Building and Measuring Safety Culture:
Getting Started & Planning Your Survey
Process
SUSP Cohort 3
March 19, 2013 & March 21, 2013
Polling Question
1.
Has your organization conducted a safety culture survey in the past
12 months?
a.
b.
c.
Yes
No
Do not know
2
Polling Question
2.
If yes, what survey instrument was used?
a.
b.
c.
d.
Safety Attitude Questionnaire (SAQ)
Hospital Survey on Patient Safety (HSOPS)
Other survey or measurement tool
Do not know
3
Learning Objectives
1. Define safety culture
2. Describe why safety culture is important for
improvement efforts
3. Identify best practices for measuring safety
culture
– Define the role and responsibilities of the survey
coordinator
– Identify characteristics of successful surveys and
action items
4
Part I
A BRIEF OVERVIEW OF SAFETY
CULTURE
5
The Armstrong Institute Model to
Improve Care
http://www.hopkinsmedicine.org/armstrong_institute
6
What is Safety Culture?
 Perceived priority of safety relative to
other goals
 Culture is the compass team
members use to guide their
behaviors, attitudes, & perceptions
on the job
• What will I get praised for?
• What will I get reprimanded for?
• What is the “right” thing to do?
Culture provides the context
for team success
7
Image source: Marysia Tomaszewska, August 8, 2012, used under a Creative Commons License
What Are the Core Aspects of
Safety Culture…
Schein, 2007
Why Safety Culture Matters
1. Safety culture is related to outcomes
– Patient outcomes

Patient care experience

Infection rates, sepsis

Postop. hemorrhage, respiratory failure, accidental
puncture/laceration

Treatment errors
– Clinician outcomes

Incident reporting, burnout, turnover
Huang et al., 2010; Mardon et al., 2010; MacDavitt
et al., 2007; Singer et al., 2009; Sorra et al., 2012;
Weaver, 2011.
9
Why Safety Culture Matters
2. Safety culture influences the effectiveness of
other safety and quality interventions
– Can enhance or inhibit effects of other
interventions
3. Safety culture can change through intervention
– Best evidence so far for culture interventions that
use multiple components
Haynes et al., 2011; Morello et al., 2012; Van
Nord et al., 2010; Weaver et al., in press
10
Part II
MEASURING SAFETY CULTURE
11
CUSP & Safety Culture
• Safety Culture is typically measured “Pre-CUSP”
(before interventions begin):
– Provides a baseline to diagnose barriers and facilitators that
can impact improvement efforts
– Then can be measured 12-18 months following start of
improvement efforts
• Use reliable and valid survey instrument
– Hospital Survey on Patient Safety (HSOPS)
• CUSP is the intervention that you will use to help you
improve culture results
12
What is the Hospital Survey on
Patient Safety (HSOPS)?
 Part of a suite of survey tools (SOPS) for hospitals, medical
offices, nursing homes
•
Sponsored by: Agency for Healthcare Research & Quality
•
Developed by Westat, public release in 2004
 The HSOPS App: An online survey tool
 Developed by the Armstrong Institute, in partnership with CeCity
 Allows participants to complete the survey online and survey coordinators to
access detailed reports of results
 Participants are asked to choose 1 to 5 for each question:
1 Strongly Disagree 2 Disagree 3 Neither Agree nor Disagree 4 Agree 5Strongly Agree
1 Never 2 Rarely 3 Sometimes 4 Most of the time 5 Always
13
HSOPS Questions & Composite
Scores
10 Composite Scores
(“Dimensions”)
No. of
Questions
Example Question
1.
Supervisor/manager expectations &
actions promoting patient safety
4
B1. My supervisor/manager seriously considers staff
suggestions for improving patient safety.
2.
Organizational learning-continuous
improvement
3
A9. Mistakes have led to positive changes here
3. Teamwork within unit
4
A1. People support one another in this unit.
4.
Communication openness
3
C4. Staff feel free to question the decisions or actions of
those with more authority.
5.
Feedback & communication about error
3
C1. We are given feedback about changes put into place
based on event reports.
6.
Nonpunitive response to error
3
A8. Staff feel like their mistakes are held against them.
(negatively worded)
7.
Staffing
4
A2. We have enough staff to handle the workload.
8.
Hospital management support for
patient safety
3
F8. The actions of hospital management show that
patient safety is a top priority.
9.
Teamwork across hospital units
4
F4.There is good cooperation among hospital units that
need to work together.
4
F5.Important patient care information is often lost during
shift changes. (negatively worded)
14
10. Hospital handoffs & transitions
HSOPS Questions & Composite
Scores (cont’d)
4 Outcome Variables
No. of
Questions
Example Question
1.
Overall perceptions of safety
4
A15. Patient safety is never sacrificed to get more
work done.
2.
Frequency of event reporting
3
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)
1
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
1
G1.
In the past 12 months, how many event
reports have you filled out and submitted?
6 Background questions
15
HSOPS Scoring
• Scoring guidelines created by AHRQ
• Scores represent the % of positive responses
– % who gave a score of 4 or 5
16
Part III
OVERVIEW OF THE SURVEY
ADMINISTRATION PROCESS
17
Effective surveys…
1.
Are confidential and anonymous
•
•
•
2.
Have a clear reason and motivation to complete them
•
3.
No way to link responses with email address or other individual
information
Results reported at unit-level
Critical that the survey coordinator, project team, and leadership focus on
survey as a tool for learning and improvement
Must be clear to staff why you are asking them to complete this survey,
what will happen with results, and what will be done based on their input
Are publically supported by both formal and informal unit
leaders
•
If leaders and colleagues view the survey as important and worthy of their
time, frontline staff will be more motivated to contribute their input
18
Two Options for HSOPS
Option 1
Option 2
Collect fresh HSOPS data from
participating work areas
Upload previously collected
HSOPS data from participating
work areas
• Use online HSOPS App to
survey work area team
members
• Upload excel file to online
HSOPS App
19
What are the key tasks & dates for Cohort 3 Teams?
Phase
Prep
(~3
wks)
Task
•
Logistical tasks
•
Planning stage
Alert participants
Who will administer?
•
•
Who will be surveyed?
Publicize! Motivate participation.
•
Create a debriefing plan
•
Provide pre-notification (post, email, meetings)
•
Ensure your survey coordinator attends 1 web
training session:
Tues April 2, 2013 @ 10am EST
Thurs April 4, 2013 @ 4pm EST
Learn the HSOPS
App
Start!
April 9, 2013 after 12noon EST
•
Upload participant email addresses or previously
collected data
Track
•
Monitor response rates (target >60%)
Remind
•
1st reminder
Remind again
•
Final reminder
End the survey
May 28, 2013 @12noon EST
•
Survey closes
Download data
report
May 29, 2013 after 12noon EST
•
Download results report from HSOPS APP
Execute
•
Debrief & plan improvements
wk
wk
wk
wk
wk
wk
wk
wk
wk
1
2
3
4
5
6
7
8
9
Who are key personnel in the
HSOPS process?
21
Survey Coordinators: Key
Responsibilities
Survey coordinators…
•
Help to coordinate the survey administration process,
•
Learn how to use the online survey database (via training webinars
and conference calls)
•
Help survey participants with the survey process,
•
Enter data about the work areas participating in the survey into the
online survey database,
•
Monitor the survey response rate using the online survey database,
•
Work with hospital and work area leadership to distribute survey
materials and information,
•
Communicate with other HSOPS Coordinators in the project
22
Online HSOPS Application
(“HSOPS App”)
23
Developing HSOPS Survey List
1. Determine whom to survey
 Clinical staff only?
 Non-clinical support staff (e.g., environmental services)?
2.
Compile unit email list
 E-mail address
 Hospital area/unit
 Staffing category (e.g., physician, nurse, technician, administrative
support)
Make sure your list is up to date, check for:
–
–
–
–
–
Staff on administrative or extended sick leave,
Staff who appear in more than one staffing category or hospital area/unit,
Staff who have moved to another hospital area/unit,
Staff who no longer work at the hospital, and
Other changes that may affect the accuracy of your list email addresses
24
Pre-Notification Materials to Inform
Unit Clinicians and Staff of HSOPS
1.
Why the hospital is conducting the survey and how staff responses
will be used,
2.
Which hospital staff were selected to be surveyed (e.g., all staff,
nursing staff, all clinical staff, a random sample of staff, etc.),
3.
How much time is needed to complete the survey, Confidentiality or
anonymity assurances,
4.
Suggested reply timeframe and how to return completed surveys,
5.
Contact information for the main hospital point-of-contact.
Sorra & Nieva, 2004
25
Why should we aim for a
response rate of 60% or higher?
Response rate =
Number of respondents who completed the online survey divided by
the total number of unit members who were invited to complete the
survey
Safety culture reflects the shared perceptions
among unit members
• Response rate of 60% is minimum necessary for a
relatively representative sample
• Important for validity and reliability of results
26
Tips for Effective Surveys
•
Communicate to all staff on the unit the importance of their valuable
input
•
Check response rates periodically and send reminders at different
times throughout the survey administration process: before the survey
is administered and a few times during the survey administration
process
•
Send periodic reminders through various communication channels,
such as emails, announcements, during staff meetings, etc.
•
Create a debriefing plan for sharing results with clinicians and staff
•
Don’t be afraid to reach out for assistance when in doubt
27
Thinking ahead: Creating a Debriefing
Plan for your Survey Results
Debriefing is…
– A semi-structured conversation among frontline clinicians
and staff that is usually led by a designated facilitator
Purpose…
1. Encourage open communication, transparency, and
interactive discussion about the survey results across all
levels
2. To engage clinicians and staff in generating and
implementing their ideas about how to create an effective
safety culture in their work area
28
Some points to cover in your debriefing
plan
29
Conducting HSOPS Debriefings:
CUSP Culture Check-Up Tool
• What is the Purpose of this Tool?
– Understand the culture of the unit
– Use teammates’ feedback to predict barriers to change and avoid
them
– Use feedback to make the most of the team’s strengths
• Who Should Use this Tool?
– Safety culture debriefing facilitators
• Use this tool to help guide the discussion and record group
decisions
30
Armstrong Institute for Patient Safety and Quality
The “Culture Check Up Tool” = Word Document
that Debriefing Facilitator can use to guide
conversation & improvement planning
31
Armstrong Institute for Patient Safety and Quality
32
Armstrong Institute for Patient Safety and Quality
We are here to support & guide:
HSOPS Calls & Timeline
 Getting Started & Planning the Process
•
Intro to measurement, basics of survey administration
•
Tues March 19, 2013 @ 10am EST & Thurs March 21, 2013 @ 4pm EST
 The online HSOPS process
•
A more detailed, technical call for survey coordinators that will walk through the
details of how to use the online survey app
•
•
Cohort 3 HSOPS Opens:
•
•
April 9, 2013 after 12noon EST
Cohort 3 HOSPS Closes:
•
•
Tues April 2, 2013 @ 10am EST & Thurs April 4, 2013 @ 4pm EST
May 28, 2013 at 12noon EST
Cohort 3 HSOPS data reports available in online HSOPS App:
•
May 29, 2013 after 12noon EST
 Interpreting HSOPS data and debriefing
•
Once data are collected and survey coordinators have download their results,
another call will be held to walk through how to read reports, debriefing staff,
and interpret results
•
Tuesday June 4, 2013 @ 4pm EST
33
Action Items:
1.
Identify a survey coordinator for participating work areas
 …Or coordinators if your team desires more than one coordinator
2.
Send collated list of survey coordinators to your coordinating entity (HEN, Hospital
association, or affinity group leader)
 If collecting new data or uploading previously collected data
 Coordinating entity to compile and send to JHU
3.
Determine whom to survey and sample size
 …Or locate previously collected data file
 Format data file
4.
If collecting fresh HSOPS data.:
 Compile unit email list
 Create informational materials to publicize the survey (posters, flyers, newsletters, meeting
agenda items)
 Send pre-notification letter, post pre-notification information, or hold pre-notification meeting
5. Create draft debriefing plan
34
Questions? Tools? Templates?
https://armstrongresearch.hopkinsmedicine.org/susp.aspx
Reminder…
You can access all
slides, call recordings,
and project tools at the
SUSP website
35
On-boarding Call Evaluation
We want to ensure that the on-boarding calls
provide useful and pertinent information for the
SUSP teams. For this reason we request that
you complete a brief evaluation following each
call. The evaluation may be found at the
following link:
• https://www.research.net/s/Onboarding_Evaluation
36
References
•
•
•
•
•
•
Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat AH, Dellinger EP, Dziekan G,
Herbosa T, Kibatala PL, Lapitan MC, Merry AF, Reznick RK, Taylor B, Vats A, Gawande
AA; Safe Surgery Saves Lives Study Group. Changes in safety attitude and relationship to
decreased postoperative morbidity and mortality following implementation of a checklistbased surgical safety intervention. BMJ Qual Saf. 2011 Jan;20(1):102-7.
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.
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.
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.
Morello RT, Lowthian JA, Barker AL, McGinnes R, Dunt D, Brand C. Strategies for
improving patient safety culture in hospitals: a systematic review. BMJ Qual Saf. 2012 Jul
31. [Epub ahead of print]
Schein E. Organizational culture and leadership, 4th edition. San Francisco, CA: JosseyBass. 2010.
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References
•
•
•
•
•
•
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 OctDec;34(4):300-11.
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].
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.
van Noord I, de Bruijne MC, Twisk JW. The relationship between patient safety culture and
the implementation of organizational patient safety defences at emergency departments.. Int
J Qual Health Care. 2010 Jun;22(3):162-9.
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.
Weaver, S. J., Dy, S., Lubomski, L., & Wilson, R. Promoting a culture of safety. In R.M.
Watcher, P.G. Shekelle, P. Pronovost (Eds.). Making healthcare safer: A critical analysis of
the evidence of patient safety practices (AHRQ report # TBD). Rockville, MD. In press.
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