Sallie Weaver, PhD Kristina Weeks, MSH, DrPH (c) Nasir Ismail, MS, PhD(c )

1. Re-measuring Safety Culture: The Follow-up HSOPS Survey Sallie Weaver, PhD Kristina Weeks, MSH, DrPH (c) Nasir Ismail, MS, PhD(c) ARMSTRONG INSTITUTE FOR PATIENT SAFETY AND QUALITY

2. Polling Question #1 What is your current role? • Surgeon • Quality improvement practitioner • Infection preventionist • OR nurse • OR technician • Anesthesiologist • OR manager • Other

3. Polling Question #2 Have you presented the HSOPS results to your unit staff/management? • Yes • No

4. Learning Objectives • Describe the value of HSOPS data • List steps to complete the HSOPS survey • Increase HSOPS response rate • Download and debrief HSOPS report

5. Can my hospital still take the survey if we have not completed a baseline survey? YES

6. When will the follow-up HSOPS survey be available for Cohort 1 and Cohort 2 teams? Survey period opens: July 1st, 2014 12noonEDT Survey period closes: September 3rd, 2014 5pmEDT

7. Today’s Agenda • Why should you complete the HSOPS Survey? • How do you complete the HSOPS survey? • How can you increase the response rate? • How do you download the HSOPS final report? • Why should you debrief that report?

8. Why Should You Complete HSOPS Survey? Hospital Survey On Patient Safety Culture (HSOPS) • Measures safety culture within the units of hospital • What does Safety Culture mean? • Perceived priority of safety relative to other goals • Attitudes, beliefs, perceptions, and values related to safety within an organization

9. Core Aspects of Safety Culture1

10. Safety Culture Is Related To Outcomes2,3,4,5,6,7,8 Patientoutcomes • Patient care experience • Infection rates, sepsis • Postoperative hemorrhage • Respiratory failure, accidental puncture / laceration • Treatment errors Clinicianoutcomes • Incident reporting • Burnout and turnover

11. HSOPS Dimensions • Supervisor / manager expectations and actions promoting patient safety • Organizational learning-continuous improvement • Teamwork within unit • Communication openness • Feedback and communication about error • Nonpunitive response to error • Staffing • Hospital management support for patient safety • Teamwork across hospital units • Hospital handoffs and transitions

12. HSOPS Sample Questions

13. HSOPS Sample Questions

14. HSOPS Sample Questions

15. How Do You Complete The HSOPS Survey? OPTION 1 • Collect the email addresses of all clinicians and staff (including physicians) that worked in the unit at least 3 months • Enter email addresses into an Excel spreadsheet • Upload the Excel spreadsheet file into the SUSP online portal https://armstrongresearch.hopkinsmedicine.org/susp.aspx

16. How Do You Complete The HSOPS Survey? OPTION 2 Alternate Method: Work Area ID • Some clinical areas prefer to submit surveys via a central pc located in within the unit • Request a work area id • Set up a workstation in the clinical area • Instruct staff to use the provided link and ID Contact susp@jhmi.edu for more information.

18. HSOPS Response Rate Polling Question #3 What was your response rate on the initial HSOPS survey? • 80-100% • 60-80% • 40-60% • 20-40% • 0-20% • Unit did not complete 1st HSOPS survey What did you do to motivate team members to participate?

19. How Can You Increase The Response Rate? • Set a goal • Make a plan! • Flyers & posters

20. Checking Response Rate & Getting Reports

21. HSOPS Reports

22. HSOPS Reports

23. What is Debriefing? Debrief survey results with all your team members • Debriefing isasemi-structured conversation among frontline clinicians and staff that is usually led by a designated facilitator • Encourages open communication, transparency, and interactive discussion • across all levels of the work area • between disciplines • Engages clinicians and staff in generating and implementing their ideas about how to create an effective safety culture in their work area

24. Making HSOPS Data Meaningful Work units that debrief around safety culture perform better • Data is data. Debriefing turns data into information. • Debriefing accelerates improvement.9 YES NO Units who used semi-structured debriefing of culture survey achieved 10.2% Reduction in Infection Rates Units who did not debrief survey results achieved 2.2% Reduction in Infection Rates

25. Making HSOPS Data Meaningful How do I use the CUSP culture check-up tool? • Share culture results with everyone on the unit during a survey debriefing • Bring together team members from your work area • Follow your debriefing plan • Take notes and recognize recurring themes • Encourage open, honest discussion about making the culture of your work area the best it can be

26. Making HSOPS Data Meaningful How do I use the CUSP culture check-up tool? • Focus on identifying system issues that the group can work on improving together instead of as individuals. • Don’t use it to point fingers at specific individuals • Use the tool to structure meetings and guide conversation. • As a group, complete all steps in this worksheet.

27. Making HSOPS Data Meaningful HSOPS debriefings with CUSP culture check-up tool What is the Purpose of this Tool? • Understand the unit culture • Use teammates’ feedback to predict and avoid barriers • Use feedback to leverage the team’s strengths Who Should Use this Tool? • Safety culture debriefing facilitators • Helps to guide the discussion and record group decisions

28. Steps in CUSP Culture Check-Up Tool • Identifies general strengths and weaknesses of your unit culture • Get specific about behaviors and attitudes that make up those strengths and weaknesses • Select opportunities for growth • Develop a strategy for addressing growth opportunities • Put plan into action • Evaluate results and share progress during SUSP team meetings

29. Culture Check Up Tool • Culture Check Up Tool is a document used by Debriefing Facilitator to guide conversation and improvement planning • Download from the SUSP portal or the AHRQ website • Tip: Download the Culture Check UpTool at • https://armstrongresearch.hopkinsmedicine.org/susp.aspx • www.ahrq.gov/professionals/education/curriculum-tools/cusptoolkit/toolkit/culturecheckup.html

30. Culture Check-up Tool https://armstrongresearch.hopkinsmedicine.org/susp

31. Culture Check up tool

33. Culture Check Up Tool Brainstorming culture discussion items

34. Debriefing Plan Highlights

35. What’s Next? • Plan debriefing strategy to share results with team • Be prepared to listen • Ask for feedback • Ask teammates to help come up with solutions • Gather a small group together and use the “culture debriefing tool” to examine the roots of problem areas and begin to formulate strategies for improvement

36. Where to find the old webinars? The link: https://armstrongresearch.hopkinsmedicine.org/susp

37. Cohort 1 & 2 Project End Date Project End August 31, 2014

38. Activities Still Open for Participation • Affinity group calls • SUSP webpage (webinars, toolkits, etc.) • SUSP data portal • HSOPS reports • SSI reports • Medconcert • SUSP help desk (SUSP@jhmi.edu)

39. What Now? Does your hospital want to continue using the data portal to track your SSI data? Or rather, do you want Sept 2014- Aug 2015 SSI data to be entered into portal? If yes, contact your CE to confirm data will continue to be uploaded routinely If no, your CE will complete one final upload in February 2015 to complete the 2 years of project data Review the data manual on how to create SSI reports in NHSN and NSQIP SUSP generating reports using the SSI data registry

40. Want To Continue Beyond August 2014? Does your hospital want to stay involved in SUSP activities (cohorts 3, 4 & 5 project calls, affinity groups, etc.) ? If yes, contact your CE and let them know your plans to continue your participation and which ones.

41. Thank you for your willingness to participate and learn together on how to prevent surgical site infections.The journey continues…..

42. References • Schein E. Organizational culture and leadership, 4th edition. San Francisco, CA: Jossey-Bass. 2010. • Huang DT, Clermont G, Kong L, Weissfeld LA, Sexton JB, Rowan KM, Angus DC. Intensive care unit safety culture and outcomes: a US multicenter study. Int J Qual Health Care. 2010 Jun;22(3):151-61. • MacDavitt K, Chou SS, Stone PW. Organizational climate and health care outcomes. JtComm J Qual Patient Saf. 2007 Nov;33(11 Suppl):45-56. • Mardon RE, Khanna K, Sorra J, Dyer N, Famolaro T. Exploring relationships between hospital patient safety culture and adverse events. J Patient Saf. 2010 Dec;6(4):226-32. • Singer SJ, Falwell A, Gaba DM, Meterko M, Rosen A, Hartmann CW, Baker L. Identifying organizational cultures that promote patient safety. Health Care Manage Rev. 2009 Oct-Dec;34(4):300-11. • Sorra J, Khanna K, Dyer N, Mardon R, Famolaro T. Exploring Relationships Between Patient Safety Culture and Patients' Assessments of Hospital Care. J Patient Saf. 2012 Jul 10. [Epub ahead of print]. • Sorra JS, Nieva VF. Hospital Survey on Patient Safety Culture. (Prepared by Westat, under Contract No. 290-96-0004). AHRQ Publication No. 04-0041. Rockville, MD: Agency for Healthcare Research and Quality. September 2004. • Weaver SJ. A configural approach to patient safety climate: The relationship between climate profile characteristics and patient safety. Doctoral dissertation. University of Central Florida. 2011. • VigoritoMC, McNicoll L, Adams L, Sexton B. Improving safety culture results in Rhode Island ICUs: lessons learned from the development of action-oriented plans. JtComm J Qual Patient Saf. 2011 Nov;37(11):509-14.