Patient Safety Culture in West Virginia

1
Patient Safety Culture in West Virginias Rural
Hospitals

• In the beginning.
• West Virginia Medical Institute

2
Background

• The IOM Report. To Err is Human, focused
  attention on patient safety and medical errors
• However, rural West Virginia hospitals did not
  have systems or infrastructure in place to
  improve processes as suggested by IOM
• WVMI saw opportunity to assist and implemented
  the WV Patient Safety Improvement Program,
  initially with corporate funds
• We received an AHRQ grant 9/2004 to expand the
  scope of the original project

3
Objectives

• Improve patient safety and the culture of patient
  safety in rural West Virginia hospitals by
• Offering a free, confidential event reporting
  system protected from legal discovery
• Developing a collaborative network to share
  information and best practices

4
Barriers to Implementation

• Lack of IT Infrastructure in rural areas of West
  Virginia
• Peer Review Statutes- Hospital legal staff feared
  data could be discoverable
• Computer Literacy of hospital staff
• Lack of trained IT staff

5
Today

• 23 hospitals are participating in the AHRQ
  project to date, 13 of these are CAH
• Baseline evaluation question What is the
  patient safety culture in West Virginias
  critical access hospitals?

6
Critical Access Hospitals

• There are 1013 CAHs across the nation
• Small rural hospitals differ from larger urban
  facilities in many different ways that can impact
  on their ability to implement and sustain patient
  safety initiatives.
• Do they differ with respect to the patient safety
  culture in their facilities?

7
Hospital Survey on Patient Safety Culture
Methodology

• Distributed to staff designated by hospital
  administration at time of system training.
• Completed surveys turned in at end of training
  session.
• Data scanned into an Excel database and analyzed
  used SAS.
• Data collection is ongoing as hospitals are still
  being recruited.

8
Hospital Survey Results

• Through April 2005, 860 surveys have been
  completed representing staff at 16 hospitals
• 10 of the 16 (62.5) are CAHs

9
Demographic Data about Respondents
1. Primary hospital work area, department or
clinical area where respondents spend most of
their work time 14.9 Many different hospital
units / No specific unit 0.3 Psychiatry /
mental health 11.1 Medicine (non-surgical) 3.8
Rehabilitation 1.9 Surgery 2.2
Pharmacy 0.6 Obstetrics 4.8 Laboratory 0.3
Pediatrics 4.4 Radiology 9.5 Emergency
department 0.3 Anesthesiology 0.3 Intensive
care unit (any type) 45.4 Other 2.
Staff position in the hospital 21.2
Registered nurse 2.6 Dietician 0.3 Physician
assistant / Nurse practitioner 8.3 Unit
assistant / Clerk / Secretary 6.0 LVN /
LPN 0.6 Respiratory therapist 6.1Patient
care assistant / Hospital aide / Care
partner 1.3 Physical, occupational, or speech
therapist 0.3 Attending / Staff physician 6.1
Technician (e.g., EKG, Lab, Radiology) 0.0
Resident physician / Physician in training 24.4
Administration / Management 6.1
Pharmacist 20.5Other
10
AHRQ Staff Survey Summary Results
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Demographic Data (continued)

• 3. Time worked
• --in the hospital 8.4 Less than 1 year 33.6 1
  to 5 years 24.9 6 to 10 years
• (years)
• 8.7 11 to 15 years 9.9 16 to 20 years 14.4
  21 years or more
• --in their current
• hospital work area 10.2 Less than 1 year 40.7
  1 to 5 years 23.1 6 to 10 years
• (years)
• 9 11 to 15 years 7.2 16 to 20 years 9.9
  21 years or more
• --in their current 4.5 Less than 1 year 24.5
  1 to 5 years 17.6 6 to 10 years
• specialty (years)
• 16.1 11 to 15 years 11.3 16 to 20 years
  26 21 years or more
• 4. Percentage of respondents with direct
  interaction or contact with patients 73.2

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Overall Perceptions of Safety

Strongly Disagree/ Neither
Strongly Agree/ Disagree
Agree
Survey Items
1. Patient safety is never sacrificed to get
more work done. (A15) 2. Our
procedures and systems are good at preventing
errors from happening. (A18) R3. It is just by
chance that more serious mistakes dont happen
around here. (A10) R4. We have patient safety
problems in this unit. (A17)
R Indicates reversed-worded items. NOTE The
item letter and number in parentheses indicate
the items survey location.
13
Frequency of Events Reported

• 1. When a mistake is made, but is caught and
  corrected before affecting the patient, how often
  is this reported? (D1)
• 2. When a mistake is made, but has no potential
  to harm the patient, how often is this reported?
  (D2)
• 3. When a mistake is made that could harm the
  patient, but does not, how often is this
  reported? (D3)

NOTE The item letter and number in parentheses
indicate the items survey location.
14
Teamwork Within Units
Strongly Disagree/ Neither
Strongly Agree/ Disagree
Agree
Survey Items
1. People support one another in this unit.
(A1) 2. When a lot of work needs to be
done quickly, we work together as a team to
get the work done. (A3) 3. In this unit,
people treat each other with respect. (A4)
4. When one area in this unit gets really
busy, others help out. (A11)
NOTE The item letter and number in parentheses
indicate the items survey location.
15
Communication Openness
Never/ Sometimes
Most of the Rarely
time/Always
Survey Items

• 1. Staff will freely speak up if they see
• something that may negatively affect
• patient care. (C2)
• 2. Staff feel free to question the decisions
• or actions of those with more authority. (C4)
• R3. Staff are afraid to ask questions when
• something does not seem right. (C6)

R Indicates reversed-worded items. NOTE The item
letter and number in parentheses indicate the
items survey location.
16
Feedback and Communication About Error

Never/ Sometimes
Most of the Rarely
time/Always
Survey Items

• 1. We are given feedback about changes put
• into place based on event reports. (C1)
• 2. We are informed about errors that happen
• in this unit. (C3)
• 3. In this unit, we discuss ways to prevent
• errors from happening again. (C5)

NOTE The item letter and number in parentheses
indicate the items survey location.
17
Nonpunitive Response to Error
Strongly Disagree/ Neither
Strongly Agree/ Disagree
Agree
Survey Items

• R1. Staff feel like their mistakes are held
• against them. (A8)
• R2. When an event is reported, it feels like
• the person is being written up, not the
• problem. (A12)
• R3. Staff worry that mistakes they make are
• kept in their personnel file. (A16)

R Indicates reversed-worded items. NOTE The item
letter and number in parentheses indicate the
items survey location.
18
Hospital Management Support for Patient Safety
Strongly Disagree/ Neither
Strongly Agree/ Disagree
Agree
Survey Items
1. Hospital management provides a work climate
that promotes patient safety. (F1) 2. The
actions of hospital management show that patient
safety is a top priority. (F8) R3. Hospital
management seems interested in patient safety
only after an adverse event happens. (F9)
R Indicates reversed-worded items. NOTE The item
letter and number in parentheses indicate the
items survey location.
19
Teamwork Across Hospital Units
Survey Items
1. There is good cooperation among hospital
units that need to work together. (F4)
2. Hospital units work well together to provide
the best care for patients. (F10) R3. Hospital
unites do not coordinate well with each other.
(F2) R4. It is often unpleasant to work with
staff from other hospital units. (F6)
R Indicates reversed-worded items. NOTE The item
letter and number in parentheses indicate the
items survey location.
20
Hospital Handoffs Transitions
Survey Items
R1. Things fall between the cracks when
transferring patients from one unit to
another. (F3) R2. Important patient care
information is often lost during shift changes.
(F5) R3. Problems often occur in the exchange
of information across hospital units.
(F7) R4. Shift changes are problematic for
patients in this hospital. (F11)
R Indicates reversed-worded items. NOTE The item
letter and number in parentheses indicate the
items survey location.
21
How Does CAH Pt. Safety Culture Differ from
Larger Hospitals in WV?

• At the level of composite scores the differences
  are minimal, with the exceptions of
• Communication Openness,
• Teamwork Across Hospital Units, and
• Hospital Handoffs and Transitions.

22
Culture differences continued

• Differences appear in specific questions
• 74 v 57 strongly agree/agree that patient
  safety is NEVER sacrificed to get more work done.
• 64 v 44 strongly agree/agree that they have
  enough staff to handle the workload.
• 29 v 44 strongly agree/agree that they work in
  crisis mode trying to do too much, too quickly
• 58 v 42 SA/A there is good cooperation among
  hospital units that need to work together

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Discussion So What?

• Reminder Convenience sample, reflecting the
  opinions of those chosen or choosing to
  participate in training.
• The patient safety culture in WV rural hospitals
  of all sizes still have areas needing
  improvement, e.g., attention to near misses,
  non-punitive response.
• Some of the ways in which CAH culture may differ,
  e.g., better teamwork, better transitions could
  theoretically support the ease with which patient
  safety interventions could be implemented.

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Time will tell
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Contact Information

• Gail Bellamy, Principal Investigator,
  gbellamy_at_wvmi.org
• Patricia Ruddick, Project Manager,
  pruddick_at_wvmi.org
• David Lomely, Analyst,
• dlomely_at_wvmi.org