Patient Measurement of Safety – Patients’

Perspective

Outline

• Introduction:

• What is PMOS?

• Why is PMOS a studied topic?

• Previous studies on PMOS

• Objective of Study

• Study Methodology and design

• Results

• Conclusion

• Q & A

Why PMOS?

•At CMC the measurement of safety has been restricted to extracting information from staff, using AHRQ patient safety culture questionnaire, incident reports etc…

•Recent literature highlighted the importance of patients as the ‘smoke detectors’ for safety

PMOS questionnaire was developed to study patient safety culture from patients’ perspective

We need new safety detectors!

Introduction on PMOS

• Patient Measurement of Safety (PMOS) is studied using YCFF factors

• YCFF being the Yorkshire Contributory Factors Framework - a comprehensive taxonomy of the factors contributing to patient safety incidents

• Patients expect safety to be a priority within health services

May provide insightful feedback regarding their safety thus reducing avoidable harm and improving health care

A validation study conducted by Rosemary McEachan et. al compared the PMOS results completed by patients with the AHRQ patient safety staff questionnaire completed by hospital staff

Factor analysis of PMOS developed by Gilles Lawton et. Al. revealed 8 key domains of safety from the 20 YCFF key contributory factors

Communication & Teamwork

Organization & Care Planning

Access to Resources

Physical Environment (Ward

Type & Layout)

Information Flow

Staff Roles & Responsibilities

Staff Training & Equipment (design &

functioning)

Overall Safety Outcome

Study Objective

• Develop a PMOS questionnaire that can be used in Clemenceau Medical Center hospital to promote organizational learning about safety

• Explore the extent to which patients are able to identify factors related to the safety of their care

• Use patients’ perspective as a tool for the measurement of their safety at CMC and to describe opportunities for safety improvement

Study Design & Methodology

• Patients were recruited from Clemenceau Medical Center from 3 medical

surgical units

• The study was approved by the hospital’s IRB

• Patients were approached and explained the study synopsis.

• Patients were given a choice to fill the questionnaire privately or fill the

survey with the help of the study coordinator

Inclusion Criteria Exclusion Criteria

Patients admitted to medical/surgical wardsPatients admitted in critical care units or outside the

medical/surgical wards

Patients are 18 years and abovePediatric patients and patients under the age of 18

years

Patients provide verbal consent to complete the questionnaire

Patients who do not agree to consent to the survey

Date of admission to date of survey = 2 days or more Patients unable to provide feedback

Study Sample

• Based on the following formula a planned sample size of 46 is needed to reach a precision level of +/- 10%:

n = N / [1 + N (e)^ 2]

n is the sample size ; N is the population size

e is the level of precision

Assuming a 95% confidence level

• A total of 46 patients were recruited

Study Tool

• The PMOS questionnaire was developed based on the 8 key domains and translated to Arabic (Arabic translation was validated twice by 2 separate readers)

• Patients were asked to answer the questions based on a five-point Likert scale (Strongly Agree, Agree, Neither, Disagree, Strongly Disagree)

Domains Number of QuestionsCommunication & Team work 6

Organization & Care Planning 7

Access to Resources 2

Physical Environment 6

Information Flow 3

Staff Roles & Responsibilities 6

Equipment (functioning & design)

2

Overall Safety Outcome 1

Open Ended Questions 2

Total Number of Questions 35

55%45%

Demographic Distribution by Gender

Male

Female50%

27%

23%

Demographic Distribution by Med/Surg Floor

5th Med/SurgFloor

6th Med/SurgFloor

7th Med/SurgFloor

9.10%

31.80%29.50% 29.50%

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

18-29 30-50 51-70 >70

Percentage

Age Groups

Demographic Distribution by Age

Demographic Distribution of Participants

Data Analysis

• A ‘positive index’ was constructed by summing the number of questions that patients responded to by using one of the two positive response options (strongly agree, or agree for positively worded questions and strongly disagree and disagree for negatively worded questions).

• Thus, patients had a score out of 33 (excluding open-ended questions) where higher responses equated to better safety.

• The mean PMOS index score for the entire sample was 28.35 (SD = 5.92).

on average patients responded positively to around 28 questions out of 33 questions in the PMOS questionnaire.

Domains with highest scorings were:

» Information flow

» Staff roles and responsibilities

» Communication

» Equipment

The domain with the least score was “delays” with 3.63 mean positive score

Positive Index Score

Variables Mean Positive Index Score SD

PMOS Positive Index 28.35 5.92

Domain 1:

Communication & Team Work

Most of the people who work in this team seem to enjoy their work

4.55 0.96

All information about my care is conveyed and shared between staff and between shifts

Staff listen to my concerns

Staff understand what I say when I share a concern

Staff communicate with me in a proper manner

Medical staff provide me with explanation of my clinical tests results

Domain 2:

Organization & Planning

I am involved in decision-making in relation to treatment

4.33 0.94

I am aware who is involved in my care

I know what to expect from those providing care

I am actively engaged in the planning of my care

I feel comfortable asking questions when something doesn’t seem right

Domain 3:

Access to Resources

In my opinion all services needed for my recovery and safety are available4.38 0.44

Services are provided within an acceptable time frame

Domain 4:

Physical Environment

Signs are available to easily navigate the hospital

4.49 1.02

Precautions are available to prevent me from falling

The physical environment of my room helps and does not hinder safe practice

Room setup is convenient; items needed during hospitalization are within my reach

My transfer and movement within the hospital setting was safe and smooth

Hand sanitizer bottles are available at reach

Domain 5:

Information Flow

All staff caring for me know about my medical history

4.7 0.58Information about my status and wellbeing is known by all staff caring for me

Everyone speaks using language I can understand

Domain 6:

Staff Roles & Responsibilities

There is enough staff to handle the workload

4.58 1.07

Staff are well trained to perform their tasks

Doctors and staff clearly understand each other’s roles and responsibilities

The responsibility of each staff that enters my room is clear to me

This team and its clinicians give the attention that patients feel they need

I have felt valued and respected by the staff caring for me

Domain 7: EquipmentEquipment/ devices used during my stay were all properly functioning

4.55 0.5All staff are well trained to use and handle equipment

Domain 8: DelaysI was prepped for my procedure to have it done on time

3.63 0.85I was informed of my imaging and/or lab test schedule and they were done within expected

time

Patients Identification of Improvements Needed for Enhanced Patient Safety

DomainTimes Domain was

IdentifiedIllustrative Statements Written by Patients

Physical Environment 6

Need to have a more quiet environment at night for patients to rest

improve cleanliness of the room

Patient transfer from department to department should be more medically safe

The automatic entrance doors of the floor open too fast that can cause patients and visitors

to fall

improve cleanliness of the bathroom in the patient's room

Patients under isolation precautions should all have their room doors closed. I stopped

walking in the floor corridor after realizing that this is not applicable for all isolation patients.

Staff Attitude & Behavior 4

Improve nurses' attitude with patients

nurses need to show more care

Staff should apply hand hygiene gel before touching anything in the patient's room and after

completing the activities inside the room

Staff should apply hand hygiene gel

Management of staff and staffing levels

/Staff workload3

The floor is understaffed with nurses

Nurses were very busy, their response to my calls were late

Need to recruit more practical nurses during the night shift

Communication and Team work 1 Need to improve communication between staff at the emergency unit

Equipment and supplies 1Some personal hygiene items needed for patients during admissions are missing such as

toothbrush and toothpaste

Scheduling and bed management 1 Decrease patients' waiting time from emergency department to the admission unit

Patients Identification of Aspects of Patient Safety that are Key for their Safety &Available

DomainTimes Domain was

IdentifiedIllustrative Statements Written by Patients

Organization & Care Planning 4

Having well developed and implemented infection control processes to prevent

hospital acquired infections

Patients receive the proper medical treatment

The availability of good medical treatment

Patients receive the proper medical treatment

Communication and Team work 2

Cooperation between staff is available

Overall the medical and nursing teams collaborate together to provide patients

with the proper medical care and a safe environment

Staff Attitude & Behavior 2

Medical and nursing staff provide patients with emotional support due to good

communication with patients

Friendly staff providing chronic patients like myself emotional support to pass

through the hardships of the disease

Physical Environment 1Good room cleanliness

Staff Training1

At the unit, nurses are well aware of patient safety measurements

Correlations Indicator Questions Vs Patient Safety

Variables Odds Ratio P-Value

All information about my care is conveyed and shared between staff and between shifts 39 0

I Was Prepped on Time 32.416 0

There is enough staff to handle the work load 24.514 0

The responsibility of each staff that enters my room is clear to me 24.514 0

I am actively engaged in the planning of my care 24.514 0

I Was Informed of My Imaging Result 18.05 0

Hand sanitizer bottles are available at reach 11.428 0.001

Medical staff provide me with explanation of my clinical tests results 9.264 0.002

I am involved in decision making in relation to treatment 9.264 0.002

Services are provided within an acceptable timeframe 7.59 0.006

• 10 questions under 6 domains were significantly correlated with patients’ perception of safety

• 2 domains did not show significant correlation to patients’ perception of safety within the hospital:

• Information flow

• Equipment (use and design)

• Within the domain “Physical Environment” the only aspect that was significantly correlated with safety was hand hygiene

patients gave clear weight on proper hand hygiene when considering what environment is safe for them.

This is also supported by patients’ responses to the two open ended questions

Conclusion

• Patients provided an overall positive feedback on their safety at CMC

• Patients did not weigh and correlate all 8 domains of PMOS questions with their safety

Patients correlated 6 domains with with their safety:

» Communication & teamwork

» Organization & Planning

» Access to Resources

» Physical Environment

» Staff Roles & Responsibilities

» Delays

• 2 additional domains were identified, but were not part of the 8 key domains:

» Staff Attitude & behavior

» Scheduling & Bed Management

“nurses perform their tasks like robots, they need to show more care”

“gap in bed management from admission to the ER department to the unit”

Where Do We Go from here?

• This pilot study is a stepping-stone to conduct a hospital-wide measurement of patient safety at CMC using PMOS

• The overall hospital-wide study shall be conducted using an updated PMOS questionnaire which shall include the following changes:

• Add questions for 2 new domains (Staff attitude and Bed management)

• Remove questions that showed no correlation with patients’ perception of safety, instead the questionnaire shall be shortened to include significant questions