionals/education/curriculum-tools/cusptoolkit/toolkit/
culturecheckup.html
Culture Check Up Tool
Culture Check Up Tool is a document used by Debriefing Facilitator to guide conversation and improvement planning
Download from the SUSP portal or the AHRQ website
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DRAFT – final pending AHRQ approval
Culture Check-up Tool
30
https://armstrongresearch.hopkinsmedicine.org/susp
DRAFT – final pending AHRQ approval
Culture Check up tool
31
DRAFT – final pending AHRQ approval32
DRAFT – final pending AHRQ approval
Brainstorming culture discussion items
Statement To Be Discussed
Unit Safety Assessment Score %What does this statement mean to you?How accurately does the unit score reflect your experience on this unit? Share examples.How would it look (what behaviors or processes would we see) in this unit if 100% of staff responded “agree strongly” with this item?Identify at least one actionable idea to improve unit results in this area.What are the next steps and how will we accomplish them?
Culture Check Up Tool
33
DRAFT – final pending AHRQ approval34
Debriefing Plan Highlights
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?
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)?
DRAFT – final pending AHRQ approval
What’s Next?
1. Plan debriefing strategy to share results with team
– Be prepared to listen
– Ask for feedback
– Ask teammates to help come up with solutions
2. 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
35
DRAFT – final pending AHRQ approval
Where to find the old webinars?
36
The link: https://armstrongresearch.hopkinsmedicine.org/susp
DRAFT – final pending AHRQ approval
Cohort 1 & 2 Project End Date
Project End
August 31, 2014
37
DRAFT – final pending AHRQ approval
Activities Still Open for Participation
Affinity group calls
SUSP webpage (webinars, toolkits, etc.)
SUSP data portal
– HSOPS reports
– SSI reports
Medconcert
SUSP help desk ([email protected])
38
DRAFT – final pending AHRQ approval
What Now?
Does your hospital want to continue using the data portal to track your SSI data?
Or rather, do you want Sept 2014- Aug 2015 SSI data to be entered into portal?
If yes, contact your CE to confirm data will continue to be uploaded routinely
If no, your CE will complete one final upload in February 2015 to complete the 2 years of project data
Review the data manual on how to create SSI reports in NHSN and NSQIP
SUSP generating reports using the SSI data registry
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DRAFT – final pending AHRQ approval
Want To Continue Beyond August 2014?
Does your hospital want to stay involved in SUSP activities (cohorts 3, 4 & 5 project calls, affinity groups, etc.) ?
If yes, contact your CE and let them know your plans to continue your participation and which ones.
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DRAFT – final pending AHRQ approval
Thank you for your willingness to participate and learn together on how to prevent surgical site infections.
The journey continues…..
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DRAFT – final pending AHRQ approval
References
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1. Schein E. Organizational culture and leadership, 4 th edition. San Francisco, CA: Jossey-Bass. 2010.
2. Huang DT, Clermont G, Kong L, Weissfeld LA, Sexton JB, Rowan KM, Angus DC. Intensive care unit safety culture and outcomes: a US multicenter study. Int J Qual Health Care. 2010 Jun;22(3):151-61.
3. MacDavitt K, Chou SS, Stone PW. Organizational climate and health care outcomes. Jt Comm J Qual Patient Saf. 2007 Nov;33(11 Suppl):45-56.
4. Mardon RE, Khanna K, Sorra J, Dyer N, Famolaro T. Exploring relationships between hospital patient safety culture and adverse events. J Patient Saf. 2010 Dec;6(4):226-32.
5. Singer SJ, Falwell A, Gaba DM, Meterko M, Rosen A, Hartmann CW, Baker L. Identifying organizational cultures that promote patient safety. Health Care Manage Rev. 2009 Oct-Dec;34(4):300-11.
6. Sorra J, Khanna K, Dyer N, Mardon R, Famolaro T. Exploring Relationships Between Patient Safety Culture and Patients' Assessments of Hospital Care. J Patient Saf. 2012 Jul 10. [Epub ahead of print].
7. Sorra JS, Nieva VF. Hospital Survey on Patient Safety Culture. (Prepared by Westat, under Contract No. 290-96-0004). AHRQ Publication No. 04-0041. Rockville, MD: Agency for Healthcare Research and Quality. September 2004.
8. Weaver SJ. A configural approach to patient safety climate: The relationship between climate profile characteristics and patient safety. Doctoral dissertation. University of Central Florida. 2011.
9. 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.