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Safety Attitudes Questionnaire
A way to measure “Culture of Safety”
Presented via Skype (2:00pm-2:15pm)URMPM World Congress 9th September 2012 –London
Krish Sankaranarayanan MS, MBA, CPHQSenior Safety OfficerTawam Hospital Abu DhabiUnited Arab Emirates
“Culture is local” and “so is change.”
Safety Attitudes Questionnaire provides a baseline to understand staff perception of safety
Early adopters- Aviation
6 main components (called characteristics) of safety culture aredescribed:• Commitment• Justness• Information• Awareness• Adaptability• Behavior
Most rigorously tested and well known tools •Safety Attitudes Questionnaire •Patient Safety Culture in Healthcare
Organizations •Hospital Survey on Patient Safety Culture •Safety Climate Survey •Manchester Patient Safety Assessment
Framework
Safety Attitudes Questionnaire- Adopted in Healthcare
J. Bryan Sexton, Ph.D., • Was the Assistant Professor in Anesthesiology and
Critical Care Medicine at The Johns Hopkins University School of Medicine.
• Currently Director of Patient Safety Operations at Duke University Hospital.
Culture of Safety Survey- Domains
1.Teamwork Climate: The perceived quality of teamwork and collaboration within a given unit.
2.Safety Climate: The perceived level of commitment to and focus on patient safety within a given unit.
3.Job Satisfaction: Employees' general feelings of positivity regarding their work experience.
4.Stress Recognition: Employees' recognition of how stressors impact their performance.
5.Working Conditions: Employees' perceptions of the quality of their work environment.
6.Perceptions of Hospital Management: Employees' perceptions of the support and competence of hospital-level management.
7.Perceptions of Unit Management: Employees' perceptions of the support and competence of unit-level management
Culture linkages to Clinical, Operational & other Outcomes
• Wrong Site Surgeries• Decubitus Ulcers • Delays• Bloodstream
Infections• Post-Op Sepsis• Post-Op Infections• Post-Op Bleeding• PE/DVT• RN Turnover• Absenteeism• VAP
• Burnout• Unit size• Communication
breakdowns• Familiarity• Spirituality• Most validated:
Qual. Saf. Health Care 2005;14;364-366
SAQ- Administration methodology•The hospital partnered with Pascal Metrics. • Identified the units and collected the list of staff.•Staff that spent 50% of their time in the
identified units were only included in the survey.•All disciplines were included in the survey.•Given a brief introduction of the purpose of the
survey•Was anonymous and a voluntary exercise.•Hand delivered survey•Done during a staff/department meeting.
SAQ- Administration methodology. Contd…
•Distributed sharpened pencil with eraser. •Didn’t leave the surveys in pigeon holes
for staff to complete.•Didn’t leave the surveys with
departments heads.•Conducted separate sessions of
physicians. •Staff dropped the completed surveys in an
envelope.
Survey participation and response rate•82% of staff in patient care areas of the whole
hospital participated in the overall 3 phases of SAQ Survey.
Location YearTargeted staff
Surveys Administered
SurveyReturned
Surveyresponse rate
Phase 1 CUSP Pilot Units 2008 199 199 199 100%
Phase 2 In-patient areas 2010 1600 1476 1450 98%
Phase 3Out-Patient & satellite locations
Qtr 42011 805 497 483 60%
Total 2604 2172 2132
Dissemination of the SAQ ? Challenges we faced•The questions in the SAQ did not translate
well.•Staff took the results personally if low
scores.•Dept managers defended low scores.
▫Especially on perception of unit management.
•Staff expected positive actions from management based on SAQ results.
Dissemination of the SAQ ?
•Results were sensitive, so did it with individual departments.
•Did not share results of one dept with the other.
•Had a senior executive leader (C-Suites)while disseminating.
•Emphasized that the SAQ was a survey on perception and NOT AN EXAM RESULT.
•Emphasized that “Culture is local” and “so is change.” (Micro System)
Perceptions of Hospital ManagementIs always low
•Staff may not see the C-suites frequently.•Staff relate themselves more with the unit
mangers than executive leaders.
2008 SAQ Phase-1 (CUSP Pilot Units)
Team
work
Safet
y
Job
Satisf
actio
n
Stress
Rec
ognit
ion
Perce
ption
s of
Hos
pital
Man
agem
ent
Perce
ption
s of
Unit
Man
agem
ent
Wor
king
Condit
ions
0%
20%
40%
60%
80%
100%
SAQ Results 2008
ICU
Pediatric Oncology
NNU
Domain
Av
era
ge
% P
os
itiv
e
2010 SAQ Phase-2 (All In-patient Units- & CUSP Pilot Units Re-survey)
2011 SAQ Phase-3 (Out-patient Units)
Team Work Climate
ICU Physicians and ICU RN Collaboration
51%
88%
0
10
20
30
40
50
60
70
80
90
100
K P L &D
RN rates ICU Physician ICU Physician rates RN
Teamwork Disconnect
•RN: Good teamwork means I am asked for my input
•MD: Good teamwork means the nurse does what I say
Safety Climate
Job Satisfaction
Stress Recognition
Perceptions Of Hospital Management
Perceptions Of Unit Management
Working Conditions
Dependent Variables of SAQ
•The primary dependent variables -teamwork climate and safety climate scale scores.
•These primary dependent variables were chosen because they are important in preventing patient harm.
•The rest of them are secondary dependent variables.
Sexton J.B., et al.: The Safety Attitudes Questionnaire: Psychometric properties, benchmarking data, and emerging research. BMC Health Serv Res 6(44):Apr. 3, 2006.Timmel J, Kent PS, Holzmueller CG, Paine L, Schulick RD, Pronovost PJ. Impact of the Comprehensive Unit-Based Safety Program (CUSP) on safety culture in a surgical inpatient unit. Jt Comm J Qual Patient Saf 2010;36(6):252-260.
Safety Climate
Perception of Unit Management
Safety Climate
Stress Recognition
Perception of Unit Management
Safety Climate
Working Conditions
Job SatisfactionTeam Work
Climate
Job Satisfaction
Safety Climate
Stress Recognition
Sample
Sample-De-briefer tool
Home work
De-briefer (Group activity without dept managers)
•Identify a specific area of concern.•Select one or two items.•Provide insights and recommendations.
•Foster actionable ideas for improvement.
Culture of Safety is a journey
•Takes as long as 5 years to develop a culture of safety that is felt throughout an organization. (Ginsburg et.al 2005)
•Need Patience, Perseverance, Commitment & Engagement.
Ginsburg, L., P. G. Norton, A. Casebeer, and S. Lewis. 2005. ‘‘An Educational Intervention to Enhance Nurse Leaders’ Perceptions of Patient Safety Culture.’’ Health Services Research 40 (4): 997–1020.
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