Shatin Cheshire Home (SCH)

SAQ taskforce

¨  To   establish   a   baseline   understanding   of   the   safety  culture   in   Sha5n   Cheshire   Home(SCH)   by   using  Chinese  version  of  Safety  A=tude  Ques5onnaire   (C-­‐SAQ)  

 ¨  Iden5fy  areas  for   improvement  and  raise  awareness  about  pa5ent  safety  in  SCH.  

¨  As   a   measurable   outcome   indicator/   internal  benchmarking   to   evaluate   pa5ent   safety  interven5ons   or   programs   and   track   change   over  5me  

 Objec've  

Safety  A/tude  Ques'onnaire(  Chi-­‐SAQ)

Validated

into C-SAQ at 2008

John  Bryan  Sexton  PhD,  MA  Director  of  the  Duke  Pa5ent  Safety  Center  Associate  Profession,  Duke  University  Medical  Center  Department  of  Psychiatry  and  Behavioral  Science  

 

Thomas  et  al.  2003)

Dr    Wui  Chiang,  Lee  Director,    General  of  the  Bureau  of  Medical  Affairs,  Department  of  Health,  Taiwan.  President,  Asian  Society  for  Quality  in  Health  care.  Director  of  Taiwan  Joint  Commission  on  Hospital  Accredita5on  (TJCHA),  

-­‐Total   three  phases  of  C-­‐SAQ  will   be   carried  out   from  2014   to  2016      (First  phase  of   SAQ  collec5on   completed  at  March  2014,   second  phase  of   SAQ   just  completed  in  April  2015)    -­‐A   long   collec'on   period(   two   weeks   )   in   each   phase   to  maximize  response  rate.    -­‐All   Staff   (Doctors,   nurses,   allied   health   professionals,  administra5ve   and   suppor5ng   staff   )are   anonymous   and    invited  to  par5cipate  in  the  survey  on  a  voluntary  basis.    -­‐Evaluate   survey   result   and   implement   improvement   program  to  rec'fy  and  focus  on  related  safety  measure.    

Measure  5  specific  SAQ  dimensions:  §  Teamwork  Climate  §  Safety  Climate  §  Job  Sa5sfac5on  §  Percep5on  of  Management  §  Working  Condi5ons  Safety  behavior  items  

*Total  42  sub-­‐items  +  demographic  informa:on  +  staff  feedbacks  

Each   item   was   scored   by   conver5ng   the   5-­‐point  Likert   scale   (1=strongly   disagree;   5=strongly   agree)   to   a   100-­‐point  scale:  Ø  1=0,          2=25,          3=50,          4=75,          5=100  

 Higher   scale   scores   indicate  more   posi5ve   a=tudes  towards   the   par5cular   safety   domain.   If   a  respondent’s  mean  score  of  each  item  or  dimension  was  75  or  higher,  he  or  she  was  reported  to  hold  a  posi've  a/tude  to  a  given  item  or  dimension.

•  Baseline  mean  score  of  each  safety  dimension  will  be  established  to    compare  differences  between  groups  

•  Mul5ple   logis5c   regression   to   clarify   the   causal  rela5onship   between   safety   culture   changes   and  clinical  outcomes  in  our  hospital  

•  Confounding   factors   will   be   adjusted   to   obtain   the  final  unbiased  es5ma5on  of  the  output  model  

 •  Staff  feedback  will  be  summarized  for  follow  up      

Overall  response  rate  87.17%  (2014)

Characteris'cs  of    safety  a/tude  survey  

respondents

Baseline  Safety  Dimension  Mean  Score  (2014)  

67.4±18.9 64.1±13.1 68.7±19.8 65.7±17.5 62.9±18.9

0.0

25.0

50.0

75.0

100.0

Teamwork climate

Safety climate Job satisfaction

Mangement perception

Working condition

2014

Percep'on  of  hospital  safety  culture  between  different  job  discipline  groups  

Doctors   Nurses   Allied  Health  professionals  

Suppor'ng  staff  

Administra-­‐'on  staff  

Catering  staff  

*Teamwork   87.5   59.7   71.3   71.9   69.7   80.7  

Safety  climate   81.3   63.4   63.4   63.0   66.0   71.6  

*Job  sa5sfac5on  

95.0   64.4   71.5   69.6   67.7   86.4  

Percep5on  of  Management  

85.0   61.3   71.0   67.7   70.2   71.9  

Working  condi5on  

81.3   59.4   68.3   63.5   63.4   74.6  

*Shows  significant  different  amongst  groups  through  ANOVA  test,  p<  0.05  

SAQ  dimension   Lowest  mean  sub-­‐item  score     Highest  mean  sub-­‐item  score  

Teamwork  Climate   Nurse  input  is  well  received  in  this  clinical  area  (59.7  ±  22.5)  

It  is  easy  for  personnel  here  to  ask  ques5ons  when  there  is  something  that  they  do  not  understand  (73.8±24.4)  

Safety  Climate   In  this  clinical  area,  it  is  difficult  to  discuss  errors  (43.2±26.1)  

I  would  feel  safe  being  treated  here  as  a  pa5ent  (76.6±22.8)  

Job  Sa'sfac'on   Moral  in  this  clinical  area  is  high  (58.2±23.6)  

I  like  my  job  (75.9±23)  

Management  Percep'on  

The  hospital  management  supports  my  daily  efforts  (58.7±23)  

The  unit  management  doesn’t  knowingly  compromise  pa5ent  safety(77.6±26.8)  

Working  condi'on   The  levels  of  staffing  in  this  clinical  area  are  sufficient  to  handle  the  number  of  pa5ents  (50.2±28.3)  

Trainees  in  my  discipline  are  adequately  supervised(68.2±21.2)  

Safety  behavior     Service  delay  by  communica5on  breakdowns(49.3±25.6)  

Encouraging  safety  repor5ng  (76.6±24)  

Mul'ple  logis'c  regression:  

There   is   very   strong   associa'on   between   management  percep'on  and  staff  collabora'on    ¨  posi5ve   a=tude   in   management   percep5on   vs   good  

collabora5on  with  nurse,  OR  =  3.95  ¨  posi5ve   a=tude   in   management   percep5on   vs   good  

collabora5on  with  administra5on  staff,  OR  =  9.22    There   is   also   strong   associa'on   between   management  percep'on  and  scope  of  pa'ent  safety    ¨  posi5ve   a=tude   in   management   percep5on   vs   priori5zing  

safety  training,  OR  =  2.93  ¨  posi5ve   a=tude   in  management   percep5on   vs   encouraging  

safety  repor5ng,  OR  =  3.00  

 

Four  main  concerns  from  staff  perspec've:    1.  Insufficient  manpower  /resources  support  2.  Safety  training  and  level  of  supervision  3.  Collabora5on,  Communica5on  ,mutual  trust  4.  Procedure  /Policy  review  

C-SAQ HCE walk round/ Q

& S round/ forum/

interviews

ü  26  feedback/  sugges5ons  from  2014  C-­‐SAQ    ü  30   feedback/sugges5ons/proposals   from  

HCE   walk   round,   Q   &   S   round/   forum/  interviews  etc.,  

Improvement  Ac'vi'es  for    safety  culture  in  SCH

¨  Enhance  staffing  /  resources  support  from  management  ¨  Enhance   daily   safety   prac5ce   ,   expand   communica5on  spectrum    

¨  Promulga5on  game  booth  for  safety  culture  “  Building  a  safety  Culture”  for  beqer  staff  engagement.  

¨  SCH  safety  newsleqer  (  quarterly,  start  from  early  2015)  to  increase  staff  awareness  in  safety  aspect.  

Remarks:  2nd  and  3rd    distribu'on  of  SAQ  are  pending  on  2Q  2015  &  2Q  2016  for  evalua'on  of  staff  safety  a/tude.

Enhance  procedure/  policy  safety  measures(  Infec5ous  Control/  Environmental/  Equipment)  

•   Grouping  of  infec5ous  cases  in  designated  ward    •   Implementa5on  of  color  coding  cleansing  system  

•   Infec5ous  control  educa5on  to  staff  and  carer  

•  Environmental  improvement  work:  add  mosquito  light  in            outdoor  area  

•  Improved  ven5la5on  system  of  kitchen  and  ward  area        •  Enhanced  and  renewed  ceiling  hoist  system  to  relief            staff  workload  

Safety  Training  /Communica'on/  

supervision  enhancement  :      

In-­‐service  training  and  briefing  session  by  supervisor   On-­‐site  safety  training  

“Building  a  Safety  Culture”                          game  booth(5  Dec  2014)  

                       “共建安全文化”攤位遊戲

Communica'on/  Staff  engagement  in  safety  culture  promulga'on  ac'vity  

Staff  Suppor've/  Engagement  Ac'vi'es  The Critical Incident Support Team (CIST) introduced their service on 5 Nov 2014.

Local  safety  newsleger  for  all  staff  

事故發生!!!點算好!"

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!唔想!

報�都�用

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篤背脊? 小事化大

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己助人

及早改善, 重安全!

避免事故重演, 減少傷害

互助互諒 重安全

安全挑戰站: 事故報告系統中”AIRS”的中文全名是甚麼? 答案:______________________ 部門/姓名:_________________ 請剪下 線並於3月31日前交往總務部胡小姐收, 首50名參加者有機會得到小禮物一

, 先到先得.

編輯顧問"!陳秀霞女士!編輯小組"!沙田慈氏質素及安全部張靜宜女士#!

!!!!!!!麥婉 姑娘#! 筱儀姑娘!

二零一五年!第一期季刊!

自 瘡 ~.~

共建安全 文化

影響前途$!

Launch of SCH safety newsletter

NEW!!  

Staff  Communica'on  Channels  Chief   Execu5ve   and  HA   Board   Members’  Visit  on  16  May  2014.  

HCE  forum  

Q  &  S  forum  

CQI  program  for  enhancement  of  clinical  safety  and  handover  

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Conclusion  u  The  SAQ’s  survey  raised  awareness  of  safety  culture   in  SCH.     It  

serves   as   a   communica'on   plajorm   that   focus   aqen5on   on  culture  priori5es   and  establish   a   common  vocabulary   and   set   of  goals  to  rally  behind.      

u  The   collec'on   of   quan'ta've   culture   data   supplemented   with  qualita've   informa'on   such   as   staff   feedback,   interview,   focus  group   could   reflect   a   holis5c   picture   of   organiza5on   safety  culture.   They   should   be   regarded   as   key   informa5on   in   the  development  of  safety  ac5on  plan.  

 u  SAQ  cultural   assessment   in   itself   could  be   regarded  as  a  pa'ent  

safety   interven'on   and   part   of   an   organiza'onal   learning   and  con'nuous  improvement  process  

The  way  ahead……..  

¨  The   2nd   and   3rd   phases   of   SAQ   data   collec5on,   analysis   and    evalua5on   will   be   held   at   2015   and   2016   respec5vely.   We  expected  that  this  longitudinal  studies  may  help  evalua5on  of  the  effects  of  safety  ac5vi5es  over  5me.  

¨  In  future,  safety  culture  assessment  may  combine  with  other  clinical  outcomes  such  as  adverse  event,  pa5ent  sa5sfac5on;  in  making  decisions  about  ways  to  improve  staff  and  pa5ent  safety.    

¨  Establish   an   internal   safety   culture   benchmark   and   explore  the  possibility  of  external  benchmarking  to  other  hospitals    

Acknowledgments:  Dr   Wui-­‐Chiang   Lee   is   appreciated   for   allowing   the  adop5on   of   Chinese   version   of   SAQ.     (M.D;   Ph.D.,   M.H.S.   Director  General   of   the   Bureau   of  Medical   Affairs,   Department   of   Health,   R.O.C.   Tai  wan;  President,  Asian  Society  for  Quality  in  Healthcare;  Director,  Taiwan  Joint  Commission  on  Hospital  Accredita5on)  

 

Dr  Herman  Lau  ,  HCE,  Sha5n  Cheshire  Home,  for  his  leading  and  support  of  the  study.    

All   Sha'n   Cheshire   Home   staff   for   their   ac5ve  par5cipa5on  in  promo5ng  safety  culture  

   

References:  

1)  Chaboyer,  W,  Chamberlain  Di,  et  al:  Safety  Culture  in  Australian  Intensive  Care  Units:  Establishing   a   Baseline   for   Quality   Improvement.   American   Journal   of   Cri5cal   Care  2013,  Vol  22(2)  P93-­‐103  

2)  Lee  WC,  Chen  SF,  Cheng  YC,  Huang  TP,  Lee  CH,  Lee  SD:  Valida'on  Study  of  the  Chinese  safety   a/tude  ques'onnaire   in   Taiwan   (in   Chinese).     Taiwan   J   Public  Health   2008,  27:6-­‐15.  

3)  Lee  WC,  Wung  HY,  Liao  HH,  Lo  CM,  Chang  FL,  Wang  PC,  Fan  A,  Chen  HH,  Yang  HC,  Hou  SM.    Hospital  Safety  Culture   in  Taiwan:    A  na'onwide  survey  using  chinese  version  safety  a/tude  ques'onnaire.    BMC  Health  Services  Research  2010,  10:  234.  

4)  Nieva  VF,  Sorra   J:  Safety  culture  assessment   :  a   tool   for   improving  pa'ent  safety   in  healthcare  organiza'ons.    Quality  Safety  Health  Care  2003,  12  (Suppl  II)  :  17-­‐23.  

5)  Sexton  JB,  Helmreich  RL,  Neilands  TB,  Rowan  K,  Vella  K,  Boyden  J,  Roberts  PR,  Thomas  EJ   :   The   Safety   A/tudes   Ques'onnaire:   psychometric   proper'es,   benchmarking  data,  and  emerging  research.    BMC  Health  Services  Research  2006,  6:44.  

6)  Sexton,  JB,  Thomas,  EJ,  Helmreich,  RL.    Error,  stress,  and  teamwork  in  medicine  and  avia'on:  Cross  sec'onal  surveys.    BMJ.  2000,  Vol320,  745-­‐749.  

7)  Thomas,   EJ,   Sexton,   JB,   Helmreich   RL.  Discrepant   a/tudes   about   teamwork   among  cri'cal  care  nurses  and  physicians.    Cri5cal  Care  Medicine.  2003,  Vol  31  (3),  956-­‐959.  

SAQ taskforce: Dr. Herman Lau (SAQ taskforce leader)

Miss Susanna Chan(GMN-SCH, SAQ taskforce advisor) Miss Lydia Wong (SCH-PTI, Principle Investigator)

Miss Kitty Mak (SCH-DM member) Mr Allan Fu (member)

Mr David Wong (RA, Statistical support)