How do we measure Culture of Safety?

Transcription

1 How do we measure Culture of Safety? BETA Healthcare Group BETA HEART Domain I: Culture of Safety All Rights Reserved 2016

2 Table of Contents How do we measure Culture of Safety?...3 SCORE Survey Administration Guide...4 SCORE Survey Administration Timeline...7 SCORE Survey Debriefing...8 Next Steps...11 References...12 Section Library...13 Section Resources

3 How do we measure Culture of Safety? As difficult as the concept of culture of safety may be to put into words, its measurement can also prove a bit elusive. In recent years, several surveys have been created to measure prescribed components that speak to either positive or negative connotations associated with culture of safety. Many healthcare facilities have chosen to use open source instruments such as Survey on Patient Safety (SOPS), published in 2002, by the Agency for Healthcare Research and Quality (AHRQ), while others have paid private companies to conduct an analysis. With the advent of new technologies, regulatory reforms and market imperatives, older survey models, both open source and those currently used by most private entities have become outdated. Through extensive research on the topic BETA Healthcare Group (BETA), through BETA HEART is partnering with Safe and Reliable Healthcare (SRH) to bring its members the scientific and clinically validated SCORE culture survey tool, capable of reliable measurement of the current healthcare environment. Having trained more than 2000 CMOs, CNOs, CQOs and PSOs across more than 600 hospitals in the last 20 years, Drs. Allan Frankel, Michael Leonard and J. Bryan Sexton have developed an advanced understanding of how to measure, codify and hardwire culture change, employee engagement and patient-centeredness across both the highest and lowest performing hospitals in the nation. This knowledge has been distilled into SCORE, an integrated survey instrument with uniquely powerful psychometric properties that enable facility leaders to anticipate and avoid performance issues related to many types of avoidable adverse events. SCORE is the Safety, Culture, Operational Reliability and Engagement survey. The six culture and engagement domains are listed below. Culture Domains Learning Environment Local Leadership Burnout Climate Personal Burnout Teamwork Safety Work Life Balance Engagement Domains Growth Opportunities Workload Job Uncertainty Intentions to Leave Advancement Participation in Decision Making 3

4 SCORE Survey Administration Guide Safe & Reliable Healthcare s (SRH) SCORE is a powerful analytical tool, but in order to create organizational change, it must be coupled with an equally powerful process. This means the effort to achieve at least a 60 to 80% response rate from employees is critical to true success. This step-by-step administration guide will assist with this effort. In general, the purpose and objectives of the survey must be clearly defined for staff. They may range from subjacent objectives such as taking the temperature of the organization or completing this year s survey to higher impact objectives such as provide diagnostic data for cultural gap analysis. The purpose and objectives should be clarified before beginning, as ambiguous purpose seldom leads to decisive action. Ownership of the survey process must first begin at the executive leadership level, as it is best to relay the importance of the survey from top level officiants. In addition, the survey champions should have an executive sponsor. This must be someone who can quickly remove barriers and supply resources as needed. Leading from the top is always best for starting new endeavors or creating change. The stakeholders or champions for your survey administration i.e. service directors, unit managers, frontline staff informal leaders may or may not be the primary owners of the process, but they will nonetheless determine whether it succeeds or fails. Having a clearly defined group of SCORE Survey Champions to guide your survey process is always to your advantage. Successful surveys require managers to be accountable for corrective actions based on survey results and debriefing insights. Problem areas identified by the survey are regarded as opportunities for improvement and the ability to use the diagnosis to create action plans is the payoff. Follow up and feedback to staff regarding what has been accomplished is crucial as correlating survey data to process improvement efforts assists with creating a trusting relationship with staff. Finally, you should consider linking survey data with important performance improvement metrics and/or benchmarks. Integrating survey data and action plan deliverables into facility-wide metrics and benchmarks assists with informing staff of the importance of culture in relation to patient safety and staff engagement. 4

5 Specifically, the SCORE survey owner and SCORE Champions should: STEP1: Survey Set Up Formulate a written survey roll out plan, identifying the purpose and objectives for conducting the survey. Select the Survey Owner and Executive Leadership Sponsor. Select your Survey Champions. Establish a time table for survey administration (The survey itself will be open for respondents for 3 to 6 weeks). Prepare survey marketing materials (web-based for the facility home page and flyers). Complete SRH online survey SCORE Facility Orientation (one-hour webinar). Complete respondent data through the SRH website. STEP 2: Survey Administration (3 to 6 weeks) Distribute SRH survey link to staff (desktop and mobile phone options). Distribute hardcopy surveys, if applicable. Engage with Survey Champions to assist with motivating staff to complete the survey by having a competition between units or services or offering unit or service awards. Use marketing materials to keep interest high. Consider using a countdown to SCORE on the facility website. Make your goal 60 to 80% participation in every unit or service. This will ensure the most accuracy of the results. Gather and return hardcopy surveys, if applicable. Consider having leadership send a thank you message to all staff at the close of the survey. You can post the message on the facility website. Receive SRH SCORE survey results two weeks post closing date. STEP 3: Analysis of Results (1 to 2 weeks) Appoint the Survey Owner to be gatekeeper for SRH access Give access to reports to Facility Managers and Feedback Session Facilitators Complete the SRH training for accessing results and producing reports (one-hour webinar) Lead review of data to identify themes and trends within the organization. The Survey Owner and Executive Leadership Sponsor should lead this effort. The review should begin no later than two weeks post SRH training. STEP 4: Debrief Results (1 to 2 months) Interpret scores and present insights to facility leaders. SRH Senior Faculty will provide debriefing training via webinar (one-hour). The session will include background on SCORE, how to analyze and debrief survey data and discuss action plans for improving specific survey findings. 5

6 Begin debriefs with units and services. This should be done by facilitators that attend the SRH Senior Faculty webinar. Begin process improvement measures based on survey results and debriefing feedback. 6

7 SCORE Survey Administration Timeline BETA HEART: SCORE Culture Survey Timeline 2017 Dates are estimates The SCORE survey administration timeline is dependent on your opt-in date. Dates will be provided to you at the HEART Domain I: Culture of Safety workshop. 7

8 SCORE Survey Debriefing Why share the results? First, employees have taken the time to participate in the survey. There is an implicit (and often explicit) understanding that they will get some feedback regarding the results. Leaders who openly share results and focus on involving employees in action plans sustain higher levels of employee engagement and demonstrate the cultural attributes that they are trying to foster. Your main objective in the debriefing process is to communicate and discuss the survey results, with the intent of creating a shared understanding of the current culture. Debriefing SCORE Results The executive leadership team should be debriefed first. The survey owner, with the help of BETA and SRH, will create a presentation that includes a brief review of the SCORE survey, overall organization results and various service and/or department and unit level data. The primary goal is to facilitate a thoughtful exploration of the data. An important aspect of the meeting with the executive leadership is the discussion and agreement regarding the data that will be shared throughout the organization and the resources needed to complete the facility-wide debriefing. Next, should come unit-specific focus groups that lead discussions with fronling staff to acknowledge positive results as well as low score areas that denote opportunities for improvement. No matter the choice of venue, communication should include an acknowledgement of employees for their participation, a recap of why the assessment was conducted, insights gathered thus far by the executive leadership team and next steps in the communication and action planning process. The next step in the debriefing process is to conduct service and/or unit-specific focus groups, taking a deeper look at their individual data. As with the executive leadership debrief, the intent is to facilitate a thoughtful exploration of the data. Common information included in focus group discussions is a review of the SCORE survey, a recap of the organization-wide data and, finally, a detailed analysis of the service or unit data. Focus group facilitators will receive training by SRH prior to leading the groups. Following the deep dive into unit-specific data, an open discussion regarding the why s of the lower ranked data points should take place. In addition, prioritizing what issues require immediate attention is paramount. Next comes brainstorming possible solutions and formulating a viable action plan. To assist with accountability and staff feedback, a 8

9 scribe should be appointed and the information from the meeting should be accessible to staff. Each time something on the action plan is completed, the staff should receive notice. Planning a Unit-Specific Debriefing Session The purpose of the staff debriefing session is to review the survey results in a small group of frontline caregivers to identify specific areas of concern and provide opportunity for staff insight and recommendations regarding viable solutions. The following approach may be helpful to assigned debriefing facilitators or managers when planning the sessions: Before the Debriefing Sessions 1. First, complete the SRH facilitator training. 2. Do a self-check how are you reacting to/feeling about your results? 3. What are the patterns you are seeing in your data? Are there certain categories that are high or low? 4. Identify the top strengths and opportunities as called in your SCORE report Prepare for meeting with your staff to solicit their input. 7. Conduct debriefing sessions to generate suggestions for making improvements. Logistical Considerations for Debriefing Sessions 1. Keep sessions small, if possible (15-20 employees). 2. All employees should be welcomed regardless of whether they completed the survey. 3. The room should comfortably seat participants. 4. Presentation equipment, if needed, should be checked prior to the meeting and ready for use. 5. A scribe should be available to record concerns and suggestions for solutions for further follow up. 6. Average session time: minutes Conducting the Debriefing Sessions 9

10 1. Your goal as a manager and/or facilitator is to learn as much as possible about how people are seeing things and why. Be an investigative reporter, not a defender of the status quo. 2. After reviewing your item-level results (both high and low scores), determine which items are of particular concern or relevance to your unit right now, due to recent or ongoing events or activities? Discuss this with the staff. 3. Discuss why these items are important to your staff? 4. What are some specific examples that illustrate how these items reflect experiences in this work setting? 5. Envision an ideal unit. Ask staff what would it look like if 100% of the respondents in this unit felt positively about these survey items (provide specific behaviors, processes, norms, policies, etc.)? 6. Agree on actionable steps to move your unit closer to the ideal unit (agree on specifics task(s); person responsible; follow- up date; external committee / leader with whom the plan is shared). 7. Have a scribe record responses this will help you fill out your action plan. 8. Thank the staff for their participation and let them know you will keep them informed moving forward. After the Debriefing Sessions 1. Create an action plan based on the information gained from the session(s). 2. Evaluate and re-evaluate the action plan for progress. 3. Share results with staff and other stakeholders at regular intervals. Next Steps Culture is the foundational cornerstone that must be in place in order to foster patient safety and staff engagement. In the next section of the toolkit will give insight as to How do we improve Culture of Safety? 10

11 References 1. Safe and Reliable Healthcare (n.d.). Surveys. Retrieved December 11, Sexton, Paine, et al A checkup for safety culture in 'my patient care area'. Jt Comm J Qual Patient Saf, 13(11): Sorra J, Gray L, Streagle S, et al. AHRQ Hospital Survey on Patient Safety Culture: User s Guide. (Prepared by Westat, under Contract No. HHSA C). AHRQ Publication No EF (Replaces ). Rockville, MD: Agency for Healthcare Research and Quality. January Sorra J, Famolaro T, Yount N, et al. Hospital Survey on Patient Safety Culture 2014 user comparative database report. (Prepared by Westat, Rockville, MD, under contract No HHSA C.) Rockville, MD: Agency for Healthcare Research and Quality; March AHRQ Publication No EF. 11

12 Section Library Patient safety outcomes: the importance of understanding the organizational culture and safety climate. Jacqueline Ross. J Perianesth Nurs Oct; 26(5): The Role of Safety Culture in Influencing Provider Perceptions of Patient Safety. Andrea C. Bishop, Todd A. Boyle. J Patient Saf Mar 10 Survey Communication Sample: Johns Hopkins BC Patient Safety & Quality Council: Culture Change Toolbox SCORE Overview: SCORE Survey Instrument Overview.pdf Debriefing Plan: Creating a Debriefing Plan.docx 12

13 Section Resources Debriefing Tips Create environment that safeguards candor Promote creative, relaxed atmosphere Actively listen (e.g. paraphrasing, eye contact) Use a scribe to accurately capture staff comments Solicit equal participation Interpret non-verbal cues Act and speak with neutrality Help group build solutions together Show optimism Manage own emotions; remain calm 13

14 Staff Debriefing At-a-Glance 1. Choose a neutral facilitator such as nurse educators or human resources to lead each session 2. State goal of session (e.g. To create the work environment all of us want to be a part of, and are proud of. ) Your goal as facilitator is to learn as much as possible about how people are seeing things and why. Be an investigative reporter, not a defender of the status quo. 3. Be sure to highlight good scores and drill down on lower- scoring items of interest with the staff. 4. Elicit staff insights about the survey responses and their perceptions of the culture. 5. Ask: What are we already doing well that we need to keep doing? (Prompt with strengths captured by the survey, if necessary). 6. Ask for specific examples of how the item affects the work setting. Example: Can you give me an example of when you felt your input was not well received? 7. Capture responses do not comment on ideas; just record them! Demonstrate understanding of issues. 8. Help staff identify items or issues that concerns them the most. 9. Thank the staff for their participation and let them know you will keep them informed moving forward. 14

15 Culture Debrief Discussion Tool After reviewing your item-level results, which item is of particular concern or relevance to this work setting right now due to recent or ongoing events or activities? % Agree Why was this item important to your group? What are some specific examples that illustrate how this item reflects your experiences in this work setting? Envision an ideal unit. What would it look like if 100% of the respondents in this unit felt positively about this survey item (provide specific behaviors, processes, norms, policies, etc.)? Agree on one actionable step to move your unit closer to the ideal unit (agree on specifics task(s); person responsible; followup date; external committee / leader with whom the plan is shared). Person Responsible: Follow-up Date: External Committee/Leader: Adapted from Sexton, Paine, et al A checkup for safety culture in 'my patient care area'. Jt Comm J Qual Patient Saf, 13(11):