Development and assessment of a Patient Safety Culture Dr Alice Oborne Consultant pharmacist safe medication use March 2014
Outline 1.Definitions 2.Concept of a safe culture 3.Assessment of patient safety culture 4.Development of a safety culture
Definition of patient safety The World Health Organization defines patient safety as the prevention of error and prevention of adverse effects to patients Patient safety can be improved by enhancing the safety culture
Safety culture Evolved in high-risk industries Staff injury data Organisational, managerial and human factors Predictive indicators Healthcare: high risk of morbidity, mortality
5 Bristol Jan 2002 Francis Feb 2013 Feb 2014 Keogh Jul 2013 Berwick Aug 2013
What is safety culture? 6 A complex framework of national, organisational and professional attitudes and values within which groups and individuals function. Organisational culture Safety culture Safety culture is a subset of organisational culture, relating to grouped beliefs and values concerning health and safety. the way we do things around here. Safety climate is the measurable components of safety culture, that can provide a snapshot of the underlying safety culture. Focuses on the shared staff perceptions about how safety is managed in their organisation. Safety climate Safety attitudes An individual s beliefs, values and perceptions about safety
Patient Safety Culture Shared values, prioritising patients; zero tolerance of substandard care; Empowering front-line staff with responsibility and freedom to deliver safe care Professional responsibility Recognising staff for their contribution
Why is safety culture important? Safety culture can vary within a hospital variation may be greater than variation between hospitals Important to assess culture in all departments of hospital Culture can be measured and improved A higher safety culture is associated with lower mortality, lower harm, lower costs
Measurement of safety culture Many measurement tools exist SAQ, AHQR, MaPSaF Some administered in groups, some questionnaires Measure organisation or department Compare departments Compare organisation over time (impact of interventions)
Examples of the dimensions 1. Team work climate It is easy for staff to ask questions when they don t understand Nurse input is well received in this clinical areas 2. Safety climate I would feel safe being treated here as a patient... Errors are handled appropriately 3. Job satisfaction I like my job. This is a good place to work 4. Working conditions Training of new staff. Trainees are adequately supervised. 5. Stress recognition When workload is excessive, my performance is impaired... less effective when tired.. 6. Perception of management Management supports my daily efforts Staffing is adequate
Patient safety culture in one Trust Three hospitals: Acute, Specialist, Children s All staff groups: doctors, pharmacists, nurses, porters, engineering Safety Attitudes Questionnaire Score of 75 or above indicates a positive patient safety culture Percent of positive responses also reflects safety culture Demographics and suggested improvements
Results 1 Demographics 52% female 59% not in a management position 43% worked at the acute site Largest group: nurses and midwives 23% worked in the hospital for over 10 years Overall Safety culture: 75 = a positive safety culture Nurses and midwives highest score
Results 2: The six dimensions On four dimensions, overall score was 75 or more 1. teamwork climate 2. safety climate 3. job satisfaction 4. working conditions Two were less than 75 1. stress recognition 2. perception of management
Results 3: percent positive replies Positive replies Job satisfaction had highest percentage positive responses Stress recognition was lowest Negative replies Team work climate had lowest negative replies Perception of management had highest percent negative reply Agrees with other findings
Results 4: Dimensions scoring over 75 Teamwork climate High: It is easy for staff here to ask questions when they do not understand Low: it is difficult to speak up if I perceive a problem with care Staff know how, but find it difficult to talk about poor patient care Safety climate High: In this clinical area, it is difficult to discuss errors High: I would feel safe being treated here as a patient Job satisfaction High: I like my job Low: morale in this clinical area is high Working conditions High: trainees in my area are adequately supervised Low: this trust does a good job of training new staff
4a. Dimensions scoring less than 75 Stress recognition High: I am less effective at work when fatigued Low: Fatigue impairs my performance during emergency situations Staff recognise the general effect of tiredness, but not impact on emergency care Perceptions of management High: management doesn t knowingly compromise patient safety Low The levels of staffing in this area are sufficient to handle the number of patients Theme around staffing levels and workload
Results 5. Safety culture score by staff Overall safety culture scores were similar between staff groups The six dimensions varied between staff groups for: teamwork climate stress recognition
Results 6: Recommendations to improve culture Staffing levels Communication Training and education Equipment and resources Management e.g. at handovers - especially new staff e.g. staff sickness
Discussion Stronger safety culture gives better clinical outcomes First patient safety culture survey that included non-clinical staff Non-clinical staff are important: influence patient safety indirectly Some staff not aware that stress or excess workload increase error risk Scores and free text recommendations similar to previous surveys
Step one: Build a Safety Culture Also Health Foundation documents
Build safety culture Examples 1. Promote open-ness and fairness; share information, ensuring learning 2. Demonstrate that patient safety is a top leadership priority. Foster effective teamwork 3. Implement integrated risk management processes. Routinely conduct organisation-wide assessments of the risk of incidents. Evaluate clinical care, procedures, processes, work environment 4. Report patient safety incidents and identify trends. Give recognition for reporting incidents and safety-driven decision-making 5. Engage patients and families in safety. Obtain feedback 6. Undertake systematic investigations of incidents for continuous learning and system improvements 7. Use safety improvements that avoid reliance on memory and vigilance 1. Reporting mechanisms: Pharmacy; trust Medication Safety Forum; directorate 2. Quarterly board report, weekly metrics. Chief Nurse, Associate Medical Director visibly support. 3. Risk management, risk assessments, FMEA Prospective risk assessment 4. Make it easy to report. Reduce blame. Feedback to reporters. Report data back. 5. PALs, Complaints, patients on trust groups 6. Root cause investigations, 7. Systems change. Environment. E-solutions Integrate safety in multidisciplinary groups: blame appears reduced by reinforcing systems approach
Conclusion Patient safety culture reflects staff values and behaviours Organisational, managerial, human factors Culture can be measured and improved The trust reached lower limit for a positive safety culture Stress recognition and perception of management lower scores Differences in staff groups on specific dimensions Improve staffing and communication common recommendations Results similar to other studies in hospitals Discussed ways to improve patient safety culture