AHRQ Safety Program for Long-term Care: HAIs/CAUTI Safety Culture Survey Results Forum: Tips, Tricks and Stories from the Field Cohort 3 September 2, 2015

Today’s Presenters 2 Ann Spenard, RN C, MSN Vice President/Principal Qualidigm Theresa Famolaro, MPS, MS Senior Study Director Westat Michelle Pandolfi, LMSW, MBA, LNHA Director of Consulting Services Qualidigm

Upon completion of this webinar, attendees will be able to: Recall what safety culture is and its importance to Review how to interpret the safety culture survey results Identify which results to focus on for improvement Describe how to address low scoring areas 3 Learning Objectives

Implement the cultural intervention (along with the CAUTI intervention) Assess resident safety culture at baseline and follow-up Identify cultural/environmental barriers to success Implement new processes and learnings to overcome those barriers 4 Program Expectations on Safety Culture

How would your staff define resident safety culture? 5 Defining Safety Culture ?

What is Resident Safety Culture? “The way we do things around here.” Exists at multiple levels: System Organization Department Unit Beliefs, values & norms Shared by staff What is: Rewarded Supported Expected 6

Talking with your staff about safety culture is important How they define safety culture could vary – and be a source of miscommunication! – Safety committee about physical plant issues vs. patient/resident safety including clinical issues and risk – Safety culture vs. culture change (person-centered care) 7 Your Safety Culture

Overall perceptions of resident safety Feedback and communication about incidents Supervisor/manager expectations and actions promoting patient safety Organizational learning Management support for resident safety Training and skills 8 12 Areas of Resident Safety Compliance with procedures TeamworkHandoffsCommunication openness Non-punitive response to mistakes Staffing

Culture Survey Domains Facility X % Positive Org Lead X Average % Positive Cohort X Average % Positive 1. Overall Perceptions of Resident Safety Feedback & Communication About Incidents Supervisor Expectations & Actions Promoting Resident Safety Organizational Learning Management Support for Resident Safety Training & Skills Compliance with Procedures Teamwork Handoffs Communication Openness Nonpunitive Response to Mistakes Staffing Nursing Home Survey on Patient Safety Culture Sample Baseline Results, by Category Note: Green = ABOVE the cohort X average % positive Red= BELOW the cohort X average % positive

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Have you heard of the AHRQ Nursing Home Comparative Database? 11 AHRQ Nursing Home Comparative Database ?

Purpose: To gather data from the AHRQ Nursing Home Survey on Patient Safety Culture into a central place to be able to compare safety culture across facilities AHRQ Nursing Home Comparative Database compares data across nursing home facilities that provide data To help facilities identify strengths and opportunities for improvement in their resident safety culture To track changes in resident safety culture over time 12 AHRQ Nursing Home Comparative Database

Your facility will receive an individual feedback report comparing their results to the comparative database A free Comparative Database Report Report provides aggregate nursing home-level statistics. Compare your results to other nursing homes like yours Access the 2014 Nursing Home Survey on Patient Safety Culture Comparative Database on the AHRQ website2014 Nursing Home Survey on Patient Safety Culture Comparative Database 13 Benefits of Participation Nursing Home Comparative Database

14 Nursing Home Survey on Patient Safety Culture Sample Individual Feedback Results from the Comparative Database

Participation is easy! HRET can submit your AHRQ Survey on Patient Safety Culture data to the Comparative Database Sign the AHRQ Data Use Agreement (DUA) – Nursing home systems/chains can submit one DUA for all nursing homes; must list each nursing home Receive your free individual Nursing Home feedback report 15 Nursing Home Database Participation

Next data submission is in April 2016 (Opens April 1, 2016) To join, contact or contact A.J. Rolle at Call Westat for more information: Nursing Home Database Registration

Step #2: Communicate & Discuss Results Step #4: Communicate Plans & Deliverables Step #6 and 7: Track Progress, Evaluate Impact and Share Step #1: Understand Your Results Step #3: Create Focused Action Plans Step #5: Implement Action Plans Action Planning for Improvement

Identify strengths & positive change Determine a cutoff for what is considered a “strength” Identify areas for improvement Determine a cutoff for what is considered an “area for improvement” Select 2-3 areas for improvement to avoid focusing on too many issues at once Discuss survey results to arrive at deeper understanding of underlying issues 18 Understanding Your Results

Review your results with an open mind – Did any areas seem to relate or have cross over? – Was there a common theme that emerged? – Example – Your facility scored lowest in these four areas… 19 Identifying Areas for Improvement What is the common theme? COMMUNICATION! Step #1: Understand Your Results

Discuss results with your leadership teams – Were there any surprises? – Have you already begun to address issues? – If you tried anything in the past – what worked? What didn’t work? Agree on 2-3 areas of resident safety on which to focus 20 Taking Action! Talk About It! Step #2: Communicate & Discuss Results

Share your survey results with your staff at meetings and post it–hold “town hall” meetings Discuss findings and areas for improvement with staff – Use learning circles to encourage open dialogue and the sharing of ideas from all levels of staff Incorporate staff ideas into your action plan Invite staff to serve on area focus teams and to meetings about the areas of focus 21 Taking Action! Tell About It! Step #2: Communicate & Discuss Results

Taking Action! Do Something About It! Assign a “champion” for each area of focus Champions are to help guide and facilitate the work of the team for their area Champions should be organized and able to collaborate with each other Example: If communication is the common theme – your champions should ideally be someone the staff listens to! 22 Step #3: Create Focused Action Plans

Taking Action! Do Something About It! Determine your next steps and timeline for addressing each area 23 Step #3: Create Focused Action Plans Time frame Interventions Staff education Milestones and goals Tracking and measurements

Post your improvement plans for everyone to see – All shifts, all departments – Consider it a QAPI project – Include residents and families in your action plans Provide updates on changes and progress often – at least quarterly 24 Taking Action! Tell Everyone Your Plan! Step #4: Communicate Plans & Deliverables

START! Don’t delay. Just begin implementing your plan. 25 Taking Action! Start and Track Your Work! Step #6 and 7: Track Progress, Evaluate Impact and Share Step #5: Implement Action Plans Review your plan and track your progress during meetings, and against your stated objectives/goals from the beginning. What needs to be changed? What works? Doesn’t work? Provide updates to staff, residents and families on changes and progress often–at least quarterly.

Review and discuss survey findings Narrow your focus by identifying your top concerns – Don’t forget to celebrate your successes! Engage and listen to staff ideas Try different interventions to address your areas of focus – Review the following ideas, categorized by dimension: Improving Patient Safety in Nursing Homes: A Resource List for Users of the AHRQ Nursing Home Survey on Patient Safety CultureImproving Patient Safety in Nursing Homes: A Resource List for Users of the AHRQ Nursing Home Survey on Patient Safety Culture Check-in with staff often and tweak your action plan as needed Check out TeamSTEPPS for Long-Term CareTeamSTEPPS for Long-Term Care 26 To Be Successful… Summary

WHY THE SAFETY CULTURE SURVEY IS IMPORTANT: EXAMPLES Real-life Stories from LTC Facilities 27

Remember Miami Jewish Health Systems A Story from the Field WHY Invested in safety Resident safety is everyone's job HOW Had laptops in each unit on each shift Allowed for paper completion as needed ANALYZING THE RESULTS Broke down results, e.g., by job title, direct care providers Created a video with employees presenting the results Decided not to compare with others; wanted to treat each opportunity for improvement as important USING THE RESULTS TO IMPROVE Worked on quick wins/low-hanging fruit first to demonstrate commitment to improvement Disseminated results in open dialogue in town hall meetings Presented video at each unit/department Convened focus groups to address OFIs requiring more study to create solutions Staff, resident and family perceptions = their reality 28

LTC Facility: Not-for-profit SNF in Connecticut Continuum of Care Independent Living Assisted Living Memory Care Home Care Hospice Care Long-term Care Outpatient Rehab Post-Acute Care Day Program Meals on Wheels 29 Why the Safety Culture Survey is Important A Story from SNF in Connecticut

Annually serves patients, residents and families in over 12 different services and programs They support the Nursing Home Culture Survey because… They are committed to continuous improvement and resident and staff safety Resident safety is everyone's job – Everyone’s opinion is important – Everyone is part of the solution Staff, resident and family perceptions = Their level of quality care 30 Why We Promote the Safety Culture Survey A Story from SNF in Connecticut

How We Did It and How We Are Using the Results A Story from SNF in Connecticut HOW Allowed for paper completion Encouraged all nurse managers to hand out survey on their neighborhoods Involved all departments, service lines ANALYZING THE RESULTS Broke down results (e.g., by job title, direct care providers) Presented PowerPoint presentation to leadership team and board of directors, staff Decided not to compare with others; wanted to treat each opportunity for improvement as important USING THE RESULTS TO IMPROVE Chose four areas needing most improvement for focused attention Disseminated results in open dialogue in town hall meetings Asked staff for feedback on action plan and areas of focus Brainstormed ideas for better communication Implemented TeamSTEPPS Repeating survey one year later 31