1. NH Patient Safety Culture Survey (AHRQ) Beth Hercher, QI Specialist Barbara Meadows, QI Specialist Patient Safety Team October 2009 Patient Safety Restraint Collaborative Learning Session 3

2. “The right care for every person, every time.” CMS Vision Statement for the National Healthcare Quality Improvement Program

3. S afe T imely E ffective Efficient Equitable P atient-centered The Institute of Medicine The “Right Care”

4. Final formatted survey Survey User’s Guide providing instruction on data collection and analysis Microsoft Excel data entry and analysis tool April 2009 Learning Session 2

5. May-June 2009 surveys conducted July 31, 2009 individual data analysis tools submitted back to QSource October 2009 presentation of aggregate data analysis Timeline

6. Safety Culture Definition The safety culture of an organization is the product of individual and group values, attitudes, perceptions, competencies, and patterns of behavior that determine the commitment to an organization’s health and safety management.

7. Nursing Home Survey on Patient Safety Culture (NH SOPS) Developed by Agency for Healthcare Research and Quality (AHRQ) Designed specifically for nursing home staff Asks for their opinions about the culture of patient safety in nursing homes

8. What the Survey Is Used for: Assess patient safety culture Develop interventions to raise staff awareness for patient safety issues Evaluate the impact of patient safety improvement initiatives Track changes in patient safety culture over time

9. NH Patient Safety Culture Dimensions 42 Items assess the following 12 dimensions of patient safety culture: 1.Communication openness 2.Compliance with procedures 3.Feedback and communication about incidents 4.Handoffs 5.Management support for resident safety 6.Nonpunitive response to mistakes

10. NH Patient Safety Culture Dimensions, cont. 7.Organizational learning – continuous improvement 8. Overall perceptions of resident safety 9. Staffing 10. Supervisor/Manager expectations and actions promoting resident safety 11. Teamwork 12. Training and skills

11. Westat has designed a data entry and analysis tool to display results from the new nursing home survey –Input individual survey data –Create graphs and tables to display your survey results overall and by various demographics –Analyze which patient safety culture dimensions may need additional attention –Share the results with others in your organization. All results are printable. NH SOPS Data Entry and Analysis Tool

12. Home Page

13. AHRQ Survey Designed to Measure 1) Two overall patient safety outcomes a. Nursing Home Recommendation b. Rating on Resident Safety 2) Twelve dimensions of culture related to patient safety

14. Recommendations to Friends Comparative Results

15. Composite Level Results Comparative results are based on 40 pilot nursing homes

16. Composite results measure the12 different domains of patient safety Calculated by averaging the percent positive responses of the items within the domain Positive response is the percent of responses that were rated a 4 or 5 (agree/strongly agree) Definition of Composite Results

17. Composite score tells you the average percentage of people who responded positively to the survey items Summarize overall how positively people answered the items in each safety culture dimension Definition of Composite Results, cont.

18. 36 IPG facilities conducted survey Top three opportunities: –Staffing –Nonpunitive response to mistakes –Communication openness Baseline Survey

19. AHRQ Patient Safety Culture Survey: Composite-Level Comparative Results

20. 20 JCAHO Sentinel Events

21. Administrative and clinical leadership commitment to quality and safety Data for learning, not judgment Organization-wide, systematic approaches to improvement Culture change/teamwork Conduct informal “RCA” ASK frontline staff and feed back data regularly What You Need to Succeed

22. Strategies and Tools to Enhance Performance and Patient Safety

23. 23 Are better able to predict the needs of other team members Provide quality information and feedback Engage in higher level decision-making Manage conflict skillfully Understand their roles and responsibilities Reduce stress on the team as a whole through better performance “Achieve a mutual goal through interdependent and adaptive actions” Effective Team Members

24. TeamSTEPPS: Developed by the Agency for Healthcare Research and Quality and the Department of Defense Purpose: To enhance performance and patient safety

25. Teamwork Exercise Divide up into your facility teams Decide who will be your team leader

26. TeamSTEPPS Emphasis: Teamwork and communication Communication and teamwork skills are essential to providing quality care and preventing medical errors

27. T EAM STEPPS 05.2 Mod 3 05.2 Page 27 Essentials

28. 28 TOPIC Who is on core team? All members understand and agree upon goals? Roles and responsibilities understood? Plan of care? Staff availability? Workload? Available resources? Briefing Checklist

29. 29 Huddle Problem solving – Hold ad hoc, “touch-base” meetings to regain situation awareness – Discuss critical issues and emerging events – Anticipate outcomes and likely contingencies – Assign resources – Express concerns

30. 30 Debrief Process Improvement Brief, informal information exchange and feedback sessions Occur after an event or shift Designed to improve teamwork skills Designed to improve outcomes – An accurate reconstruction of key events – Analysis of why the event occurred – What should be done differently next time

31. 31 TOPIC Communication clear? Roles and responsibilities understood? Situation awareness maintained? Workload distribution? Did we ask for or offer assistance? Were errors made or avoided? What went well, what should change, what can improve? Debrief Checklist

32. T EAM STEPPS 05.2 Mod 3 05.2 Page 32 Essentials Scenario Part 1 Mrs. Smith, at 70 yrs old, fell while walking her dog. Following the surgery to repair the hip fracture, it is determined that she will require rehabilitation in the nursing home. The family lives out of state. What TeamSTEPPS tool would be effective here?

33. T EAM STEPPS 05.2 Mod 3 05.2 Page 33 Essentials 5 days later….. While assisting Mrs. Smith, Annie, the new C.N.A., notices a reddened area on the coccyx. She understands from her recent team training that this could be a problem if she doesn’t inform the team. Using TeamSTEPPS tools, what is Annie’s next step?

34. T EAM STEPPS 05.2 Mod 3 05.2 Page 34 Essentials What occurs next is crucial…. The team lead has had several shift problems and is running late. Though she hears Annie’s report, she states “We’ll just leave it for the next shift, get Mrs. Smith dressed and down to the activities room.” What tool does Annie need?

35. T EAM STEPPS 05.2 Mod 3 05.2 Page 35 Essentials

36. When Communication is Crucial When the patient has had a change in condition When there has been a change in the Plan of Care When reporting off at shift change Upon being assigned a new patient

37. Streamlining Communication Effective communication is: Complete Clear Brief Timely

38. T EAM STEPPS 05.2 Mod 3 05.2 Page 38 Essentials SBAR Prep S ituation – the punch line in 5-10 seconds B ackground – the context, objective data, how did we get here A ssessment – what is the problem ? R ecommendation – what do we need to do ?

39. T EAM STEPPS 05.2 Mod 3 05.2 Page 39 Essentials

40. SBAR Excercise

41. T EAM STEPPS 05.2 Mod 3 05.2 Page 41 Essentials Next step…reporting out The team lead recognized Annie’s concerns; they agree to go to the room together and check the reddened area. The area is deep red, 6cm and the resident reports pain on assessment. What TeamSTEPPS tool would help the team lead in her communication to the physician?

42. T EAM STEPPS 05.2 Mod 3 05.2 Page 42 Essentials

43. Next Steps May-June 2010 Re-administer paper survey tool Response feedback entered into data analysis tool July 31, 2010 Data analysis tool submitted to QS ource

44. Thank You! NH Patient Safety Culture Team Contacts: Beth Hercher, ext. 2640 Barbara Meadows, ext. 7202 1.800.528.2655 This presentation and related materials were developed by QSource, the Medicare Quality Improvement Organization for Tennessee, under contract with the Centers for Medicare & Medicaid Services (CMS), a division of the Department of Health and Human Services. Contents do not necessarily reflect CMS policy. QSOURCE-TN-109.62-2008-16