The Hospital Culture of Transitions Survey

Transcription

1 The Hospital Culture of Transitions Survey A New Way of Looking at Patient Flow March 23, 2016 Mark McClelland DNP, RN, CPHQ Nurse Researcher

2 Acknowledgements Danielle Lazar, MA Lindsay Wolfe, MPH Debora Goetz Goldberg, PhD, MBA Mark Zocchi, MPH; Jenny Twesten, MPH; Jesse M. Pines, MD, MBA James Bena, MS Nancy Albert PhD, RN Robert Wood Johnson Foundation Urgent Matters Program Cleveland Clinic Health System Authors have no conflict of interests

3 Crowding

4 Purpose To develop a survey that would enable hospital staff, leaders, administrators and researchers to assess and influence staff attitudes, values, beliefs and practices about transitions and the improvement of transitions.

5 Background Transitions Organizational Culture

6 Transitions Hospitalized patients undergo an average of 24 transitions during their inpatient stay ED Inpatient units Inpatient units OR PACU and ICU Inpatient units Radiology/Diagnostic depts. Inpatient units

7 Transitions Defined The transfer of information and responsibility for patient care between providers resulting in patient movement between locations.

8 Culture Defined The pattern of shared basic assumptions that was learned by a group as it solved its problems of external adaptation and internal integration, that has worked well enough to be considered valid and, therefore, to be taught to new members as the correct way to perceive, think, and feel in relation to those problems. (italics added) Schein, E.H, Organizational Culture and Leadership 3rd edition. Jossey-Bass, San Francisco, CA p.17

9 Artifacts Espoused Beliefs and Values Underlying Assumptions

10 Peter Drucker

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12 Significance 1. Culture is poorly understood 2. Patient safety 3. Teamness of an entire facility

13 Methods and Results Construct Identification Technical Expert Panel Item Development Research Team Item Testing Delphi Panel Survey Testing Hospital employees

14 Construct Identification Technical Expert Panel (TEP) 10 members Convenience sample Nurses, Physicians, ED Tech, Transportation Supervisor? high What attitudes, customs, values, beliefs and shared practices, related to the highlevel dimensions, would facilitate or hinder quality transitions in care?

15 Transition Factors Policy dissemination to affected staff Communication is not standardized Leadership involvement and presence Enforcement of new standards Staff workload Task ownership Silo mentality vs. interdepartmental cooperation Patient centered focus v. "my workload centered focus Units perceive that they are the only ones that are busy Leadership ability to motivate staff Power struggles

16 Technical Expert Meeting Didactic Prework results - Brainstorming Ranked Transition Factors Importance and Changeability Grouped and Titled Transition Factors

17 Final Pile Titles (Constructs) 1. Organizational Priorities 2. Leadership 3. Workload 4. Operations 5. Communication 6. Work Ethic 7. Shared Goals 8. Patient-Centeredness

18 Item Development Developed by research team Items based on transition factors Associated with constructs

19 Item Testing Delphi Panel Recruitment Review Clarity Importance Improvements

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21 Delphi Round 1 53 items sent out 8 items Very Clear and Very Important - Retained 7 items Unclear and Not Important Discarded 5 items Important and Not Clear Rewritten and resent Delphi Round 2 38 items sent out 36 items Clear and Important - Retained 2 items - Not important - Discarded

22 Survey Testing Pilot Test Purpose evaluate flow Recruitment Nurse 7 Admin/Management 2 PA/NP 1 Patient Care Assistant 1 Clerk/Secretary 1

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25 Psychometric testing Reliability A measure is considered reliable if it would give us the same result over and over again. Think "repeatability" or "consistency Validity Does the survey accurately reflect the phenomenon of interest?

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31 Sample 757 staff responded of which 492 returns were deemed usable The typical respondent was a nurse working on a medical surgical unit for 1-5 years in a large facility

32 Factor Analysis A statistical method for describing variability among observed, correlated variables Results in a potentially lower number of unobserved variables called factors - Confirmatory Factor Analysis (CFA) - Exploratory Factor Analysis (EFA)

33 Factor Identification

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35 The Items Factor 1: Hospital Leadership 14% variance At my hospital there are clear policies and/or procedures describing safe and timely patient transitions in care. Training and education are provided on safe and timely patient transitions in care. At my hospital transitions in care are viewed as a patient safety issue. Senior hospital leaders communicate the importance of safe and timely patient transitions in care. Senior hospital leadership encourages creativity and innovation to address problems with transitions in care. There are good hospital-wide processes in place for informing staff about new policies

36 The Items Factor 2: Other Unit's Culture 8% variance Patient transitions in care going to other units/departments are delayed because staffs on other units avoid accepting new patients At my hospital staff in other units/departments delay receiving patient transfers until they can 'get caught up' with their other work I am satisfied with the timeliness of the transfer of patients going to other units/departments Please give your hospital an overall grade for patient transitions in care. 0.45

37 The Items Factor 3: My Unit's Culture 8% variance In my unit/department there are staff who will delay accepting transfers if it is close to the end of shift Patient transitions in care coming to my unit/department are delayed because staff on my unit/department avoids accepting new patients Staff delay incoming patient transfers until they can 'get caught up' with their other work. 0.49

38 The Items Factor 4: Unit Leadership 8% variance My supervisor/manager is responsive to staff suggestions for improving transitions in care When I have concerns about decisions made by my unit/department manager I feel free to approach him/her with my concerns In my unit/department employees are rewarded for working together as a team for safe and effective transitions in care. 0.51

39 The Items Factor 5: Use of Data 8% variance Data are collected related to patient transitions in care. (i.e. turnaround times, analyzing patient flow sheets, etc.) 0.95 Data are used to improve patient transitions in care (i.e. setting benchmarks, assessing trends over time, providing staff feedback on performance) 0.85

40 The Items Factor 6: Busy Workload 7% variance The level of my workload prevents me from completing effective and timely patient transitions in care to other units In my unit/department staff are often too busy to plan for upcoming patient transitions in care I do not feel a responsibility for a patient until they are on my unit. 0.26

41 The Items Factor 7: Priority of Patient Care 6% variance Senior hospital leaders make decisions based on what is best for hospital finances rather than what is best for patient care Supervisors/managers (e.g. charge nurse, bed coordinator) make decisions based on immediate needs of the unit/department rather than what is best for patient care. 0.62

42 The Subscales

43 The Survey

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45 Hospital Culture of Transitions: Next steps Further psychometric studies Scoring and norm referencing Widespread dissemination available at no charge on the Urgent Matters website.

46 References Pronovost P, Sexton B. Assessing safety culture: guidelines and recommendations. Qual Saf Healthcare. 2005;14: Schein EH. Organizational Culture and Leadership. 4th ed. San Francisco, CA: John Wiley & Sons; Sexton JB, et al. The Safety Attitudes Questionnaire: psychometric properties, benchmarking data, and emerging research. BMC Health Services Research Apr 03;44(6) doi: /

47 Thank You