1. Safety Culture Surveys
15 September 2016
Jo Pendray
Improvement Lead

3. Why assess safety culture?
“Culture will trump rules, standards and control strategies every single time” “A safer NHS will depend far more on major cultural change than on a new regulatory regime” “The NHS in England can become the safest health care system in the world…..it will require a culture firmly rooted in continual improvement” Don Berwick, 2013

4. Key messages from the Francis Inquiry – 290 recommendations, 4,000 pages
This was a system failure as well as failure of an individual organisation
No single recommendation should be regarded as the solution to the many concerns identified
A fundamental change in culture is required across the NHS
We need to secure the engagement of every single person serving patients in the change that needs to happen

5. Culture…. ‘the social glue’

6. Safety Culture Maturity Model

7. SCORE Safety Culture Survey
Communication
Operational Reliability
(Engagement)
Developed by Drs Bryan Sexton, Allan Frankel and Michael Leonard

8. Profile of work South West 29 work settings 6 Acute Trusts
3 Mental Health Trusts
9 GP practices
SW AHSN
National (PiSCES)
Haelo GP Practices
WEAHSN 8 GP Practices
EEAHSN wards
IoW Mental Health Trust

9. Domains in the SCORE Survey
Learning Environment
Perception of Local Leadership
Burnout / Resilience
Teamwork Climate
Safety Culture
Work Life Balance

10. Learning Environment Utilising suggestions Learns lessons
Fixes problems to improve quality
Gains insights into what we do well
Protected by local management

11. Local Leadership Communicates expectations Provides feedback
- positive
- useful
- meaningful
- frequent
Available at predictable times

12. Burnout & Personal Burnout
Perception of burnout of colleagues
Personal burnout
Emotionally unhealthy
Exhaustion
Frustrated by job
Working too hard

13. Teamwork Disagreements resolved by what is right for the patient
Not difficult to speak up about patient care
Easy to ask questions
Different disciplines work as a team
Dealing with difficult colleagues
Communication breakdown

14. Safety Climate I would feel safe being treated here as a patient
Values of leaders and staff are the same
Suggestions about quality acted upon
Errors handled appropriately
Appropriate feedback
Easy to discuss & learn from errors

15. Work Life Balance Breaks Meals Late home Difficulty sleeping
Changed personal plans
Frustrated by technology

16. Develop a Culture of Safety
Safe and reliable person centred care requires a culture of safety: an environment in which healthcare professionals treat each other with respect, leaders drive effective teamwork and promote psychological safety, teams learn from errors and near misses and from each other.
Staff are aware of the inherent limitations of human performance in complex systems and there is a visible process of defect identification, continuous learning and driving of improvement.
Attribution: A Edmonson. J Reason, D Marx. Thomas-Kilman. E Schein. D McGregor

17. What Next? Debriefing – open, safe & emphasis on opportunity
Analysis of areas needing action
Identify improvement projects & plans
Use Quality Improvement methodology
Survey again!

18. Improvement The insights are critical for organisational improvement
and the ability to drive habitual excellence
Specific actions can be taken to increase organisational
strengths and address areas of fundamental opportunity

19. Value
“SCORE has given us a valuable way of delving down into a deeper layer of understanding and insight...and to continue to develop, grow and thrive but in a more healthy and sustainable way!”
“Sometimes, we are so service focussed that we forget that we are people – staff health and wellbeing is as important as the care we provide… it is crucial to build resilience and sustainability.”
Associate Director, Mental Health Trust

20. Value
“An element of poor communication …. was something that we could fix really quickly and easily, simply by improving the way people speak to each other.”
 ”A bigger theme emerged - burnout and unhappiness with the perception of the lack of staffing and lack of space. This was taken up with the trust … who were really receptive.”
“We identified areas for improvement, such as the allocation of time – how much time is needed for nurses to write up rotas etc.”
Consultant, A&E Service

22. Continuous Learning System
A clear, reliable process to identify problems / defects – e.g. learning boards
Are the basics right every time?
Ensure someone owns the problem and action is taken
Regularly feedback to those who identify defects / problems – builds trust
Share the learning widely
High performing teams build in the capacity for improvement at a local level – in real time (like troubleshooting its part of the day job and everyone's business)
Transparency - have a clear, reliable process to identify defects – e.g. learning boards
Agile and responsive - continuously assess and review to ensure they are getting the basics right every time
Ensure someone owns the problem and is fixing it in a timely manner – this can rapidly build trust and drives local improvement
Regularly feedback to those who identify defects / problems
Think clinically – patients observation chart – you assess, collect info, analyse it take action, improve patient condition
High performing teams build in the capacity for improvement at a local level – in real time
Attribution Allan Frankel and IHI 2013