1. Context and Problem At a national level 65% of all staff in GP practices completed the survey. LHB’s took different approaches to encouraging uptake, with some linking partication to Locally Enhanced Service payments. However, there was no clear evidence that payment increased the likelihood of practices participating, and two LHB’s achieved 100% participation of practices without making payments. Strategy for Change Lessons Learnt A large Scale Survey of Safety Culture in Primary Care Tim Heywood – Leadership Content Specialist 1000 Lives Campaign For more information, contact Tim.Heywood@nliah.wales.nhs.uk Survey questions and responses We developed an online safety culture assessment tool. This was offered to all GP Practices in Wales. We emphasised that the survey report would be produced for each Practice and that Practice level information would not be shared with others. Over 3000 GP practice staff took part in the survey, including the full range of practice based staff. A key component of the Campaign is a focus on safety culture, and we wanted to gain an understanding of perceptions of safety culture in General Medical practice. We could find no evidence of previous attempts at large-scale engagement of GP practices in a shared endeavour to explore patterns of safety culture and to take action for positive change. We therefore needed to develop a survey tool and implementation approach for ourselves. The 1000 Lives Campaign in Wales is breaking new ground by reaching beyond hospital settings at a national level to seek system-wide engagement in safety improvement, including primary and community care. Figure 1: Profile of participating staff Figure 2: Response rates The survey included 27 statements covering leadership and teamwork; communication; reporting and learning; relationships with the LHB. Respondents were asked to indicate their level of agreement, using a 5 point Likert Scale. Figure 3 shows the national pattern of responses to the leadership and teamwork domain (dark green indicates strong agreement, and red strong disagreement). Figure 3: Leadership and teamwork response profiles Effects of Changes All reports provided to practices included questions to stimulate discussion about observed response patterns and potential improvement actions. Some Practices have subsequently produced action plans. LHB’s are finding aggregated results reports useful for increasing understanding of culture patterns across health communities. There has also been positive feedback from individual practices, including the following: We were impressed with the high level of support for this initiative; and were surprised to see the level of positivity the responses: 65% of respondents strongly agreed that “this practice is concerned with improving patient safety”, and a further 28% tended to agree. There was also similarity between responses from different staff groups, which we have interpreted as a positive indicator of a positive safety culture. We have found that GP practices are willing to participate in the Campaign to address safety culture and that finance may not be the dominant driver in encouraging participation. It is important to ensure good communication about the purpose of the survey; to give assurances about reporting processes (particularly timeliness and confidentiality); and to offer follow-up support in order to maximise participation. “It was a useful tool that highlighted things about the Practice that we did not previously know”. “The report was useful for in-house teaching sessions” (e.g. on incident reporting). “There was a real value in including ALL staff in the process”. “We would like to do the survey again”. We will be offering a repeat of this survey during 2010. This will enable us at a national level to observe whether there have been any changes in safety culture patterns.