Patient Safety Culture

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Patient Safety Culture

• Liane Ginsburg
• Assistant Professor
• School of Health Policy Management
• York University
• lgins_at_yorku.ca

Mark Fleming Assistant Professor Department of
Psychology Saint Mary's University Mark.fleming_at_sm
u.ca

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Patient Safety Culture - Outline

• Why is it important?
• What is it?
• How is it measured?
• How might the data be used?
• Do we need different tools for different sectors
  / staff groups?

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Importance of culture

• There is a need for a cultural change, the status
  quo is no longer acceptable (IOM, 1999)
• The Change foundation recommends Creating a
  culture of safety to improve patient safety
  (February 2004)
• The Canadian Patient Safety Institute will
• influence change in culture to improve patient
  safety

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Everything and nothing

• Sometimes culture is just a lazy catch all term
  for a mishmash of practices that are somehow
  meant to combine to produce a coherent approach
  to safety calls for a change in culture are
  little more than feel good messages p153
  (Vincent, 2006)

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Organisational Culture

• Culture has been defined as
• A pattern of basic assumptions
• Invented, discovered or developed by a given
  group
• Learnt from coping with problems of external
  adaptation and internal integration
• That has worked well enough to be considered
  valid
• Is taught to new members (as the)
• Correct way to perceive, think and feel in
  relation to problems
• Schein 1990 p110

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Culture model
Culture
Basic Assumptions(Taken for granted/ unconscious)
Artefacts(Indicators)
Espoused values(Attitudes about Systems
PeopleBehaviour)
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Why the interest in Safety Culture?

• It is thought to be related to actual levels of
  patient safety it is used as a proxy for safety
  as it is more easily quantifiable
• Coercive and normative mechanisms

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How do we Measure Safety Culture?

• Quantitative approaches
• Just learning about their sensitivity to
  differences between units / organizations and to
  change over time
• Is it a org or unit-level phenomenon? This has
  really practical implications for who and how
  many to survey and how to report the data for an
  organization
• Qualitative approaches
• Provide a kind of depth and richness that is
  quite different

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Areas Measured

• AHRQ Dimensions
• Overall perceptions of safety
• Frequency of events reported
• Supervisory Leadership
• Organizational learningcontinuous improvement
• Teamwork within units
• Communication openness
• Feedback communication about error
• Nonpunitive response to error
• Staffing
• Hospital management support for patient safety

• Teamwork across hospital units
• Hospital handoffs transitions
• PLUS
• Patient safety grade
• of events individuals reported in last 12
  months
• MSI Dimensions
• Valuing Safety in the Organization
• Supervisory Leadership
• Fear of Repercussions
• State of Safety

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How its done Quantitatively

• Tools available that organizations can implement
  on their own
• Freedom to do as needed can be used for internal
  diagnosis and monitoring
• This capacity is important once we have the right
  tool (eg that will be sensitive to diffs /
  change)
• AHRQ promotes this, we are working on it with the
  MSI through use of survey implementation
  resources / handbook
• External comparison becomes more problematic due
  to inconsistent methods and samples

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How its done Qualitatively

• Interviews and focus groups can be used to
• Help assess how well surveys are detecting real
  differences in safety culture (done more in a
  research)
• As a proactive or reactive mechanism to promote
  learning and improvement and move safety forward
• unit specific dialogue to diagnose problems,
  bring discussion of the culture of safety to the
  surface, monitor progress in improving culture
• may be a valuable, yet underutilized tool for
  enhancing safety
• requires a certain level of immediate supervisory
  commitment
• would also fit with more senior level commitment
  and leadership walkarounds

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How to Use the Data

• Identification of learning opportunities
• Areas with low scores relative to other areas
• Units or organizations with low scores relative
  to other units / orgs
• Learning from best practice places seems to be
  terribly under-utilized as a strategy for
  implementing change
• Some areas easier to address than others valuing
  safety, reporting practices, state of safety,
  supervisory leadership

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Performance / Improvement Learning Tool
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What we are Doing in CPSI study

• Testing instruments value with different staff
  groups and sectors with 2 large samples
• Testing instruments sensitivity to change and
  differences using qualitative approaches
• Looking at links between safety culture data and
  safety improvement activity
• Fall 2006 data to build pan-Canadian Database
• Trying to create org capacity to measure their
  own culture while continuing to build national
  capacity to learn from one another using the
  pan-Canadian database

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Staff / Sector Specific Measurement

• Preliminary analysis suggests the MSI works
  reasonably well across settings / sectors, but
  has some applicability issues wrt staff groups
• the MSI works equally well across different
  in-patient settings (general acute, LTC, acute
  MH)
• MSI has a set of 5 or so items that apply only to
  those staff members involved in direct care

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Using the MSI in Pediatric Settings

• MSI has been used in one large childrens
  hospital
• Prelim analysis suggest it works well
• Instrument works well in LTC and acute MH
  settings
• Consideration needs to be given to whether
  pediatric sites would benefit from questions in
  additional domains