Interpreting Safety Culture Survey Data and Using Results for Improvement

1. Interpreting Safety Culture Survey Data and Using Results for Improvement Sallie J. Weaver, PhD Nasir Ismail, M Sc Mike Rosen, PhD

2. Roadmap • I have data….but now what? • Some food for thought regarding next steps and debriefing survey results Armstrong Institute for Patient Safety and Quality

3. Poll question • Have you (or your team’s survey coordinator) downloaded or reviewed the HSOPS “aggregate report” for your work area? • Yes • No Armstrong Institute for Patient Safety and Quality

4. Remember: Culture is Local Armstrong Institute for Patient Safety and Quality

5. Part I Understanding the HSOPS Aggregate Report Armstrong Institute for Patient Safety and Quality

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9. 80 100 100 80 0 80%

10. HSOPS Aggregate Report

12. Who completed the survey: Pg. 2-4 80% (n = 80) Armstrong Institute for Patient Safety and Quality

13. Composite Score: Pg. 6-7Scores = Percent positive responses • Interpreting Composite Scores: • The big picture view • Higher is better

14. Composite Score: Pg. 6-7Scores = Percent positive responses • Interpreting Composite Scores: • The big picture view • Higher is better

15. Questions: Pg. 8-25Percent positive = Green Percent neutral = YellowPercent negative = Red

16. Questions provide a deeper dive:For positively worded items, more green is better Armstrong Institute for Patient Safety and Quality

17. Questions: Pg. 8-25 *For negatively worded items, more RED is better

18. Questions provide a deeper dive:*For negatively worded items, more RED is better Armstrong Institute for Patient Safety and Quality

19. Part II Using the CUSP Culture Check-up Tool to Debrief Survey Results Armstrong Institute for Patient Safety and Quality

20. CUSP Culture Check-Up Tool • What is the Purpose of this Tool? • Understand the culture of the unit • Use teammates’ feedback to predict barriers to change and avoid them • Use feedback to make the most of the team’s strengths • Who Should Use this Tool? • Safety culture debriefing facilitators • Use this tool to help guide the discussion and record group decisions Armstrong Institute for Patient Safety and Quality

21. CUSP Culture Check-Up Tool How Do I Use this Tool? • Share culture results with everyone on the unit • Bring together team members from your work area • Follow your debriefing plan • Take notes and recognize recurring themes • Purpose = Open, honest discussion about ideas to make the culture of your work area the best it can be • Focus on identifying system issues that the group can work on improving together instead of individuals • NOT used to point fingers at specific individuals • Use the tool to structure meetings and guide conversation • As a group, complete all steps in this worksheet Armstrong Institute for Patient Safety and Quality

22. Steps in CUSP Culture Check-Up Tool • STEP 1: Your team identifies the general strengths and weaknesses of your unit culture. • STEP 2: Your team identifies the specific behaviors and attitudes that make up those strengths and weaknesses. • STEP 3: Debriefing facilitator encourages group reflection. Your team chooses opportunities for growth, understanding that cultural strengths can help fix cultural weaknesses. • STEP 4: Your team identifies a strategy for fixing the opportunities selected in step three. • AHRQ recommends creating ‘safety briefings’ – short updates for frontline teammates about patient safety issues in the work are. For more ideas, go to: http://www.ahrq.gov/qual/patientsafetyculture/hospimpdim.htm. • STEP 5:Your team works out the details of putting strategy into action. • STEP 6:Your team evaluates your plans. Be sure to meet again and check in on progress at your SUSP team meetings Armstrong Institute for Patient Safety and Quality

23. The “Culture Check Up Tool” = Word Document that Debriefing Facilitator can use to guide conversation & improvement planning Armstrong Institute for Patient Safety and Quality

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25. Next Steps: Implementing your team’s HSOPS Debriefing Plan • Debriefing is… • A semi-structured conversation among frontline clinicians and staff that is usually led by a designated facilitator • Purpose… • Encourage open communication, transparency, and interactive discussion about the survey results • Across all levels • To engage clinicians and staff in generating and implementing their ideas about how to create an effective safety culture in their work area Armstrong Institute for Patient Safety and Quality

26. Some points to cover in your debriefing plan Armstrong Institute for Patient Safety and Quality

27. Recent Finding #2: CUSP teams that debrief around safety culture perform better • Data is data • Debriefing turns data into information • Debriefing accelerates improvement Units who did not debrief survey results 2.2% Reduction in Infection Rates Units who used semi-structured debriefing of culture survey 10.2% Reduction in Infection Rates Vigorito MC, McNicoll L, Adams L, Sexton B. Improving safety culture results in Rhode Island ICUs: lessons learned from the development of action-oriented plans. JtComm J Qual Patient Saf. 2011 Nov;37(11):509-14.

28. Changing Culture in Practice: National CLABSI ProjectExample • Baseline HSOPS survey Target non-punitive response to error • What did they do? • Clarified the language and definitions of events, errors, glitches with all unit clinicians & staff • Education campaign to define and differentiate process errors (e.g., expected behavior not clear, not known) from intentional violations • Created shared mental model about expected safety behavior, as well as what to report, when, and when/how to follow-up • Follow up…hot off the presses! Non-punitive response, communication openness, supervisor support Armstrong Institute for Patient Safety and Quality

29. In Sum • Review the survey report for your unit • Can be helpful to distill the report down into 3-5 key slides • Decide when, how, and where to debrief your teammates (and leaders) on these results • Be prepared to listen • Ask for feedback • Ask teammates to help come up with solutions • Gather a small group together and use the “culture debriefing tool” to examine the roots of problem areas and begin to formulate strategies for improvement

30. Thank you!