Research on Safety Culture & NSQIP

It evaluates the current activities. Context Current activities The proposed research is an optional addition to the current activities. It evaluates the current activities. Research What’s going on? Across BC we are working very hard to improve the quality of care. NSQIP, culture survey, CCM, and others like efficiency and LEAN Speak to the importance and significance of this work, WHY it matters: to improve care for patients, Collecting data on our outcomes allows us to improve. It helps us make improvement  a normal, ongoing part of work. Why are unique? - Large – scale interventions High Quality data sources Not as many interventions as other provinces/ countries Why publish?  to promote our work, add to existing knowledge. Greatest gap in literature is the connection between culture and NSQIP - We have 24 hospitals enrolled in NSQIP and 14 that have done a culture survey. We see some advanced work in regard to the Surgical Safety Checklist. We have structures in place to learn from each other. We should be really proud of what we’re doing in BC.

Background Safety culture = shared beliefs and patterns of behaviour that determine how we work together to achieve quality care. Safety culture affects patient outcomes. Communication breakdown  patient harm. Safety culture is also important for its effects on provider experience. [Safety culture is] the product of individual and group values, attitudes, perceptions, competencies and patterns of behaviour that determine the commitment to, and the style and proficiency of, an organisation’s health and safety management Teamwork and relationships between providers of different professions have received considerable attention for their effects on care (Mazzocco, Petitti et al. 2009). There is strong evidence for the connection between culture and items such as staff turnover and job satisfaction (Huang, Clermont et al. 2007). Working conditions, particularly nurse working conditions, are also proven indicators of patient outcomes (Thomas, Sexton et al. 2005). There is a three way connection between culture, provider experience and patient outcomes which this study hopes to address.

Why Participate? To be part of new research that looks at the role of culture in BC (The aggregate findings from all sites will be published) To receive your own results. Quantify the effects of culture at your hospital Answer the question  ‘Is it worth investing in culture interventions?’ Identifies ingredients for successful culture change. Novel contribution to the academic literature. Promotes the work of the BC surgical community: brings to light of others the work that is already being done in BC Assesses the impact of culture on patient and provider experience in BC by answering the question 'Does culture matter?' Evaluates the potential improvements in patient and provider experience as a result of culture interventions; in other words, 'Is it worth investing in culture interventions?' Identifies the mechanisms and causal ingredients of successful culture initiatives: traces the process of change of culture to identify the key factors for the change Provides an opportunity to make a novel contribution to the academic literature : while there is evidence on the link between culture and either patient outcomes or provider experience, the three-way association has not been studied, also there’s little evidence on effectiveness of culture interventions or causal ingredients for culture change. In order to conduct this research at a provincial level we must work together. That’s the scale at which we have the best opportunity to produce novel findings. An additional benefit of participating in this work is the ability to say that your data is reflected in the findings. “This applies to our hospital”

Research Questions Is safety culture in surgical departments in BC correlated with clinical outcomes, rates of adverse event reporting, overtime, sick time and/or staff turnover? Can a conscious effort to change safety culture lead to culture change?

Time frame for data collection Data Requested Variable Measured by Format Time frame for data collection Safety Culture Safety Attitudes Questionnaire (SAQ) and OR collaboration question Average of each domain on SAQ + total culture score. Provincial averages of OR collaboration question. Spring 2012 Wave 2 pending Clinical Outcomes NSQIP data (11 variables) Aggregate rates of each post-operative outcome July 2011 onwards Adverse event reporting rate Patient Safety Learning System Number of adverse events reported at each severity level (0-5) in each unit Staff Overtime Health Authority HR Total overtime hours and total hours worked in each surgical unit Staff Sick time Total sick time hours and total hours worked in each surgical unit Staff Turnover Rate of staff turnover in surgical units Culture Improvement 10 questions completed by surgical unit leads. Record of culture improvement activity Fall 2013

Data Analysis – Q1 (2012 & 2013) Is safety culture in surgical departments in BC correlated with clinical outcomes, rates of adverse event reporting, overtime, sick time and/or staff turnover? Is culture correlated with clinical outcomes? Is culture correlated with the rate of adverse event reporting? Is culture correlated with the level of overtime? Is culture correlated with the level of sick time? Is culture correlated with staff turnover? Do correlations exist among any of these five elements of health services (clinical outcomes, rate of adverse event reporting, overtime, sick time, and staff turnover)?

Value of Q1 We would be able to provide evidence whether culture matters in BC and in your hospital with YOUR data. 3 way association between safety culture, patient outcomes and provider experience. Culture distribution across units and hospitals. Is culture local or is it more/less similar across the province? Identify disconnect in perception of teamwork between surgeons, nurses and anesthesiologists. We would be able to know the value of culture in health institutions – this helps us direct funding better to valuable factors in order to ensure patient safety Is culture local or is it more/less similar across the province? Addresses the 3-way connection talked about earlier Do all professions have similar perception of teamwork, if not, why? Gender? Hierarchy?

What Q1 adds to literature? Makary et al. 2006 Our study

What Q1 adds to literature? Safety Culture Patient Outcomes Provider Experience 2010 Our Study

What Q1 adds to literature? 2006 Our Study 2008 Units % who agree or strongly agree that “disagreements are handled appropriately”

Data Analysis – Q2 (2013) Can a conscious effort to change safety culture lead to culture change? Are there changes in culture and the five elements of health services over time? Are changes in culture associated with culture improvement efforts? What elements of the improvement process, or the process of implementing culture interventions, are the causal factors in observed changes in culture?

Value of Q2 Will provide evidence on the effectiveness of culture interventions. Identifies the mechanisms and causal ingredients of successful culture initiatives. Will provide powerful insight when designing future culture improvement initiatives in the health care sector. Are the culture interventions working? Are they leading to change in culture and health service elements? How are they making a difference? What particular factor(s) or ingredient(s) is responsible for the greatest positive culture/ health service change? How can we use this knowledge to design future interventions?

What Q2 adds to literature? 2013 2010 Neily et al.

How can I be involved? Health authorities and physicians are invited to enrol and agree to submit data starting in Spring 2013. Health authorities and physicians are invited to be co-investigators. Identify one individual to act as a research liaison.

Next steps… Return the Research Enrolment Form to RBrooke@BCPSQC.ca Ethics UBC BREB approved BCPSQC will be responsible for all HA Ethics applications Data Submission – March 2013

THANK YOU! Rebecca Brooke More Information: http://bcpsqc.ca/clinical-improvement/sqan/research/ Contact: Rebecca Brooke Email: rbrooke@bcpsqc.ca Tel: (604) 668-8227

FAQ Hospital level vs. Unit level? Aligning time frames? Privacy? This study is a multi-hospital study performed at the unit level. We have taken into account the fact that different data is available at different levels and appropriate tools will be used to make data comparisons possible. Aligning time frames? NSQIP data  monthly (annual year), HR data  biweekly (fiscal year), SAQ  cross-sectional. Appropriate tools will be used to align time frames for comparisons/ correlational analysis. Privacy? We will be using aggregate data to see trends at a provincial level, so individual hospitals will not be singled out.