1. AHRQ Safety Program for Long-term Care: HAIs/CAUTI Safety Culture Survey Results Forum: Tips, Tricks and Stories from the Field Cohort 4 November 18, 2015 Michelle Pandolfi, MSW, MBA, LNHA Director of Consulting Services Qualidigm Ann Spenard, RN C, MSN Vice President/Principal Qualidigm

2. Upon completion of this webinar, attendees will be able to: Review and interpret safety culture survey results Identify which results to focus on for improvement Describe how to address low scoring areas 2 Learning Objectives

3. How would staff at your facility define resident safety culture? 3 Defining Safety Culture ?

4. 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 4

5. Talking with staff about safety culture is important. How staff 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) 5 Your Safety Culture

6. Implement the cultural intervention (along with the clinical 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 6 Program Expectations on Safety Culture

7. 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 7 12 Areas of Resident Safety Compliance with procedures TeamworkHandoffsCommunication openness Nonpunitive response to mistakes Staffing

8. Culture Survey Domains Facility X % Positive Org Lead X Average % Positive Cohort X Average % Positive 1. Overall Perceptions of Resident Safety849087 2. Feedback & Communication About Incidents 887186 3. Supervisor Expectations & Actions Promoting Resident Safety 86 81 82 4. Organizational Learning598073 5. Management Support for Resident Safety608072 6. Training & Skills826276 7. Compliance with Procedures537166 8. Teamwork726468 9. Handoffs667671 10. Communication Openness386156 11. Nonpunitive Response to Mistakes345452 12. Staffing356053 8 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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10. Have you heard of the AHRQ Nursing Home Comparative Database? 10 AHRQ Nursing Home Comparative Database ?

11. Purpose: To gather data from the AHRQ Nursing Home Survey on Patient Safety Culture into a central place and be able to compare safety culture across facilities. Benefits: Facilities receive an individual feedback report comparing their results to the comparative database and a report that provides aggregate nursing home-level statistics. You can access the 2014 Nursing Home Survey on Patient Safety Culture Comparative Database on the AHRQ website.2014 Nursing Home Survey on Patient Safety Culture Comparative Database 11 AHRQ Nursing Home Comparative Database

12. Participation is easy! To join, contact DatabasesOnSafetyCulture@westat.com or contact A.J. Rolle at ajrolle@aha.orgDatabasesOnSafetyCulture@westat.comajrolle@aha.org 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. Please call Westat for more information: 1-888-324-9790 12 Nursing Home Database Participation

13. 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

14. Identify strengths and 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 14 Understand Your Results

15. Review your results with an open mind: Did any areas seem to relate or have crossover? Was there a common theme that emerged? Example – Your facility scored lowest in these four areas… 15 Identify Areas for Improvement What is the common theme? COMMUNICATION! Step #1: Understand Your Results

16. 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 16 Take Action! Talk About It! Step #2: Communicate & Discuss Results

17. Share your survey results with your staff at meetings and post results – 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 attend meetings about the areas of focus 17 Take Action! Tell About It! Step #2: Communicate & Discuss Results

18. Take Action! Do Something About It! Assign a “champion” for each area of focus: Champions 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! 18 Step #3: Create Focused Action Plans

19. Take Action! Do Something About It! Determine your next steps and time line for addressing each area 19 Step #3: Create Focused Action Plans Time frame Interventions Staff education Milestones and goalsTracking and measurements

20. 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 20 Take Action! Tell Everyone Your Plan! Step #4: Communicate Plans & Deliverables

21. START! Don’t delay. Just begin implementing your plan. 21 Take 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.

22. 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 22 To Be Successful… Summary

23. WHY THE SAFETY CULTURE SURVEY IS IMPORTANT: EXAMPLES Real-life Stories from LTC Facilities 23

24. 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 24

25. 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 25 Why the Safety Culture Survey Is Important A Story from SNF in Connecticut

26. 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 26 Why We Promote the Safety Culture Survey A Story from SNF in Connecticut

27. 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 27

28. Stay Updated with Useful Resources 1.AHRQ Safety Program for Long-term Care: HAIs/CAUTI Project WebsiteAHRQ Safety Program for Long-term Care: HAIs/CAUTI Project Website Login information Username: ltcsafety Password: ltcsafety 2.TeamSTEPPS ® for Long-term CareTeamSTEPPS ® for Long-term Care 28 3.AHRQ Nursing Home Comparative Database informational videoAHRQ Nursing Home Comparative Database informational video 4.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 5.Safety Culture Survey Results Discussion GuideSafety Culture Survey Results Discussion Guide 6.LTC Safety ToolkitLTC Safety Toolkit