Using Safety Culture to Drive Habitual...

Model for Improvement

Patient Safety Officer Executive Development Program

Institute for Healthcare Improvement

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




3*Adapted from Safeskies 2001, “Aviation Safety Culture,” Patrick Hudson, Centre for Safety Science, Leiden University

PATHOLOGICALWho cares as long as we’re not caught

Chronically Complacent

REACTIVESafety is important. We do a lot every

time we have an accident

CALCULATIVEWe have systems in place to manage all

hazards

PROACTIVEAnticipating and preventing problems before

they occur

GENERATIVESafety is how we do business around here

Constantly Vigilant

Evolution of A Culture of Safety and

Reliability

Where are you?

Safety Culture Instruments

• SAQ

• HSOPS

• Manchester

• All are validated instruments – psychometrically

• 60% response rate minimum

• Unit level – caregiver specific




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




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. 350-383

Amy Edmondson

8

What is Culture?

• The visible attributes

• The espoused values

• The hidden values• —Edgar Schein

“The way we do things

around here.”




Where Do You Have Opportunity?

• Leadership

• Psychological Safety

• Learning from error

• Teamwork

• Human factors

• Learning and improvement

Courtesy Natasha Scott, PM




% o

f re

spo

nd

ents

rep

ort

ing

ab

ove

ad

equ

ate

team

wo

rk

Teamwork in the eye of the beholder: ICU RNs and ICU MDs rate each other

62 Michigan ICUs 2004Only ICUs with 5 or more physicians

reported here (all had 5 or more RNs)

Teamwork Climate Across

Michigan ICUs

No BSI 21%

No BSI = 5 months or more w/ zero

The strongest predictor of clinical excellence: caregivers feel comfortable

speaking up if they perceive a problem with patient care

No BSI 31% No BSI 44%

Attribution: J. Bryan Sexton




Attr: Margaret Vigorito

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

Linking Culture and Outcomes:

RI ICU Effort to Decrease Infection

Attribution: Margaret Vigorito, MS, RN

ICU’s that reflected on their

SAQ scores and took action:




15Courtesy Natasha Scott PM

16

Courtesy Natasha Scott, PM




17

Courtesy Natasha Scott PM

18





19


20





Debriefing Culture Data Locally

- CONFIDENTIAL-

21

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

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




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




What Are You Going to Do ?

Using Safety Culture to Drive Habitual...

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