Understanding and Using Your HSOPS Results Dolores Hagan, RN BSN K-HEN Education/Data Manager Kentucky Hospital Association 1

Goals Provide a safer environment for patients Encourage error reporting for the purpose of learning from and preventing errors Encourage error and system analysis – not person analysis Empower staff to speak up appropriately when a patient safety risk is observed 2

Survey Purpose Examines patient safety culture from a staff perspective May be completed by all types of staff from housekeeping to nurses and physicians Best suited for – Staff who have direct contact or interaction with patients (clinical and non-clinical) – Staff whose work directly affects patient care (pharmacy, lab, environmental services, etc – Physicians or physician extenders who spend most of their work 3

Best suited for – Staff who have direct contact or interaction with patients (clinical and non-clinical) – Staff whose work directly affects patient care (pharmacy, lab, environmental services, etc – Physicians or physician extenders who spend most of their work hours in the hospital (ED physicians, hospitalists, etc) – Hospital supervisors and managers 4

What it Measures Seven unit-level aspects of safety culture – Supervisor/Management expectations and actions promoting safety (4 items) – Organizational learning—continuous improvement (3 items) – Teamwork within units (4 items) – Communication openness (3 items) – Feedback and communication about errors (3 items) – Nonpunitive response to error (3 items) – Staffing (4 items) 5

Three hospital-level aspects of safety culture – Hospital management support for patient safety (3 items) – Teamwork across units (4 items) – Hospital handoffs and transitions (4 items) 6

Four Outcome variables – Overall perceptions of safety (4 items) – Frequency of event reporting (3 items) – Patient safety grade (of the hospital unit) (1 item) – Number of events reported (1 item) 7

Response Rate Agency for Healthcare Research and Quality (ARHQ) recommends a minimum of 50 percent to ensure a reasonable level of reliability Encourage that you set your minimum goal to 60% (# eligible respondents X 0.6) Monitor response rate throughout the survey period Encourage staff to complete 8

Survey Specifics Survey period is typically 14 days – May be extended for 7 days if your response rate is too low Resurvey is recommended in approximately 12 months 9

Survey Coordinator Checklist Determine the best dates for your hospital Select departments and/or staff types that will be eligible to complete the survey – Calculate the total number eligible and provide to KHA Encourage senior leadership support(especially CEO) and promotion of the survey Distribute the survey link to staff Monitor response rate at 7 and 10 days 10

For further information about this feedback report, contact: Dolores Hagan, RN, BSN K-HEN Education and Data Manager Kentucky Hospital Association (502) Hospital Survey on Patient Safety Culture Feedback Results Good Care Hospital Anywhere, Kentucky September

Survey Background The Hospital Survey on Patient Safety Culture was sponsored by the Quality Interagency Coordination Task Force (QuIC), a group established in accordance with a 1998 Presidential directive to ensure that all Federal agencies involved in purchasing, providing, studying, or regulating health care services are working together and toward a common goal of improving quality care. The survey was funded by the Agency for Healthcare Research and Quality (AHRQ). The development of this safety culture assessment tool included a review of the scientific literature pertaining to safety, error and accidents, as well as error reporting. In addition, hospital employees and managers were interviewed to identify key patient safety and error reporting issues. Other published and unpublished safety culture assessment tools also were examined. 12

Survey Measures Four overall patient safety outcomes: 1.Overall perceptions of safety 2.Frequency of events reported 3.Number of events reported 4.Overall patient safety grade The research survey also is intended to measure: The Hospital Survey on Patient Safety Culture is designed to measure: Ten dimensions of culture pertaining to patient safety: 1.Supervisor/manager expectations & 6. Nonpunitive response to error actions promoting patient safety 7. Staffing 2.Organizational learning – continuous 8. Hospital management support improvement for patient safety 3.Teamwork within units 9. Teamwork across hospital units 4.Communication openness 10. Hospital handoffs & transitions 5. Feedback & communications about error 13

Survey Methodology In September, 2012 the Hospital Survey on Patient Safety Culture was distributed to Good Care Hospital employees. Overall, 83 responses to the survey were received, a 70% response rate. In this report, the percentages of employee responses to specific survey items are grouped according to the safety culture dimensions being assessed. Some percentages shown in the graphs may not add to exactly 100%, due to rounding. Since the total number of respondents was 70%, in each graph 1 % is approximately equivalent to one person’s answers. 14

Demographic Data about Respondents 1. Primary hospital work area, department or clinical area where respondents spend most of their work time: 9%Many different hospital units/No specific unit0%Psychiatry/mental health 10%Medicine (non-surgical)5%Rehabilitation 6%Surgery4%Pharmacy 7%Obstetrics7%Laboratory 0%Pediatrics10%Radiology 3%Emergency department1%Anesthesiology 3%Intensive care unit (any type)37%Other 0%Blank/Missing 2. Staff position in the hospital: 20%Registered nurse0%Dietitian 0%Physician Assistant/Nurse Practitioner7%Unit Assistant/Clerk/Secretary 4%LVN/LPN5%Respiratory Therapist 3%Patient care assistant/Hospital aide/care partner3%Physical, occupational, or speech therapist 0%Attending/Staff physician14%Technician (e.g. EKG, Lab, Radiology) 0%Resident physician/Physician in training8%Administration/Management 1%Pharmacist35%Other 0%Blank/Missing 15

Demographic Data (continued) Time worked --in the hospital (hours /week) 3%Less than 20 hours43%20 to 39 hours55%40 hours or more --in the hospital (years) 9%Less than 1 year39%1 to 5 years18%6 to 10 years 16%11 to 15 years7%16 to 20 years12%21 or more years --in their current hospital work area (years) 13%Less than 1 year39%1 to 5 years15%6 to 10 years 15%11 to 15 years11%16 to 20 years6%21 or more years --in their current specialty (years) 8%Less than 1 year31%1 to 5 years18%6 to 10 years 16%11 to 15 years14%16 to 20 years14%21 or more years 4. Percentage of respondents with direct interaction or contact with patients: 73%

Main Findings: Strengths We identify as strengths, those positively worded items which about 75% of respondents endorse by answering “Agree/Strongly agree,” or “Most of the time/ Always” (or when about 75% of respondents disagreed with negatively worded items). A number of strengths emerged from the results*: Composite-Leve l Teamwork Within Units – 85% Supervisor/Manager Expectations & Actions Promoting Patient Safety – 81% Organizational Learning – Continuous Improvement – 80% Management Support for Patient Safety – 83% Feedback and Communication about Error – 76% Overall Perceptions of Safety – 78% Teamwork Across Hospital Units – 75% 17 *All taken from general results—not department/title specific

Main Findings: Strengths (Cont’d) Item-Level Frequency of Events Reported –When a mistake is made that could harm the patient, but does not it is often reported – 85% Staffing –We use more agency/temporary staff than is best for patient care – 76% 18 *All taken from general results—not department/title specific

Main Findings: Areas for Improvement Areas with the potential for improvement were identified as items which about 50% of respondents answered negatively using “Disagree/Strongly disagree” or “Never/Rarely” (or when 50% of respondents disagreed with positively worded items). A number of areas for improvement emerged from the results: Item-Level Non-punitive Response to Error –Staff worry that mistakes they make are kept in their personnel file R - 46% 19

Overall Perceptions of Safety R Indicates reversed-worded items. NOTE: The item letter and number in parentheses indicate the item’s survey location. Survey Items % Strongly Disagree/ % Neither % Strongly Agree/ Disagree Agree 1.Patient safety is never sacrificed to get more work done. (A15) 2.Our procedures and systems are good at preventing errors from happening. (A18) R 3.It is just by chance that more serious mistakes don’t happen around here. (A10) R 4.We have patient safety problems in this unit. (A17) 20

Frequency of Events Reported 1.When a mistake is made, but is caught and corrected before affecting the patient, how often is this reported? (D1) 2.When a mistake is made, but has no potential to harm the patient, how often is this reported? (D2) 3.When a mistake is made that could harm the patient, but does not, how often is this reported? (D3) % Never/ % Sometimes % Most of the Rarely time/Always Survey Items NOTE: The item letter and number in parentheses indicate the item’s survey location. 21

Number of Events Reported Respondents were asked to indicate the number of events they had reported in the past 12 months. 1. In the past 12 months, how many event reports have you filled out and submitted? (Survey item G1) 22

Overall Patient Safety Grade Respondents were asked to give their work unit an overall grade on patient safety. 2. Please give your work area/unit in this hospital an overall grade on patient safety. (Survey item E1) % of Respondents A Excellent B Very Good C Acceptable D Poor E Failing 23

Supervisor/Manager Expectations & Actions Promoting Patient Safety R Indicates reversed-worded items. NOTE: The item letter and number in parentheses indicate the item’s survey location. Survey Items % Strongly Disagree/ % Neither % Strongly Agree/ Disagree Agree 1. My supervisor/manager says a good word when he/she sees a job done according to established patient safety procedures. (B1) 2. My supervisor/manager seriously considers staff suggestions for improving patient safety. (B2) R 3.Whenever pressure builds up, my supervisor/manager wants us to work faster, even if it means taking shortcuts. (B3) R 4.My supervisor/manager overlooks patient safety problems that happen over and over. (B4) 24

Organizational Learning—Continuous Improvement NOTE: The item letter and number in parentheses indicate the item’s survey location. Survey Items % Strongly Disagree/ % Neither % Strongly Agree/ Disagree Agree 1.We are actively doing things to improve patient safety. (A6) 2.Mistakes have led to positive changes here. (A9) 3.After we make changes to improve patient safety, we evaluate their effectiveness. (A13) 25

Teamwork Within Units NOTE: The item letter and number in parentheses indicate the item’s survey location. Survey Items % Strongly Disagree/ % Neither % Strongly Agree/ Disagree Agree 1.People support one another in this unit. (A1) 2.When a lot of work needs to be done quickly, we work together as a team to get the work done. (A3) 3.In this unit, people treat each other with respect. (A4) 4.When one area in this unit gets really busy, others help out. (A11) 26

Communication Openness 1. Staff will freely speak up if they see something that may negatively affect patient care. (C2) 2. Staff feel free to question the decisions or actions of those with more authority. (C4) R 3. Staff are afraid to ask questions when something does not seem right. (C6) R Indicates reversed-worded items. NOTE: The item letter and number in parentheses indicate the item’s survey location. Survey Items % Never/ % Sometimes % Most of the Rarely time/Always 27

Feedback and Communication About Error 1.We are given feedback about changes put into place based on event reports. (C1) 2. We are informed about errors that happen in this unit. (C3) 3.In this unit, we discuss ways to prevent errors from happening again. (C5) NOTE: The item letter and number in parentheses indicate the item’s survey location. Survey Items % Never/ % Sometimes % Most of the Rarely time/Always 28

Nonpunitive Response to Error R 1.Staff feel like their mistakes are held against them. (A8) R 2. When an event is reported, it feels like the person is being written up, not the problem. (A12) R 3.Staff worry that mistakes they make are kept in their personnel file. (A16) R Indicates reversed-worded items. NOTE: The item letter and number in parentheses indicate the item’s survey location. Survey Items % Strongly Disagree/ % Neither % Strongly Agree/ Disagree Agree 29

Staffing Survey Items % Strongly Disagree/ % Neither % Strongly Agree/ Disagree Agree R Indicates reversed-worded items. NOTE: The item letter and number in parentheses indicate the item’s survey location. 1.We have enough staff to handle the workload. (A2) R 2.Staff in this unit work longer hours than is best for patient care. (A5) R 3.We use more agency/temporary staff than is best for patient care. (A7) R 4.We work in “crisis mode” trying to do too much, too quickly. (A14) 30

Hospital Management Support for Patient Safety R Indicates reversed-worded items. NOTE: The item letter and number in parentheses indicate the item’s survey location. Survey Items % Strongly Disagree/ % Neither % Strongly Agree/ Disagree Agree 1.Hospital management provides a work climate that promotes patient safety. (F1) 2.The actions of hospital management show that patient safety is a top priority. (F8) R 3. Hospital management seems interested in patient safety only after an adverse event happens. (F9) 31

Teamwork Across Hospital Units R Indicates reversed-worded items. NOTE: The item letter and number in parentheses indicate the item’s survey location. Survey Items % Strongly Disagree/ % Neither % Strongly Agree/ Disagree Agree 1.There is good cooperation among hospital units that need to work together. (F4) 2.Hospital units work well together to provide the best care for patients. (F10) R 3.Hospital units do not coordinate well with each other. (F2) R 4.It is often unpleasant to work with staff from other hospital units. (F6) 32

Hospital Handoffs & Transitions R Indicates reversed-worded items. NOTE: The item letter and number in parentheses indicate the item’s survey location. Survey Items % Strongly Disagree/ % Neither % Strongly Agree/ Disagree Agree R 1.Things “fall between the cracks” when transferring patients from one unit to another. (F3) R 2.Important patient care information is often lost during shift changes. (F5) R 3.Problems often occur in the exchange of information across hospital units. (F7) R 4.Shift changes are problematic for patients in this hospital. (F11) 33

(verbatim with spelling and grammar edits) 9% of respondents wrote comments (N = 6) “Section I: Your Comments—Please feel free to write any comments about patient safety, error, or event reporting in your hospital.” 1.HOPE THIS IS A GOOD SURVERY, UNALBLE TO ANSWER SOME QUESTIONS BECAUSE IT IS NEVER BLACK OR WHITE 2. PATIENT & STAFF SAFETY IS, HAS BEEN AND ALWAYS WILL BE VERY IMPORTANT TO ME! 3.Any comment or suggestion regarding patient safety is taken very seriously by our EOC Committee and actions are taken to address concerns presented. Administration fully supports the EOC and all hospital committee's. We are very fortunate. 4.If it is not already being done regularly (at least weekly), I would like to suggest that a system be implemented to check ALL wheelchair, and hospital bed brakes to make sure they are working correctly. 5.I used to love coming to work. Now I hate it. Sometimes coworkers are laughing, singing and talking so loud I can't concentrate. Then you end up doing their work because they have been busy doing other things not related to work. Staff Comments 34

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