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Database compares safety culture survey results
Share lessons learned and effective interventions
Currently, 382 hospitals have submitted data to the Agency for Healthcare Research and Quality (AHRQ)'s Hospital Survey on Patient Safety Culture's comparative database. This new database serves as a central repository for data so hospitals can compare their safety culture survey results, and includes data from all participating hospitals, with 108,621 individual respondents.
Previously, hospitals were able to compare their results only against preliminary benchmarks based on data from 20 hospitals that participated in a pilot test of the survey in 2003. (These preliminary benchmarks are available at www.ahrq.gov/qual/hospculture/prebenchmk.htm.)
Organizations may find it helpful to look at trends impacting other institutions, says James B. Battles, PhD, senior service fellow for patient safety at AHRQ. "It gives them a look at other hospitals, broken down by region," he says. "Or organizations that have carefully analyzed their results can serve as their own benchmark, and start developing programs to target areas where they have weaknesses." AHRQ has developed several tools designed to help institutions address problems identified by the culture survey, such as poor teamwork and communication. AHRQ and the Department of Defense have just released a comprehensive team work improvement initiative called TeamSTEPPS.
Battles says "it is based in part on the airline industry, with methodologies to improve patient care and safety in high-stress situations like ORs and emergency departments," says Battles.
Quality professionals will find it useful to compare themselves against other hospitals, says Joann Sorra, PhD, of the Rockville, MD-based Westat, a research organization that developed and pilot tested the AHRQ's survey tool. "While it is useful for hospitals to examine their own data to identify areas for improvement, it is also helpful to know what areas other hospitals are struggling with," she says.
The database report provides averages, standard deviations, and percentiles on the survey items and composites. It also provides averages broken down by bed size, teaching status, geographical region, hospital work area, staff position, and several other variables.
The overall goal is for hospitals to identify areas for improvement in their patient safety culture, says Sorra. Hospitals can examine their own data as well as compare against other hospitals when trying to identify these areas of focus.
"As hospitals begin to address these areas, they can share lessons learned, interventions, and strategies with one another to share what has worked," she says.
Surge of momentum
A number of recent initiatives have mirrored the goals of the AHRQ's patient safety culture survey, including the Patient Safety Improvement Act of 2005. "There are provisions in that act designed to deal with the issues that are showing up in the culture survey," says Battles. "It reinforces why that legislation is necessary. We badly needed it and it is finally here."
In light of this new legislation, hospitals should carefully review their human resources policies and procedures regarding incident reporting, advises Battles. "There may be HR rules and policies in place that tend to be very punitive, and if hospitals are not careful they could find themselves in trouble," he says.
In the National Quality Forum's report "Safe Practices for Better Healthcare — 2006 Update," the use of a patient safety culture instrument is recommended. "Everybody is talking about creating a culture of safety in health care, and the patient safety culture survey is a way to measure our progress in getting there," says Battles. "We have an instrument in the public domain that is valid and reliable and we want people to use it. Now this new database allows institutions to see where they may stand in relationship to that."
The benchmark data will allow Denver-based Catholic Health Initiatives to compare similar size facilities with their peers, says Jeff Norton, director of clinical services.
"The data is going to be extremely useful and we are anxiously awaiting it," he says. "The availability of this data is part of what's making the AHRQ culture of safety survey the industry gold standard."
The analysis tools and benchmarking data are transparent and available to everyone, which makes conducting the survey and analyzing the results easier. "Subsequently, we can spend more time making changes to improve safety for our patients and that's what this is all really about," says Norton. "At the end of the day, a good hospital stay is to go home healthy. That's what we want for every one of our patients and the AHRQ safety survey and the benchmarking data are helping to make that happen." To share results with senior leaders, the organization will publish a system-level report with the benchmark data.
However, some quality professionals question whether they will be able to get truly valid comparisons. "I have not placed a lot of value on comparative external data," says Barbara Horne, RN, vice president and chief nursing officer at Indian River Memorial Hospital in Vero Beach, FL. "It is difficult to determine the validity of the comparisons. To me, the more valuable comparison for us is comparing our scores year to year."
When comparing your hospital's results against results from the database, it is important to keep in mind that the database only provides relative comparisons, says Sorra. "Even though your hospital's survey results may be better than the database statistics, you may still believe there is room for improvement in a particular area within your hospital in an absolute sense," says Sorra.
The database results show that there are some patient safety composites that even the highest-scoring hospitals could improve upon. "Therefore, the comparative data should be used to supplement your hospital's own efforts toward identifying areas of strength, and areas on which to focus patient safety culture improvement efforts," advises Sorra.
Indian River has completed the AHRQ's survey twice, and is going to complete a third survey in fall 2007. By comparing the results to previous surveys, the organization can see if they are making progress in any area or department more than others, says Horne.
"We are now using the safety culture survey results as one of the areas managers must address in their incentive pay program goals, if appropriate based on identified needs," reports Horne. "It will be interesting to see if the focus will result in improvement in problem areas."
As a result of the first safety culture survey, changes have been made to formalize communication during patient handoffs when patients are sent for diagnostic testing, and also between units when patients are transferred to another level of care. "Those changes resulted in some incremental improvements," says Horne.
In the last 18 months, every one of the 70 hospitals in the Catholic Health Initiatives system has completed the AHRQ's survey tool. "It has been an instrumental tool in accelerating our system-wide patient safety activities," says Norton. One of the hospitals in the system, Martin, KY-based Our Lady of the Way Hospital, implemented a revised handoff process as a result of the survey's results. "They were recently surveyed, and The Joint Commission specifically noted that they were doing an excellent job with this," Norton reports.
Several Catholic Health facilities are now in the second round of surveying, having implemented improvements since the first survey. "We know there have been significant changes made to improve safety, and we are looking forward to seeing how this is reflected in the survey results," says Norton.
Staff concerns revealed
The survey results give you an opportunity to show senior leaders the reality of how professional staff truly feel about patient safety. "For those of us who have been working in this area the results are not surprising, but in some cases the results can be quite surprising to management," says Battles. "There is a tendency for senior leaders to overestimate this, and they may need to take a good hard look at this area."
Indian River's second survey revealed that staff were fearful of punitive action being taken when reporting incidents. "There is still a great deal of concern on the part of our staff, which is reflected in the survey results. We are now looking at our incident-reporting system, trying to determine the best approach to taking the fear of punitive actions out of the process," says Horne.
To assuage concerns, staff were offered access to their personnel files in their home departments at the time of their annual performance evaluations, or any other time during the year they might want it. "Some took the opportunity, but most did not," says Horne. "It didn't have any impact on the feeling that there is a threat to job security within the existing incident-reporting system. That strongly implies that staff do not use the system as it was intended."
[For more information, contact:
James B. Battles, PhD, Senior Service Fellow for Patient Safety, Agency for Healthcare Research and Quality, 540 Gaither Road, Rockville, MD 20850. Phone: (301) 427-1332. Fax: (301) 427-1341. E-mail: email@example.com.
Barbara Horne, RN, Vice President and Chief Nursing Office, Indian River Memorial Hospital, 1000 36th Street, Vero Beach, FL 32960. Phone: (772) 567-4311. E-mail: firstname.lastname@example.org.
Jeff Norton, Director, Clinical Services, Catholic Health Initiatives, 1999 Broadway, Suite 2600, Denver, CO 80202. Phone: (859) 221-7550. E-mail: JeffNorton@catholichealth.net.
To access the AHRQ survey on-line, go to www.ahrq.gov/qual/hospculture. Or to order printed copies, call (800) 358-9295 or e-mail AHRQPubs@ahrq.hhs.gov. For questions about the survey, send an e-mail to email@example.com.]