Fostering a Culture of Quality & Safety at Providence Health Care

November 16, 2012

Meghan MacLeodQuality Improvement Specialist

Dr Adrienne MelckGeneral Surgeon & NSQIP Surgeon Champion

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Overview

Quality, Safety & Care Experience at PHC

Quality Improvement in the Surgical Program

OR Culture Survey>Teamwork & Communication

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PHC Quality & Safety Structure

Board

Quality & Performance Improvement Cte of the Board

Senior Leadership TeamCouncil for Excellence

Quality, Patient Safety & Clinical Risk Management

Committee

Medical Advisory CteCouncil for Excellence

Infection Control Standards Committee

Program/Service Quality & Safety Ctes (7)

Other Ctes

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Performance metrics

Strategic priorities

SurgicalQuality

Committee

Surgical Program Quality Improvement Structure

Working GroupsMortality Review

Urinary Tract InfectionsColorectal Surgery (ERAS)Surgical Safety Checklist

OR Culture Survey

Unit Leadership TeamsMSJ Periop

MSJ Surgical WardSPH Surgical Wards

SPH Periop

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OR Culture Survey

Sponsored by BC Surgical Quality Action Network (SQAN)

Pascal Metrics (over 500 hospitals across Canada / US)

14 hospitals currently participating in BC

7 domains

•Teamwork climate, safety climate, job satisfaction, stress recognition, working conditions, perceptions of senior management, perceptions of local management

•Each with 4-7 questions

Reports by facility, work area & discipline

•Benchmark reports, summary reports, raw rates, bar graphs, scatter plots, heat maps ….

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Survey Response Rates

Area Response Rate (%)

MSJ Surgical Suite 100

SPH OR 78

SPH Surgical Day Care 100

SPH Post-Anesthetic Care Unit 75

SPH High Acuity Unit 89

7Teamwork Clim

ate

Safety Climate

Job Satisfactio

n

Stress Recognitio

n

Working Conditions

Perceptions of

Senior Mgmt

Perceptions of

Local Mgmt

Ave

rag

e P

erc

ent

Po

siti

ve

Goal Zone

Danger Zone

PHC Overall Results

49

61

4442

292732

42

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Area Results within BC: Teamwork Climate

Aver

age

Perc

ent P

ositi

ve Goal Zone

Danger Zone

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Area Results by Provider: Safety Climate

Safety Climate Overall 62 70 50 29

I would feel safe being treated here as a patient 77 100 80 71

Medical errors are handled appropriately 67 89 70 83

I know the proper channels to direct questions regarding patient safety 85 80 85 71

I receive appropriate feedback about my performance 54 78 55 40

It is difficult to discuss errors (negatively worded) 17 33 20 0

I am encouraged to report patient safety concerns I have 67 78 80 43

The culture makes it easy to learn from the errors of others 69 67 60 43

Area by Provider Type

Proportion of respondents reporting “high” or “very high” agreement

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Nurseswith each other:

69%

Surgeonswith each other:

82%

Anesthesiologistswith each other:

100%

% of OR caregivers reporting “high” or “very high” levels of communication & collaboration with other members of the OR team.

79%

79%

34%

72%

46%

68%

Communication & Collaboration

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Qualitative Comments

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Culture Survey Working Group

Membership

•NSQIP Surgeon Champions

•Anesthesia Lead

•Program Director

•Nursing Operations Leaders

•OR Nursing Supervisor

•Business Analyst

•Quality Improvement Specialist

First Steps

Understand data

Questions!> (eg, Local vs. senior mgmt)

Share right away>Mass email with tidbits of data & plan going forward

Present high level data PHC QPSCRM Cte Surgical Business Cte All Party Rounds Dept meeting

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Sharing & Acting on Results

Engage in dialogue with each area/department & care provider (Surgeon, Nurse, Anesthesiologist, Porter, etc)

Clarify meaning of responses

(eg, Perceptions of Senior Management)

Uncover important issues

Determine Staff priorities for change

Safety Climate Overall 62 70 50 29

I would feel safe being treated here as a patient

77 100 80 71

Medical errors are handled appropriately

67 89 70 83

I know the proper channels to direct questions regarding

85 80 85 71

I receive appropriate feedback about my

54 78 55 40

It is difficult to discuss errors (negatively worded)

17 33 20 0

I am encouraged to report patient safety concerns I have

67 78 80 43

The culture makes it easy to learn from the errors of others

69 67 60 43

Area by Provider Type

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Emerging Themes

Performance feedback

Staff recognition

Communication with management

Closing the loop on incident reporting

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Next Steps

Developing trust

This is not “just another survey”

We are taking responses/data to heart & committing to do what is doable

Addressing priority issues

Communication

Feedback

System transparency

Readminister survey

Link with Surgical Safety Checklist and other Working Groups

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Thoughts onTeamwork & Communication,Quality, Safety & Care Experienceat PHC