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© 2009
On the CUSP: STOP BSI On the CUSP: STOP BSI The Hospital Survey of Patient Safety (The Hospital Survey of Patient Safety (HSOPS)HSOPS)
© 2009
WHY Culture?WHY Culture?
Sentinel Event AlertIssue 40, July 9, 2008Behaviors that undermine a culture of safety
Intimidating and disruptive behaviors can foster medical errors,(1,2,3) contribute to poor patient satisfaction and to preventable adverse outcomes,(1,4,5) increase the cost of care,(4,5) and cause qualified clinicians, administrators and managers to seek new positions in more professional environments. (1,6) Safety and quality of patient care is dependent on teamwork, communication, and a collaborative work environment. To assure quality and to promote a culture of safety, health care organizations must address the problem of behaviors that threaten the performance of the health care team.… 3
Communication Breakdowns are frequently the root cause of…undesirable outcomes
4
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““Culture” provides context forCulture” provides context for team success team success
Pronovost: Health Services Research 2006
Senior TeamStaff
leaders leaders
Engage How does this make the world a better place?
Educate What do we need to do?
ExecuteWhat keeps me from doing it?How can we do it with my resources and culture?
Evaluate How do we know we improved safety?
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Culture Assessment Culture Assessment
• Typically “Pre-CUSP” ~ before interventions begin or as soon as possible near the project launch
• Use validated instrument– HSOPS– SAQ– ? Other
• CUSP is the intervention we use to help you improve culture results
• Will provide blinded comparative data for ICUS that administer HSOPS as part of the On the CUSP: Stop BSI project
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Culture Assessment andCulture Assessment andOn the CUSP: Stop BSIOn the CUSP: Stop BSI
• DISTINCT process ~ planned for early MAY– Conference Call for State Project Leaders– Conference Call for Hospital Survey Leaders
• Will use AHRQ HSOPS tool (free)– WESTAT researchers will analyze data and create
reports– Participating sites will have full access to
AHRQ/HSOPS resources• QSRG will facilitate data collection
– SURVEY MONKEY• QSRG will facilitate use of tools to improve culture
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““Hopkins Direct” Hopkins Direct” QSRG rather than MHAQSRG rather than MHA
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HSOPS ProcessHSOPS Process
REGISTRATION• Hospital Identifiers (AHA ID; Medicare Provider #)• Hospital Contact Information• Survey selection process
– ICU vs. whole hospital– Web based (HIGHLY recommended) vs Paper **
• ICU staffing informationADMINISTRATION• Time parametersREPORT GENERATION• Goal: 6-8 weeks after administration is complete
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HSOPS: A Closer Look HSOPS: A Closer Look
From:Results from the AHRQ Hospital Survey on Patient Safety Culture
Joann Sorra, Ph.D. WestatAHRQ Annual Conference 2008:Promoting Quality…Partnering for ChangeSeptember 2008Bethesda, MD
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BackgroundBackground
Hospital Survey on Patient Safety Culture (HSOPS)
Developed by Westat, funded by AHRQ
Survey development process:
Reviewed literature & existing surveys
Interviewed hospital staff
Identified key areas of safety culture
Developed survey items & pretested
Obtained input from researchers & stakeholders
Pilot tested in 21 hospitals with 1,437 respondents
Final survey released November 2004 www.ahrq.gov/qual/hospculture
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HSOPS Patient Safety Culture HSOPS Patient Safety Culture Dimensions Dimensions
42 items assess 12 dimensions of patient safety culture
1. Communication openness
2. Feedback & communication about error
3. Frequency of event reporting
4. Handoffs & transitions
5. Management support for patient safety
6. Nonpunitive response to error
7. Organizational learning--continuous improvement
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8. Overall perceptions of patient safety
9. Staffing
10. Supv/mgr expectations & actions promoting patient safety
11. Teamwork across units
12. Teamwork within units
Patient safety “grade” (Excellent to Poor)
Number of events reported in past 12 months
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HSOPS Patient Safety Culture HSOPS Patient Safety Culture DimensionsDimensions
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HSOPS Comparative DatabaseHSOPS Comparative Database
AHRQ has funded an HSOPS comparative database Annual reports (2007 & 2008)– http://www.ahrq.gov/qual/hospsurvey08/
Purposes: Comparison—of survey results in efforts to establish, improve and maintain a culture of patient safety
Assessment and Learning—in patient safety improvement process (rather than basis for determining punitive actions or external judgment of hospital performance)
Supplemental Information—to help hospitals identify strengths and areas with potential for patient safety culture improvement
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2008 HSOPS Comparative Database2008 HSOPS Comparative Database
519 U.S. hospitals, 160,176 respondents Average # respondents per hospital = 309 staff
Survey administration Paper 48% Web 27% Both 25%
Average hospital response rate = 54% Paper 60% Web 44% Both 52%
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Hospital Strengths & Areas for Hospital Strengths & Areas for ImprovementImprovement
1. Teamwork Within Units
2. Supervisor/Mgr Support for Patient Safety
3. Management Support for Patient Safety
4. Org Learning--Continuous Improvement
9. Teamwork Across Units
10. Staffing
11. Handoffs & Transitions
12. Nonpunitive Response to Error 44%
45%
55%
57%
70%
70%
75%
79%
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Patient Safety GradePatient Safety Grade
24%
48%
23%
4% 1%0%
20%
40%
60%
80%
100%
AExcellent
BVery Good
CAcceptable
DPoor
EFailing
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52%
28%
13%5% 2% 1%
0%
20%
40%
60%
80%
100%
None 1 to 2 3 to 5 11 to 20 21 or more
6 to 10
Number of Events ReportedNumber of Events Reported
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Results by Hospital CharacteristicsResults by Hospital Characteristics
Smaller hospitals (49 beds or fewer) scored highest on all dimensions of safety culture
Smallest hospitals (6 – 24 beds) 21% more positive on Handoffs & Transitions than largest hospitals (400+ beds)
56% positive vs. 35%
No differences teaching vs. non-teaching
Government hospitals scored higher than non-govt on Handoffs & Transitions Staffing Teamwork Across Units
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AHRQ: Future ActivitiesAHRQ: Future Activities
New Medical Office and Nursing Home surveys on patient safety culture
Same development steps as HSOPS Pilot tested in 202 medical offices & 40 nursing homes Toolkit materials similar to HSOPS:
» Survey Administration User’s Guides» Preliminary Comparative Results from Pilot Tests» Microsoft Excel Data Entry & Reporting Tools» PowerPoint Survey Feedback Templates
Comparative databases in 2010 Voluntary data submission Free comparative report
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Long-term AHRQ Support for SOPSLong-term AHRQ Support for SOPS
AHRQ will support all 3 surveys for next 4 years
Three, in-person SOPS User Group Meetings Combined with CAHPS User Group Meeting Free registration December 4-5, 2008 in Scottsdale AZ April 2010 in Baltimore MD
Free technical assistance & national conference calls
SOPS user network
Gathering information about interventions being
implementing to address areas for improvement
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International HSOPS UsersInternational HSOPS Users
International Hospital SOPS comparative database
Focus on countries participating in the World Health Organization’s (WHO) High 5s Patient Safety Initiative
• http://www.who.int/patientsafety/solutions/high5s/en/index.html
Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the U.S.
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International HSOPS UsersInternational HSOPS Users
24 countries
- Australia - Malta- Bahrain - Netherlands- Belgium - Norway- Brazil - Saudi Arabia - Canada - Scotland- Denmark - Serbia- El Salvador - Spain- France - Sweden- Germany - Switzerland- Greece - Taiwan - Ireland - Turkey- Italy - United Kingdom
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To Learn MoreTo Learn More
• DatabasesOnSafetyCulture@ahrq.hhs.gov
• SafetyCultureSurveys@ahrq.hhs.gov
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On the CUSP: Next StepsOn the CUSP: Next Steps
1. Determine what culture tool your hospital/ICU is using
– Determine whether your participating units will administer HSOPS as part of this project
2. Respond to email from your state coordinator who will collect participant information for HSOPS survey process
3. Designate a survey coordinator in each unit4. Survey coordinators will participate in a training
call in April 5. Survey administration targeted for MAY