Indian River Memorial Hospital

1
Indian River Memorial Hospital

• Barbara Horne, VP/Chief Nursing Officer
• 335-bed not-for-profit community hospital in Vero
  Beach, Florida
• Early adopter of survey
• Decided to conduct a patient safety survey
• Establish a baseline measurement
• Perceived mistrust in past was it dissipating?

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Decision to Use AHRQ Survey

• Learned of AHRQ survey at workshop
• Research-based
• Easily administered
• Support available during administration and
  evaluation
• Can be used across the organization
• After discussion with developers at Westat,
  removed 4 staffing questions
• Concerned about setting up an unrealistic
  expectation that staffing patterns would be
  changed based on results of the survey

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Survey Sample

• 1,200 to 1400 employees depending on the time of
  year including seasonal and per diem staff. We
  average about 1000 paid FTEs per pay period.
• Initial discussion about including non-clinical
  staff, but decided they should participate
• Non-clinical staff spend time in care delivery
  areas, make observations, see results of care
  delivered, or talk with patients after discharge
• Offer a different perspective in regard to
  culture
• Wanted across-the-board assessment to be able to
  compare clinical versus non-clinical responses

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Data Collection Procedure

• IS guru developed a web-based version of the
  survey and placed it on our intranet. Meal ticket
  incentive
• A certificate could be printed upon completion of
  the web survey
• Survey promotion activities
• Letter sent to employees homes before survey from
  the CEO
• Notice on pay checks
• Posters and e-mails sent out
• Follow-up letter midway through time period
• 6-week data collection time period
• Due to hurricanes, extended the field period!

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Survey Response

• 619 surveys completed greater than 50 response
  rate largely due to incentive of meal ticket
  attached to completion
• 75 of respondents were clinical staff
• More manager support and encouragement may have
  improved our response rate, but we did much
  better than we anticipated

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Survey Results

• Hospital technical staff developed a survey
  results reporting tool in Excel
• Bar charts, 5-point Likert scales condensed into
  just three points (negative, neutral, positive)
• Can display results in aggregate, by department,
  length of service or by job classification
• Distributed survey results electronically through
  the Excel tool
• We provided initial input for Premiers
  Customized Excel tool which is similar to what we
  developed

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Sharing Survey Results

• Results shared with all directors and managers
• Has been distributed house wide through
  Department Directors and Managers.
• Surprised and pleased with the extent of
  participation
• Encouraged overall with the results (less
  negative than anticipated)
• Concerned that pockets of staff may perceive
  there to be a risk of retribution for bringing
  safety issues to light

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Action Planning/Follow-up

• VP/CNO had one-on-one conversations with managers
  in areas of concern plan to do further follow-up
• Currently developing individual goal-based
  incentive pay program
• For managers, would like one goal to address
  issues raised in survey as appropriate
• Leadership Academy of the Advisory Board Company
  in Washington, DC presented a module on patient
  safety to our midlevel managers specifically
  using our survey results.
• Communication between departments needs to be a
  focus of manager

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PACU/Surgical Unit Tool

• Patient name/brief history
• Surgical Procedure
• Surgeon/Anesthesiologist
• Type of anesthesia
• IV Fluids
• Estimated Blood Loss
• Pain Score
• Last pain med given
• Discharge Order check marked?
• Last Vital Signs
• Length of stay as Phase I PACU patient
• Other essential information to know?

10
Lessons Learned Future Plans

• Needed 3 hospital staff who worked together on
  the survey project
• All were detail-oriented, good at follow through
• Next time, plan to improve survey results
  follow-up
• Give staff access to results more quickly
• Initiate action plans more quickly
• Definitely plan to redo the survey after 1 year,
  hopefully in the fall
• Not during the peak of hurricane season!

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