Slide 1 Patient Safety Culture in the Radiologic Sciences Jeff Legg Virginia Commonwealth University Laura Aaron Northwestern State University of Louisiana Melanie Dempsey Virginia Commonwealth University Slide 2 Today s bjectives Define and discuss the concept of patient safety culture Describe research on patient safety culture among various health professions, including the radiologic sciences Discuss how safety culture can impact our profession and students Slide 3 What Is Culture? shared patterns of: behaviors and interactions cognitive constructs understanding learned through socialization shared patterns identify the members The learned and shared behavior of a community of interacting human beings Banks, J.A., Banks, & McGee, C. A. (1989). Multicultural education. Needham Heights, MA Allyn & Bacon. Useem, J., Useem, R., Donoghue, J. (1963). Men in the Middle of the Third Culture: The Roles of American and Non-Western People in Cross-Cultural Administration Human Organization, 22(3).
Slide 4 Patient Safety Culture Common concepts: employees taking action when problems arise safety as the responsibility of all employees at all levels a shared sense of teamwork and communication drives the institution safety as the priority and employees are not afraid to report adverse events Bodur, S, Filiz E. Validity and reliability of Turkish version of Hospital Survey on Patient Safety Culture and perception of patient safety in public hospitals in Turkey. BMC Health Services Research. 2010; 10:28. Slide 5 Why Measure PSC? state of the current organizational culture success with patient safety initiatives establish framework within which to justify change and demonstrate positive results gain consensus organizational values how to proceed Slide 6 Why Measure PSC? to maximize the potential of patient safety initiatives regular measurement at both the departmental and administrative level
Slide 7 Measuring Patient Safety Culture Two measurement tools: 1. Institute for Healthcare Improvement Safety Climate Survey Center of Excellence for Patient Safety Research & Practice, 2004 2. Hospital Survey on Patient Safety Culture Agency for Healthcare Research and Quality, 2006 many regulatory agencies still measure success using blame-based standards that discourage disclosure Slide 8 Research on PSC Underreporting of medical accidents, incidents, and errors Indiana SOM study formally reported incidents rare Adams 2011 study Rad therapy error rates/barriers to reporting 78% strongly agree error reporting 16% reprimand Logio LS, Ramanujam R. Medical trainees formal and informal incident reporting across a five-hospital academic medical center. The Joint Commission Journal on Quality and Patient Safety 2010 36. Adams R. National study to determine the comfort levels of radiation therapists to report errors. Study presented at: 35th ASRT Radiation Therapy Conference; October 2-4, 2011; Miami, FL. Slide 9 Research on PSC Institutional factors-va and nonfederal hospitals teaching status and increase in some patient safety related events lack of an overall consistent relationship hospital structural characteristics (i.e., bed size, nurse staffing levels, urban/rural locale) and patient safety. Rivard PE, Flixhaousr An, Chrstiansen CL, Zhao S, Rosen AK. Testing the association between patient safety indicators and hospital structural characteristics in VA and nonfederal hospitals. Med Care Res Rev 2010 67: 321
Slide 10 Research on PSC Saudi Arabia Various personnel (1224), 13 hospitals in Riyadh Positive patient safety grade Perception-management overlooked safety problems Norway 500 bed hospital PSC varies by hospital department Alahamdi HA. Assessment of patient safety culture in Saudi Arabian hospitals. Quality and Safety in Health Care 2010;19. Deilkås E, Hofoss D. Patient safety culture lives in departments and wards: Multilevel partitioning of variance in patient safety culture. BMC Health Services Research 2010 10:85. Slide 11 Research on PSC Turkey Physicians and nurses HSOPSC Low PSC High teamwork but low error/event reporting Bodur S, Filiz E. Validity and reliability of Turkish version of Hospital Survey on Patient Safety Culture and perception of patient safety in public hospitals in Turkey. BMC Health Services Research 2010 10:28 Slide 12 RT Patient Safety Research no studies focusing specifically on radiologic technologists radiation therapy and angiography selected measure the culture of patient safety as perceived by radiation therapists and angiographers
Slide 13 ARRT databases Methods Entire universe of VI/CI techs (3,180) SRS of radiation therapists (~10,000) 2,000 for + 2% Slide 14 3 postcards sent to visit program website Online version of the Hospital Survey on Patient Safety Culture Methods Slide 15 HSOPSC Hospital Survey on Patient Safety Culture patient safety issues, error reporting unit and institutional level Cronbach s alpha (mid 70s low 80s)
Slide 16 RT Patient Safety Culture Valid return (n) Response Rate Confidence interval Angiographers 468 14.7% +4.18 Radiation therapists 169 8.6% +7.47 Slide 17 RT Patient Safety Culture: Radiation Therapists Patient Safety Culture Dimension N Mean (SD) Minimum- Unit [department] level Maximum Supervisor/manager expectations and actions promoting safety* 166 15.14 (3.54) 4-20 Organizational learning continuous improvement** 167 11.07 (2.38) 4-15 Teamwork within units* 167 15.78 (3.38) 4-20 Communication openness** 168 11.16 (2.59) 3-15 Feedback and communication about error** 165 11.28 (2.67) 6-15 Nonpunitive response to error** 163 9.56 (3.50) 3-15 Staffing* 161 15.32 (3.11) 5-20 Hospital level Hospital management support for patient safety* 158 11.53 (2.53) 5-15 Teamwork across hospital units * 149 14.03 (3.16) 5-20 Hospital handoffs and transitions * 147 13.36 (3.26) 4-20 Slide 18 RT Patient Safety Culture: Radiation Therapists N Mean (SD) Minimum-Maximum Perceived patient safety* 166 15.75 (3.38) 5-20 Event reporting frequency** 161 11.81 (2.92) 3-15 *Scale: 4: strongly disagree, 8: disagree, 12: neither agree nor disagree, 16: agree, 20: strong agree **Scale: 3: strongly disagree, 6: disagree, 9: neither agree nor disagree, 12: agree, 15: strong agree Grade N (Valid %) A 70 (41.7) B 73 (43.5) C 20 (11.9) D 4 (2.4) F 1 (.5)
Slide 19 RT Patient Safety Culture: Angiographers Patient Safety Culture Dimension N Mean (SD) Minimum- Unit [department] level Maximum Supervisor/manager expectations and actions promoting safety* 456 14.41 (3.63) 4-20 Organizational learning continuous improvement** 456 11.09 (2.14) 4-15 Teamwork within units* 462 15.68 (2.90) 6-20 Communication openness** 462 10.99 (2.46) 3-15 Feedback and communication about error** 459 10.91 (2.65) 3-15 Nonpunitive response to error** 454 9.71 (2.90) 3-15 Staffing* 443 14.19 (3.09) 5-20 Hospital level Hospital management support for patient safety* 443 10.88 (2.69) 3-15 Teamwork across hospital units * 435 13.19 (3.07) 5-20 Hospital handoffs and transitions * 431 12.31 (3.33) 4-20 *Scale: 4: strongly disagree, 8: disagree, 12: neither agree nor disagree, 16: agree, 20: strong agree **Scale: 3: strongly disagree, 6: disagree, 9: neither agree nor disagree, 12: agree, 15: strong agree Slide 20 RT Patient Safety Culture: Angiographers N Mean (SD) Minimum-Maximum Perceived patient safety* 457 15.07 (3.22) 4-20 Event reporting frequency** 446 10.11 (3.13) 3-15 *Scale: 4: strongly disagree, 8: disagree, 12: neither agree nor disagree, 16: agree, 20: strong agree **Scale: 3: strongly disagree, 6: disagree, 9: neither agree nor disagree, 12: agree, 15: strong agree Grade N (Valid %) A 157 (34.7) B 206 (45.6) C 71 (15.7) D 16 (3.6) F 2 (0.4) Slide 21 Conclusions Above average patient safety culture Communication Error reporting and mechanisms National Center for Patient Safety call for culture change prevention, not punishment
Slide 22 Opportunities Radiation therapy departments Error prevention practices Safety rounds Safety coaching Students/educational programs Slide 23 Acknowledgements Dr Aaron: Rapides Regional Medical Center Radiologic Technology Endowed Professorship