Using Safety Culture to Drive Habitual Excellence. Objectives

Transcription

1 Using Safety Culture to Drive Habitual Excellence Michael Leonard, MD September 9, 2012 Disclosure: I am a Principal in a company called Pascal Metrics Inc. that develops and implements safety metrics. We will disclose the commercial interests we have, and present a balanced view of the topic. Objectives Understand why high quality safety culture data is essential to drive behavioral change Learn why unit level data showing the perceptions of caregiver groups is essential Know that debriefing with measurable action is a valuable part of the process

2 Evolution of A Culture of Safety and Reliability GENERATIVE Safety is how we do business around here Constantly Vigilant PROACTIVE Anticipating and preventing problems before they occur CALCULATIVE We have systems in place to manage all hazards REACTIVE Safety is important. We do a lot every time we have an accident PATHOLOGICAL Who cares as long as we re not caught Chronically Complacent *Adapted from Safeskies 2001, Aviation Safety Culture, Patrick Hudson, Centre for Safety Science, Leiden University Where are you? 3 Safety Culture Instruments SAQ HSOPS Manchester All are validated instruments psychometrically 60% response rate minimum Unit level caregiver specific

3 What s Your Experience? Survey instrument Response rates Unit level data Captured by caregiver types What is the measurable action loop? Culture of Safety No one is ever hesitant to voice a concern about a patient Caregivers capable, conscientious and playing by the rules feel comfortable to speak up regarding errors, near misses and adverse events When people do speak up, they have a high degree of confidence that the organization will act on their concerns and tell them. There is a cyclic flow of information that leads to analysis, action and feedback a learning organization to reinforce well defined behaviors and values

4 Psychological Safety Psychological safety is a belief that one will not be punished or humiliated for speaking up with ideas, questions, concerns, or mistakes. A shared sense of psychological safety is a critical input to an effective learning system Psychological Safety and Learning Behavior in Work Teams. Administrative Science Quarterly, Vol. 44, No. 2 (Jun., 1999), pp Amy Edmondson What is Culture? The way we do things around here. The visible attributes The espoused values The hidden values Edgar Schein 8

5 Where Do You Have Opportunity? Leadership Psychological Safety Learning from error Teamwork Human factors Learning and improvement Courtesy Natasha Scott, PM

6 % of respondents reporting above adequate teamwork Teamwork in the eye of the beholder: ICU RNs and ICU MDs rate each other 62 Michigan ICUs 2004 Only ICUs with 5 or more physicians reported here (all had 5 or more RNs) Teamwork Climate Across Michigan ICUs No BSI = 5 months or more w/ zero No BSI 21% No BSI 31% No BSI 44% The strongest predictor of clinical excellence: caregivers feel comfortable speaking up if they perceive a problem with patient care Attribution: J. Bryan Sexton

7 Attr: Margaret Vigorito Linking Culture and Outcomes: RI ICU Effort to Decrease Infection ICU s that reflected on their SAQ scores and took action: ICU s that did NOT reflect on their SAQ scores: Increased their SAQ scores in 5 of 6 domains Achieved a 10.2% decrease in BSI rates Achieved a 15.2% decrease in VAP rates Increased their SAQ scores in 1 of 6 domains Achieved a 2.2% decrease in BSI rates Achieved a 4.8% increase in VAP rates Attribution: Margaret Vigorito, MS, RN

8 Courtesy Natasha Scott PM Courtesy Natasha Scott, PM

9 17 Courtesy Natasha Scott PM 18 Courtesy Natasha Scott PM

10 19 Courtesy Natasha Scott PM 20 Courtesy Natasha Scott PM

11 Debriefing Culture Data Locally Local debrief sessions target improvement at the clinical area level Sessions empower caregivers to own the data Use the DEBRIEFer Tool Link to specific action 21 - CONFIDENTIAL- The DEBRIEFer tool, Page 1 Focuses on a single clinical area Highlights extremes in the data: Presents some of the least positive items Presents some of the most positive items Helps affirm what people feel and encourages them to discuss things that are felt by many but rarely talked about Encourages an improvement-focused discussion grounded in the data

12 The DEBRIEFer tool, Page 2 Discussion form guides a structured reflection on a single item Narrows focus Identifies a manageable problem to work on Meeting members create an action plan targeting a single, chosen item One actionable step that they commit to taking Specific date by which they will have taken the action Workforce Engagement 7S Surgical Floor 2009 Percent Favorable 2010 Percent Favorable 2010 Hospital Partner Attribution: Jill Cooper PSPH

13 What Are You Going to Do?