Shatin Cheshire Home (SCH) SAQ · PDF file%...
Transcript of Shatin Cheshire Home (SCH) SAQ · PDF file%...
Shatin Cheshire Home (SCH)
SAQ taskforce
¨ To establish a baseline understanding of the safety culture in Sha5n Cheshire Home(SCH) by using Chinese version of Safety A=tude Ques5onnaire (C-‐SAQ)
¨ Iden5fy areas for improvement and raise awareness about pa5ent safety in SCH.
¨ As a measurable outcome indicator/ internal benchmarking to evaluate pa5ent safety interven5ons or programs and track change over 5me
Objec've
Safety A/tude Ques'onnaire( Chi-‐SAQ)
Validated
into C-SAQ at 2008
John Bryan Sexton PhD, MA Director of the Duke Pa5ent Safety Center Associate Profession, Duke University Medical Center Department of Psychiatry and Behavioral Science
Thomas et al. 2003)
Dr Wui Chiang, Lee Director, General of the Bureau of Medical Affairs, Department of Health, Taiwan. President, Asian Society for Quality in Health care. Director of Taiwan Joint Commission on Hospital Accredita5on (TJCHA),
-‐Total three phases of C-‐SAQ will be carried out from 2014 to 2016 (First phase of SAQ collec5on completed at March 2014, second phase of SAQ just completed in April 2015) -‐A long collec'on period( two weeks ) in each phase to maximize response rate. -‐All Staff (Doctors, nurses, allied health professionals, administra5ve and suppor5ng staff )are anonymous and invited to par5cipate in the survey on a voluntary basis. -‐Evaluate survey result and implement improvement program to rec'fy and focus on related safety measure.
Measure 5 specific SAQ dimensions: § Teamwork Climate § Safety Climate § Job Sa5sfac5on § Percep5on of Management § Working Condi5ons Safety behavior items
*Total 42 sub-‐items + demographic informa:on + staff feedbacks
Each item was scored by conver5ng the 5-‐point Likert scale (1=strongly disagree; 5=strongly agree) to a 100-‐point scale: Ø 1=0, 2=25, 3=50, 4=75, 5=100
Higher scale scores indicate more posi5ve a=tudes towards the par5cular safety domain. If a respondent’s mean score of each item or dimension was 75 or higher, he or she was reported to hold a posi've a/tude to a given item or dimension.
• Baseline mean score of each safety dimension will be established to compare differences between groups
• Mul5ple logis5c regression to clarify the causal rela5onship between safety culture changes and clinical outcomes in our hospital
• Confounding factors will be adjusted to obtain the final unbiased es5ma5on of the output model
• Staff feedback will be summarized for follow up
Overall response rate 87.17% (2014)
Characteris'cs of safety a/tude survey
respondents
Baseline Safety Dimension Mean Score (2014)
67.4±18.9 64.1±13.1 68.7±19.8 65.7±17.5 62.9±18.9
0.0
25.0
50.0
75.0
100.0
Teamwork climate
Safety climate Job satisfaction
Mangement perception
Working condition
2014
Percep'on of hospital safety culture between different job discipline groups
Doctors Nurses Allied Health professionals
Suppor'ng staff
Administra-‐'on staff
Catering staff
*Teamwork 87.5 59.7 71.3 71.9 69.7 80.7
Safety climate 81.3 63.4 63.4 63.0 66.0 71.6
*Job sa5sfac5on
95.0 64.4 71.5 69.6 67.7 86.4
Percep5on of Management
85.0 61.3 71.0 67.7 70.2 71.9
Working condi5on
81.3 59.4 68.3 63.5 63.4 74.6
*Shows significant different amongst groups through ANOVA test, p< 0.05
SAQ dimension Lowest mean sub-‐item score Highest mean sub-‐item score
Teamwork Climate Nurse input is well received in this clinical area (59.7 ± 22.5)
It is easy for personnel here to ask ques5ons when there is something that they do not understand (73.8±24.4)
Safety Climate In this clinical area, it is difficult to discuss errors (43.2±26.1)
I would feel safe being treated here as a pa5ent (76.6±22.8)
Job Sa'sfac'on Moral in this clinical area is high (58.2±23.6)
I like my job (75.9±23)
Management Percep'on
The hospital management supports my daily efforts (58.7±23)
The unit management doesn’t knowingly compromise pa5ent safety(77.6±26.8)
Working condi'on The levels of staffing in this clinical area are sufficient to handle the number of pa5ents (50.2±28.3)
Trainees in my discipline are adequately supervised(68.2±21.2)
Safety behavior Service delay by communica5on breakdowns(49.3±25.6)
Encouraging safety repor5ng (76.6±24)
Mul'ple logis'c regression:
There is very strong associa'on between management percep'on and staff collabora'on ¨ posi5ve a=tude in management percep5on vs good
collabora5on with nurse, OR = 3.95 ¨ posi5ve a=tude in management percep5on vs good
collabora5on with administra5on staff, OR = 9.22 There is also strong associa'on between management percep'on and scope of pa'ent safety ¨ posi5ve a=tude in management percep5on vs priori5zing
safety training, OR = 2.93 ¨ posi5ve a=tude in management percep5on vs encouraging
safety repor5ng, OR = 3.00
Four main concerns from staff perspec've: 1. Insufficient manpower /resources support 2. Safety training and level of supervision 3. Collabora5on, Communica5on ,mutual trust 4. Procedure /Policy review
C-SAQ HCE walk round/ Q
& S round/ forum/
interviews
ü 26 feedback/ sugges5ons from 2014 C-‐SAQ ü 30 feedback/sugges5ons/proposals from
HCE walk round, Q & S round/ forum/ interviews etc.,
Improvement Ac'vi'es for safety culture in SCH
¨ Enhance staffing / resources support from management ¨ Enhance daily safety prac5ce , expand communica5on spectrum
¨ Promulga5on game booth for safety culture “ Building a safety Culture” for beqer staff engagement.
¨ SCH safety newsleqer ( quarterly, start from early 2015) to increase staff awareness in safety aspect.
Remarks: 2nd and 3rd distribu'on of SAQ are pending on 2Q 2015 & 2Q 2016 for evalua'on of staff safety a/tude.
Enhance procedure/ policy safety measures( Infec5ous Control/ Environmental/ Equipment)
• Grouping of infec5ous cases in designated ward • Implementa5on of color coding cleansing system
• Infec5ous control educa5on to staff and carer
• Environmental improvement work: add mosquito light in outdoor area
• Improved ven5la5on system of kitchen and ward area • Enhanced and renewed ceiling hoist system to relief staff workload
Safety Training /Communica'on/
supervision enhancement :
In-‐service training and briefing session by supervisor On-‐site safety training
“Building a Safety Culture” game booth(5 Dec 2014)
“共建安全文化”攤位遊戲
Communica'on/ Staff engagement in safety culture promulga'on ac'vity
Staff Suppor've/ Engagement Ac'vi'es The Critical Incident Support Team (CIST) introduced their service on 5 Nov 2014.
Local safety newsleger for all staff
事故發生!!!點算好!"
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!唔想!
報�都�用
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篤背脊? 小事化大
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己助人
及早改善, 重安全!
避免事故重演, 減少傷害
互助互諒 重安全
安全挑戰站: 事故報告系統中”AIRS”的中文全名是甚麼? 答案:______________________ 部門/姓名:_________________ 請剪下 線並於3月31日前交往總務部胡小姐收, 首50名參加者有機會得到小禮物一
, 先到先得.
編輯顧問"!陳秀霞女士!編輯小組"!沙田慈氏質素及安全部張靜宜女士#!
!!!!!!!麥婉 姑娘#! 筱儀姑娘!
二零一五年!第一期季刊!
自 瘡 ~.~
共建安全 文化
影響前途$!
Launch of SCH safety newsletter
NEW!!
Staff Communica'on Channels Chief Execu5ve and HA Board Members’ Visit on 16 May 2014.
HCE forum
Q & S forum
CQI program for enhancement of clinical safety and handover
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Conclusion u The SAQ’s survey raised awareness of safety culture in SCH. It
serves as a communica'on plajorm that focus aqen5on on culture priori5es and establish a common vocabulary and set of goals to rally behind.
u The collec'on of quan'ta've culture data supplemented with qualita've informa'on such as staff feedback, interview, focus group could reflect a holis5c picture of organiza5on safety culture. They should be regarded as key informa5on in the development of safety ac5on plan.
u SAQ cultural assessment in itself could be regarded as a pa'ent
safety interven'on and part of an organiza'onal learning and con'nuous improvement process
The way ahead……..
¨ The 2nd and 3rd phases of SAQ data collec5on, analysis and evalua5on will be held at 2015 and 2016 respec5vely. We expected that this longitudinal studies may help evalua5on of the effects of safety ac5vi5es over 5me.
¨ In future, safety culture assessment may combine with other clinical outcomes such as adverse event, pa5ent sa5sfac5on; in making decisions about ways to improve staff and pa5ent safety.
¨ Establish an internal safety culture benchmark and explore the possibility of external benchmarking to other hospitals
Acknowledgments: Dr Wui-‐Chiang Lee is appreciated for allowing the adop5on of Chinese version of SAQ. (M.D; Ph.D., M.H.S. Director General of the Bureau of Medical Affairs, Department of Health, R.O.C. Tai wan; President, Asian Society for Quality in Healthcare; Director, Taiwan Joint Commission on Hospital Accredita5on)
Dr Herman Lau , HCE, Sha5n Cheshire Home, for his leading and support of the study.
All Sha'n Cheshire Home staff for their ac5ve par5cipa5on in promo5ng safety culture
References:
1) Chaboyer, W, Chamberlain Di, et al: Safety Culture in Australian Intensive Care Units: Establishing a Baseline for Quality Improvement. American Journal of Cri5cal Care 2013, Vol 22(2) P93-‐103
2) Lee WC, Chen SF, Cheng YC, Huang TP, Lee CH, Lee SD: Valida'on Study of the Chinese safety a/tude ques'onnaire in Taiwan (in Chinese). Taiwan J Public Health 2008, 27:6-‐15.
3) Lee WC, Wung HY, Liao HH, Lo CM, Chang FL, Wang PC, Fan A, Chen HH, Yang HC, Hou SM. Hospital Safety Culture in Taiwan: A na'onwide survey using chinese version safety a/tude ques'onnaire. BMC Health Services Research 2010, 10: 234.
4) Nieva VF, Sorra J: Safety culture assessment : a tool for improving pa'ent safety in healthcare organiza'ons. Quality Safety Health Care 2003, 12 (Suppl II) : 17-‐23.
5) Sexton JB, Helmreich RL, Neilands TB, Rowan K, Vella K, Boyden J, Roberts PR, Thomas EJ : The Safety A/tudes Ques'onnaire: psychometric proper'es, benchmarking data, and emerging research. BMC Health Services Research 2006, 6:44.
6) Sexton, JB, Thomas, EJ, Helmreich, RL. Error, stress, and teamwork in medicine and avia'on: Cross sec'onal surveys. BMJ. 2000, Vol320, 745-‐749.
7) Thomas, EJ, Sexton, JB, Helmreich RL. Discrepant a/tudes about teamwork among cri'cal care nurses and physicians. Cri5cal Care Medicine. 2003, Vol 31 (3), 956-‐959.
SAQ taskforce: Dr. Herman Lau (SAQ taskforce leader)
Miss Susanna Chan(GMN-SCH, SAQ taskforce advisor) Miss Lydia Wong (SCH-PTI, Principle Investigator)
Miss Kitty Mak (SCH-DM member) Mr Allan Fu (member)
Mr David Wong (RA, Statistical support)