1. Improving Your Practice Safety Culture

2. Aims Why is safety culture important
How can we develop our safety culture?
The nuts and bolts of using Safequest 2 2

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

4. 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…’

5. 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

6. Airlines and nuclear power have very strong safety culture

7. What would strong safety culture look like in your place of work ?
Group Work
What would strong safety culture look like in your place of work ?
Ask delegates to discuss this question at their tables and feedback their responses

8. 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

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

10. Francis Report and Culture
There was an atmosphere of fear of adverse repercussions
There was a 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

11. Team Culture Scores Achieving Goal Low 21% Medium 33% High 55%
NO blood stream infections for 5 months by implementing a checklist for central lines insertion
Team Culture Scores
Achieving Goal
Low
21%
Medium
33%
High
55%
This charts illustrates that intensive care teams with strong safety culture scores provide more reliable care

12. 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

13. 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?

14. 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

15. 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 15

16. 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

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

18. 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

19. The planning element
Pm will click on link from the relevant webpage
They will need to register the practice 19

20. 20

21. PMs then follows the step by step guide

22. 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 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. 22

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

24. Plan Distribute Complete
Process
Plan Distribute 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 24

25. This slide is shows the questions in the workload section of the survey25

26. This slide shows the communication section26

27. 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
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 27

28. 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 28

29. 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. 29

30. 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 30

31. Making the most of your Results - Guidance
Identify uptake - what does this tell you?
Identify a +ve element of culture
Identify a –ve element of culture
Look in detail at the questions where you might improve
Compare to other practices
Compare between staff groups
Compare with previous results if appropriate
Summarize – Complete QOF summary sheet and Action plan
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

32. 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

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

34. don’t miss the point !
Emphasise that the survey is a starting point for practice discussions, don’t get caught up with numbers. 34

35. 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 35

36. “Weren’t as good as we thought we were”
“Mismatch between what the clinical and non clinical staff thought”
“Prompted some very open discussion” 36

37. Some practices may need support and /or facilitation
Some practices will need support/ facilitation – it is up to each board how they provide this

38. Positive Change Increased frequency of staff meetings.
At least one doctor to attend staff meeting.
2 way 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

39. 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"

40. Key points The findings are for your practice teams
Don’t get too focused on the numbers
Concentrate on how you might use the results to drive improvements

41. Key Points It’s a tool, a snapshot
Discuss, Reflect and Change as a practice team
Takes time to change
Some practices will need support
Oh and its in the QOF… ( 5 points)
Reinforce that the safety climate survey is in QOF

42. 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

43. 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 .

44. The completion, reflection and actions resulting from the safety climate survey is a good way to change culture – but it takes time ..

45. Questions