To achieve better results for surgical patients, healthcare facilities tend to focus on technical issues such as surgeons’ skills and OR equipment. However, a non-technical factor, the so-called “safety culture,” might be equally important in delivering high-quality patient care, investigators report in a study published online in the Journal of the American College of Surgeons in advance of print publication.
“The non-technical skills of care coordination, teamwork, and ownership over the delivery of care are measured as safety culture,” said lead study author Martin Makary, MD, MPH, FACS, professor of surgery and health policy & management at Johns Hopkins University School of Medicine, Baltimore. “Anybody who cares for patients knows that a hospital’s culture contributes to a patient’s outcome, and this study affirmed that observation.”
The study is one of the first to evaluate the impact of an organization’s teamwork and safety culture on patient outcomes. Makary defined safety culture as “the organizational characteristics of delivering great care” and the attitude of “how we do things around here.” He added, “It’s a compilation of burnout, perceptions of management, the connectedness of care, and staff’s willingness to speak up when they have a concern.”
The study results measured 12 safety culture factors that influenced rates of a specific complication, surgical site infection (SSI) after colon procedures, at seven Minnesota hospitals. SSI rates after surgery at the hospitals ranged from 0-30%, with an average rate of 11.3%, and surgical unit safety culture scores ranged from 16-92 on a percent-positive scale.
Researchers used a cross-sectional sample from the Minnesota Hospital Association to combine safety culture survey data with SSIs after colon operations during 2013. The hospitals were surveyed using the Hospital Survey on Patient Safety Culture, from the Agency for Healthcare Research and Quality. Of the 12 safety culture factors measured, 10 were found to influence the rates of SSI after colon operations:
- overall perceptions of patient safety;
- teamwork across units;
- organizational learning;
- feedback and communication about error;
- management support for patient safety;
- teamwork within units;
- communication openness;
- supervisor/manager expectations of actions promoting safety;
- non-punitive response to error;
- frequency of events reported.
The safety factors not associated with infection rates were handoffs and transitions, as well as staffing.
Feedback and communication after errors (the learning hospital response) had the widest variation among surveyed hospitals, ranging from 21-79% positive, while the smallest variation was in scores for teamwork across units, with a range from 24-49% positive.
The study illustrated the significance of three characteristics of good safety culture, Makary said: an ability and willingness to learn from past mistakes, a high degree of interest in adopting best practices, and an ability to collaborate to benchmark performance.
“The study supports what many surgeons have known for a long time, and that is that the organizational culture matters,” Makary said. “While we have traditionally only studied the incremental patient benefits of different medications and surgical interventions, it turns out that organizational culture has a big impact on patient outcomes.”
One notable study limitation was that the researchers only investigated one type of surgical outcome. “There are hundreds of outcome variables that can be measured with a safety culture,” Makary said. (Access the abstract at http://bit.ly/221zNB2.)
Voluntary data collected on patients’ experiences
Beginning in January 2016, the Centers for Medicare and Medicaid Services (CMS) started voluntary monthly data collection using the Outpatient and Ambulatory Surgery Patient Experience of Care Survey (OAS CAHPS).
The OAS CAHPS survey was developed by the Agency for Healthcare Research and Quality. It includes 37 questions that assess patient experience measures for hospital-based outpatient departments (HOPDs) and freestanding ASCs, as well as patient-reported health outcomes.
The survey measures patients’ experiences on important topics when choosing a facility, such as communication and care provided by providers and office staff, preparation for the surgery or procedure, and post-surgical care coordination.
All HOPDs and ASCs are welcome to participate in the Voluntary National Reporting Program. Approved survey vendors, including Press Ganey, will conduct the survey on behalf of HOPDs and ASCs. Data will be submitted to CMS’s contractor RTI and posted for participating HOPDs and ASCs to preview before the data are publicly reported. (For more information, go to http://go.cms.gov/1XotIcW or email AmbSurgSurvey@cms.hhs.gov.)