The medical office survey on patient safety culture MOSPSC! Opinions and views! of EQuiP network General Practitioners! Dr Isabelle DUPIE! Dr André NGUYEN VAN NHIEU! EQuiP Conference Dublin 4 th March 2017
Declaration of Financial Interests or Relationships Speaker Name: André NGUYEN VAN NHIEU I have no financial interests or relationships to disclose with regard to the subject matter of this presentation.
Declaration of Financial Interests or Relationships Speaker Name: Isabelle DUPIE I have no financial interests or relationships to disclose with regard to the subject matter of this presentation.
Context! EQuiP Conference Dublin 4 th March 2017
The safety culture of an organisation is the product of the individual and group values, attitudes, competencies and patterns of behaviour that determine the commitment to,and the style and proficiency of, an organisation s heath and safety programmes.! To explore the link between the risks patients face and! the way things are done in our practices! Whereas safety culture was initially seen as potentially directly impacting on safety, there was now a growing awareness that it might provide only a necessary foundation!! Organisations with a positive safety culture are characterised by:!! communcations founded on mutual trust! shared perceptions of the importance of safety! Confidence in the efficacity of preventive measures!
Patient Safety! in primary care! A lower technology environment! ut! Millions of interaction occuring every day! A high heterogeneity in its organisation! Complex and various organisational arrangements etween primary and secondary care interface! The role of patient in patient safety! How to measure safety culture! in Primary care organizations?!
The LINNAEUS-PC collaboration had put forward two tools to assess safety culture in a organisation :! the primary care version of the Manchester Patient Safety Framework (MaPSaF)! the Medical Office Survey on Patient Safety Culture (MOSPSC) from the Agency for Healthcare Research and Quality (AHRQ)! Both these tools have been field-tested in primary care settings in several European states.
Survey designed specifically for outpatient medical office providers and staff! Asks for their opinions about the culture of patient safety and health care quality in their medical offices.! Designed to measure the culture of patient safety! in an organisation (single medical office)! With at least 3 providers! To be completed by ALL staff and providers! Need confidentiality!
Source the «Survey User s Guide» Can be used as : A diagnostic tool to assess the status of patient safety culture in a medical office.! An intervention to raise staff awareness about patient safety issues.! A mechanism to evaluate the impact of patient safety improvement initiatives.! A way to track changes in patient safety culture over time. Comparison : To allow medical offices to compare their patient safety culture survey results with other medical offices!
Source the «Survey User s Guide» Can be used as : A diagnostic tool to assess the status of patient safety culture in a medical office.! And what do EQuiP An intervention to raise staff awareness about delegates think about the patient safety issues.! survey?! A mechanism to evaluate the impact of patient safety improvement initiatives.! A way to track changes in patient safety culture over time. Comparison : To allow medical offices to compare their patient safety culture survey results with other medical offices!
AIM! EQuiP Conference Dublin 4 th March 2017
! 38 European GPs motivated by quality improvement in family medecine!! The aims of our study :! To spread the tool among EQuiP delegates! To explore their views and opinions on the MOSPSC! To explore with them the feasibility of the MOSPSC among European countries!
METHODS! EQuiP Conference Dublin 4 th March 2017
+ MOSPSC! 10 dimensions of PSC! 60 questions! Feasibility! Opinion on the practical feasibility! Group interview! Cross-sectional study! Nov 15 - Apr 16!! +! Characteristics! 8 Individual interviews! Feasibility of a study on Patient Safety Culture!
Results! Part 1 : Participants Characteristics! Part 2 : Questionnaires results (MOSPSC + feasibility)! Part 3 : Qualitative approach!
Characteristics! Participation Rate 29/40 (72,5%) 19 countries involved Male 63% / Female 37%
Structure! 76% working in one location! 63,3% working only with GPs and 10% in singlehanded practice 26,8% working with primary care providers! 10% working with specialists!
Structure (2)! Only 4 delegates have specialists in their practice! 27% have a nurse practitioner! 56% have a nurse! 20% work with midwives in their practice! 86% with no secretary!
Medical Office Survey on Patient Safety Culture!
AHRQ Questionnaire! Based on the Hospital Survey on Patient Safety Culture! 60 questions / 12 dimensions of PSC! Used from the billing staff to the director of the practice/office!
Level of providers! 1. Overall Perceptions of Patient Safety and Quality 2. Owner/Managing Partner/Leadership Support for Patient Safety 3. Communication Openness 4. Communication About Error 5. Teamwork
Level of structure! 1. Owner/Managing Partner/Leadership Support for Patient Safety 2. Patient Care Tracking/Follow-up 3. Office Processes and Standardization 4. Information Exchange with Other Settings 5. Organizational Learning 6. Staff Training
Presenting the results:! radial plots! - 1 radius = 1 dimension - 1 cercle = scale of results in mean % - Colour = provider
0 1/4 1/2 3/4 1 1 1/4 0 1/4 1/2 3/4 1 1 1/4 0 1/4 1/2 3/4 1 1 1/4 0 1/4 1/2 3/4 1 1 1/4 Focus on Work Pressure! C3 : In this office, we often feel rushed when taking care of patients! C3 24% 17% 59% Positive Neutral Negative C6 : We have too many patients for the number of providers in this office! C6 24% 31% 45% Positive Neutral Negative C11 : We have enough staff to handle our patient load! C11 41% 28% 31% Positive Neutral Negative C14 : This office emphasizes teamwork in taking care of patients! C14 48% 14% 38% Positive Neutral Negative
Equip Meeting Prague 21-23rd April 2016
Positive safety culture! or developed when 75% positive answers or more on a dimension! =<50% : potential for improvement!
with 81% and 86% 56%
What about comparing countries?!
Denmark Spain «Saisissez une citation ici.»! -Gilles Allain!
Rating Patient Safety? 73% rated as good or very good 32
Feasibility study!
Understanding PS Culture! 53,3% felt it help them understanding PSC! 40% couldn t say if it helped or not «it helped in some way as it opened my mind for things like timely availability of laboratory results as part of safety»
Feasible or not?! 73,3% think the results will help organizations to decide to improve safety! 63% find it would be interesting to use MOSPSC! 46% think it would be feasible in their country / 43% without financial support!
Who wants to join?! 63,3% would like to be involved! Already 5 versions of MOSPSC (English, French, Spanish, Danish, Portuguese)
QUALITATIVE DATAS! EQuiP Conference Dublin 4 th March 2017
1- After seeing the survey, how do you think this tool could be used in your medical office?!! 2 - If you wanted to launch the survey in your practice, what would be the positive points put forwards?!! 3 - What could be the benefits of using the tool to compare the practices /primary care structures in your country and between european countries?! WORKSHOP / Focus group! April 24th 2016!! 9 participants! 8 GPs - 5 EQuiP delegates! 1 director of Agency for! Healthcare Quality!! 3 Questions :!
! 1. Positive feedbacks given to the survey tool! 2. Some precautions highlighted by participants! 3. Concerns and reluctance factors! 4. Comparison of the structures!!
!! ositive feedbacks given to the survey! It increases the awareness of patient safety in primary care! "They really want to open disclosure with the problem they have. They use the clinical system and they were proud they were able to talk because they thought medical doctors and nurses didn t want to talk about these things It helps, first of all to realize what you are not doing right and what you are doing right We try to understand and share about this patient incidents. Perhaps this survey could initiate that kind of review in a structure
!! Positive feedbacks given to the survey! It raises interesting questions about their practices including office organization and teamwork.! The survey is useful mostly as a starting point! «The usefulness of this survey is probably to begin a discussion between the healthcare professionals inside the structure.»! The same questionnaire is addressed to different people so we have the perceptions of different professionals! I m working with 14 people in my practice; The first problem will be the openness in communication. So that would be a big issue! And I think it can be used as a starting point for discussion because it s actually not a survey on patient safety but it s a survey on views of professionals about patient safety!!
Positive feedbacks given to the survey tool! It spots the weakness points where improvements are necessary from the viewpoint of the team members, and by a participative non-top-down process! «For my practice, it is useful because it helps you to reflect on what you re doing everyday»! «If they think there is a problem in any area of functioning like communication, they have to list that. Then the only advice to use that as a starting point of discussion.»! «On the other hand, if we have that spider web, it would set an agenda for the to start with»!
ome precautions highlighted by participants! To handle these necessarily sensitive issues, a proper presentation of the survey is needed! Benefits of the survey presuppose a sufficient trust within the team and regarding the goals and uses of the outcomes.! So I think this would be useful if everybody in the practice trusted each other enough to cope with the responses to deal with them!! Conducting an investigation when a problem is already known might not serve the team! There is no point measuring a problem that we already know. What we need is take action!!
!! Concerns and reluctance factors! Lack of time but a challenge to face! I think in general I think practices in my country would not take this on because they don t have the time! We tried to make several protocols to better communicate but it takes time and we don t have enough time! We face complexity with patients, more comorbidities, polypharmacy so if we don t aware, we will be just in the border of mistakes all the time and it s quite difficult for people We have a challenge to do. We need to take time!
! Concerns and reluctance factors!.! Validity of the questionnaire! «The questionnaire is deemed too long and would need to be shortened»!. «The risk to lose validity is too great and that a new validation would require too much preliminary work»! That s one step. The other step is the validation of how much it can be reproducible, how much is it actually reliable if you do it in different professions?
! oncerns and reluctance factors! Very negative views were also voiced In some countries, the prospect of having to complete one more questionnaire no longer is accepted.! I wouldn t be able to launch a questionnaire at this very moment. There is a very strong wind against ticking any box! Some people no longer believe in the possibility of change at the local level. They feel that the decisions must be taken at the health care system level.! Who s going to make the changes? Because then it becomes a system problem?! Others consider the tool insufficient! I m missing the patient perspective!
! Concerns and reluctance factors!! Comparisons between teams (or countries) are generally seen as irrelevant! Comparing countries will not be possible unless you compare the context! Who will do something about that? So comparing practices, how helpful is that?!!
Conclusion! EQuiP Conference Dublin 4 th March 2017
!! onclusion! The survey is best seen by EQuiP delegates as a starter for a reflexive process of discussion.! This process is very valuable if it addresses the real concerns and problems as felt by the field professionals, and leads to actions and improvements.! We need solutions to «take time» for quality improvement process in general practice.! Its use to compare organizations seems not relevent to EQuiP delegates!!