Improving Your Practice Safety Culture

Aims Why is “safety culture” important? ........what does this mean?? How can we develop our safety culture/does it need developing? Using “Safequest” 2 2

What is Safety Culture? Explain to delegates that this session will look in more detail at safety culture and human factors 3

The way things are done around here Safety Culture “Individual and group values, attitudes, perceptions and patterns of behaviour that determine their commitment to safety management” The way things are done around here NHS Education for Scotland 2010 This is the technical definition of safety culture - or in other words – ‘the way things are done around here…’

Why is a strong Safety Culture Important? A strong safety culture essential to safe reliable care in any workplace They evidence across many industries tells us that a strong safety culture is essential to safe reliable care in the workplace

Airlines and nuclear power have very strong safety culture

Positive Safety Culture Safety a Priority Eliminate “shame and blame” Accept staff will make errors Build systems to make care safer Foster a culture where people can speak up Team training Organizational learning from errors and near-misses A positive strong safety culture should have all these aspects

The mid staffs trust is an example of a very poorly developed safety culture

Francis Report and Culture Atmosphere of fear of adverse repercussions Lack of openness It did not listen sufficiently to its patients and staff or correct deficiencies highlighted Above all it failed to tackle an insidious negative culture involving tolerance of poor standards These points from the Francis report highlight the poor safety culture

Developing your Safety Culture Understanding its importance Thinking about it Measuring your culture Discussing it and reflecting on results Focussed action to Improve it In order for practices to fully develop their safety culture they need to realise the importance of it and that every staff member plays a part in patient safety. The tool will help measure the safety climate in practice, following which practices can discuss, reflect and take action to improve it

Levels of maturity with respect to a safety culture E. Risk management is an integral part of everything that we do D. We are always on the alert for risks that might emerge C. We have systems in place to manage all identified risks B. We do something when we have an incident Ask the audience where they think the NHS sits on this scale – there is no right or wrong answer. A. Why waste our time on safety?

Using the SafeQuest Safety Climate Survey work in practice? The safequest safety climate survey is a validated tool for use in primary care to take a snapshot of your teams safety culture

Safety Climate Survey On line Practice centred Measurement Diagnosis Catalyst for change It is completed on line by staff Its anonymous It compares your scores with other teams who have completed it Measurement- against other practices and with your previous results over time It compares clinicians and non clinicians and managers and non managers responses It is used to highlight successes and challenges And provide a catalyst and focus for change 13

Safety systems and learning Areas of Focus: Teamwork Workload Communication Leadership Safety systems and learning The questions ask about 5 key areas of safety culture

Plan Distribute Complete Review Discuss Change Process Plan Distribute Complete Review Discuss Change The next few slides highlight the process of undertaking the survey

PLAN Plan DO Distribute Complete STUDY Review Discuss ACT Change Process PLAN Plan DO Distribute Complete STUDY Review Discuss ACT Change It is a bit like a PDSA cycle

The planning element Pm will click on link from the relevant webpage They will need to register the practice 17

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PMs then follows the step by step guide

set up distribution list adding those that should complete it set up distribution list adding those that should complete it. It is important that staff are apprised in advance of the reasons for completing the survey, and reassured that all responses are anonymous. The survey will take no more than 15-20 minutes to complete. It is recommended that all practice staff and anyone involved in or considered part of the practice team complete the survey. However, it remains the discretion of individual practices to decide who they invite to participate. 20

The practice manager is able to see who has completed the survey and prompt them to complete

Plan Distribute - ?involve “locality managers” Complete Process Plan Distribute - ?involve “locality managers” Complete Some staff may not have completed need chasing up!! However with clear explanation from the outset, and time aside, this shouldn’t be a big problem. More accurate the more that have completed it You need to decide on a date that the survey will close and tell staff 22

This slide is shows the questions in the workload section of the survey 23

This slide shows the communication section 24

Negative Questions The Performance of the team is impaired by excessive workload* When pressure builds up team members are expected to work faster even if it means taking shortcuts* Where negative questions* results have been reversed and a high score is therefore desirable Watch out for these ones – can be confusing within report. Practices should note that some questions within the survey are framed negatively to ensure reliable results The results of these negative questions are reversed so that a higher score is preferable Negative questions are highlighted with an asterix in the report 25

When completing the questionnaire staff will be asked to input the above demographics – this is to ensure different perspectives of staff groups are represented in the results 26

What to do with the report? Close survey when all have completed Download / Print off Distribute to all team Arrange meeting to discuss findings Using the report, and reviewing it is the most important part of the process. Guidance recommends that the report is distributed to all staff, with the results being discussed at a practice meeting There are facilitation guides available on the HIS website, to allow productive discussion of the findings Some practices may require facilitation if the results are negative, practices should contact their health board if this support is required. 27

Have a look at the report What does it show you? Sample Report Have a look at the report What does it show you? What questions does it raise? What questions do you have? You may wish to provide delegates with a sample report, and allow some time for table discussion of the above questions 28

Making the most of your Results Identify uptake – is this telling you something? Identify positive/negative elements of culture Look in detail at the questions/areas where you might improve Compare to other practices Compare between staff groups Compare with previous results , if repeating Summarize – Complete QOF summary sheet and Action plan Links via Refhelp to HIS site - help facilitate discussion! Highlight to delegates that going through the report in a structured way will be ensure the maximum benefit. Practices should then go through the process outlined above. This guidance is available to practices and they should be encouraged to follow it as will help them identify areas for improvement and bring about change. Additionally it will support them to complete the reflection sheet required for QOF

Practices should discuss each section of the report, highlighting both positive and negative aspects, comparing results of clinicians / non clinicians and management / non management – often management and clinicians can score more highly than the rest of the practice teams – discuss the reasons for this. Ensure both negative and positive results are discussed

Group Discussion What would be the benefits and challenges of completing and discussing the safety climate survey Ask delegates to discuss this questions, and feedback

Insights “Many of us in the practice staff hadn’t really made the link that us failing to communicate in was a threat to patient safety ….we had a lot of really good stuff came out of it, a lot of very open discussion” The evaluation from pilot practices was very positive 32

Positive Change Increased frequency of staff meetings. At least one doctor to attend staff meeting. Increased communication over a variety of issues. Newsletter/minutes after each meeting. Quarterly meeting involving whole practice. This is an example of what happened in a practice who has already completed the survey

Quotes from Practice “ it did sound good, being able to ask questions and get answers straight away from Drs/or receiving instructions etc instead of going through a third party” “beneficial....encouraged to speak out if you think something isn’t right"

Key points The findings are for your practice teams (consider carefully though) “Employees”/NHSB staff etc. Don’t get too focused on the numbers Concentrate on how you might use the results to “drive improvements” Key issue Emphasis on change/improvement, if needed

Key Points It’s a tool, a “snapshot” Discuss, Reflect and Change as a practice team Takes time to change Important to repeat Present in QOF Specifies 2 x cycles Reinforce that the safety climate survey is in QOF

QOF Annually Practice teams Discuss Action Plan Reflection Sheet Before march 2014 Need to complete the survey with GPS and employed staff Discuss the findings as a team Produce an action plan Share reflection sheet and action plan with your HB

Reflection Sheet What positive aspects of your team’s safety culture were highlighted in the report and your discussions? What aspects of your safety culture do you as a team feel you could improve? What steps will you take to improve these aspects of your safety culture? What else might you change to improve your safety culture? Would you like any support or guidance to make changes in your practice? If so, what would be useful? This is a sample of the reflection sheet that practices will be asked to complete and share with the HB – it will also act as a very good summary of the discussions and is something to refer back to – this is available on the HIS website .

Relevant Links…….. http://www.healthcareimprovementscotland.org/our_work/patient_safety/spsp_primary_care_resources/safety_climate_survey.aspx Interpretation guides/FAQs/link to safequest http://www.sehd.scot.nhs.uk/pca/PCA2013(M)02guide.pdf QoF 2013/14 Guidance, section 6ii QI domain http://www.refhelp-borders.scot.nhs.uk/ See Primary care/GP contract/Patient safety