Safety Culture. QI In Ac1on 29 th June Ma; Hill Consultant Anaesthe-st, Plymouth Regional Pa-ent Safety Officer, SWAHSN.

Transcription

1 Safety Culture QI In Ac1on 29 th June 2016 Ma; Hill Consultant Anaesthe-st, Plymouth Regional Pa-ent Safety Officer, SWAHSN

2 Why talk about culture at a QI mee1ng? The culture supports improvement efforts QI methodology used to in improve culture

3 How does culture support improvement?

4 Avedis Donabedian Systems awareness and systems design are important for health professionals, but are not enough. They are enabling mechanisms only. It is the ethical dimension of individuals that is essen1al to a system s success. Ul1mately, the secret of quality is love. Donabedian A. Evalua1ng the quality of medical care. Milbank Memorial Fund Quarterly, 1966, 44:

5 Deming s System of Profound Knowledge Culture Profound Knowledge

6 With thanks to Mike Williams Cultural insights

7 Why measure safety culture? Be;er safety culture associated with be;er pa1ent outcomes Support our staff to deliver the best care that they can To know which aspects we can improve To know if we are ge\ng be;er

8 Can we measure safety culture? Checklist for Assessing Institutional Resilience Culture of Safety Survey Danish Patient Safety Culture Questionnaire Error Orientation Questionnaire Hospital Culture Questionnaire Hospital Survey on Patient Safety Hospital Survey on Patient Safety Culture Manchester Patient Safety Assessment Framework Nursing Unit Cultural Assessment Instrument Patient Safety Climate in Aesthesia Patient Safety Culture Questionnaire Patient Safety Culture in Healthcare Organisations Survey Safety Attitudes Questionnaire Safety Climate Assessment Tool Safety Climate Scale Safety Climate Survey Stanford Safety Culture Instrument Safety Climate Survey Stanford Safety Culture Instrument Teamwork and Patient Safety Attitudes Questionnaire Trainee Supplemental Survey TUKU Safety Culture in Health Care Survey Veteran Affairs Palo Alto / Stanford Patient Safety Center for Inquiry Veterans Health Administration Patient Safety Culture Questionnaire Vienna Safety Culture Questionnaire World Alliance for Patient Safety Hand Hygiene Campaigns Healthcare - Units Survey on Patient Safety Culture.

9

10 Results

11 Key messages about measuring safety culture Psychological security Teamwork Unit level Leadership Trust level Leadership Benchmarking Burnout Inspec1on Good Bad Ugly

12 Psychological security I ve cut the corners off the ques1onnaire so that you won t be able to iden1fy me A. Consultant

13 SAQ Climate Domains for Orthopaedic Theatres Job sa1sfac1on Working condi1ons Stress recogni1on Percep1on of Hospital Management Percep1on of Theatre Management Safety climate Teamwork climate Percentage posi1ve

14 SCORE All Culture Domains Unit A

15 SCORE All Culture Domains Unit B

16 The doctors and nurses here work together as a well co-ordinated team. It is easy for personnel here to ask ques1ons when there is something that I have the support I need from other personnel to care for pa1ents. Disagreements in this clinical area are resolved appropriately (i.e. not who is In this clinical area, it is not difficult to speak up if I perceive a problem with Nurse input is well received in this clinical area Teamwork Climate Percentage posi1ve

17 SCORE Teamwork Domain Unit B

18

19 Local Unit Leadership Crucial Response rates Subsequent improvement Hardly a competent workman can be found who does not devote a considerable amount of 1me to studying just how slowly he can work and s1ll convince his employer that he is going at a good pace Frederick Winslow Taylor, 1910

20 Percep1on of Theatre Management The levels of staffing in this clinical area are sufficient to handle the number of pa1ents. I get adequate, 1mely info about events that might affect my work, from: THEATRE Problem personnel are dealt with construc1vely by our: THEATRE Management is doing a good job: THEATRE Management doesn't knowingly compromise pt safety: THEATRE Management supports my daily efforts THEATRE Percentage posi1ve

21 SCORE Local Leadership Domain Unit A

22 Trust Level leadership

23

24 Trust level leadership Leadership walkrounds Broken window theory More than just visibilty Poten1al harm from doing them badly Ro;eau L, Shojania KG, Wbster F. BMJ Qual Saf 2014; Oct 23(10): Kelling GL, Coles CM. Fixing Broken Windows: Restoring Order And Reducing Crime In Our Communi1es. Touchstone, New York, 1998.

25 Benchmarking We may be the best but that doesn t mean that we are any good Ingvar Kamprad Ikea

26

27 SCORE Burnout Domain Unit A

28 SCORE Burnout Domain Unit B

29

30 NHS Employers. The staff engagement toolkit, 2013.

31 It s what we do when nobody is looking Post Francis Ring of Gyges: Plato BC

32 Point scoring? Command and control? Focus on the wrong kind of excellence? Inspec1on it s what we do when they are going to come and have look

33

34 Culture and QI Donabedian & Deming Be;er pa1ent outcomes Be;er staff metrics Culture is the essen1al underpinning for successful Quality Improvement

35 Ques1ons? Thank you. If you are interested in measuring the culture in your workplace, please get in touch.