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What is Patient Safety Culture?

By Tina Scott, System Director of Clinical Performance
      Emily Burdin, System Director of Patient Safety
Safety culture is the attitude, beliefs, perceptions and values that employees share in relation to safety in the workplace. Safety culture is a part of organizational culture, and has been paraphrased as, “the way we do things around here.” Individual organizations, and even departments within organizations, develop their own culture over time. Employee culture drives our behavior, but surprisingly, is often overlooked as we develop strategies for performance improvement. In our journey to high reliability, it is so important that EMHS is mindful of our various cultures when developing these strategies.
All EMHS member hospitals participated in the Agency for Healthcare Research and Quality (AHRQ) Hospital Survey on Patient Safety Culture in 2016. For the first time, EMHS has a complete, systemwide baseline of information regarding about how our staff perceive patient safety. Side-Bar-(4).JPG

Once all the surveys were completed, the results were analyzed at the system, member, and individual department or unit level. In February and March, the EMHS Office of Patient Safety shared the survey results with each organization. These debriefs, as they were called, were targeted toward executive leadership, and frontline managers and directors. The purpose of these debriefs was to share the results, discuss the drivers of change and any key themes, and talk about the use of data for safety improvement. The EMHS Office of Patient Safety also cross walked the survey data to other data sets that organizations rely on to identify other areas of opportunity.
Across the system, there were a number of common themes that arose from the survey data. Engagement in survey participation was variable across the system. Second, our employees’ perceptions of patient safety culture trail the national averages. Third, there were a number of systemwide opportunities that were identified, including handoffs and transitions, teamwork across units, and management support for patient safety. Finally, there was a significant gap in perception between leaders and frontline staff.
While there have been identified opportunities for improvement, it is important to dive in to each component to understand the questions that make up the composite to truly understand where the opportunities are. The following themes make up the composites referenced above:
Handoffs and transitions:

  • Things “fall between the cracks” when transferring patients from one unit to another.
  • Important patient care information is often lost during shift changes.
  • Problems often occur in the exchange of information across hospital units.
  • Shift changes are problematic for patients in this hospital.
 Teamwork across units:
  • There is good cooperation among hospital units that need to work together.
  • Hospital units work well together to provide the best care for patients.
  • Hospital units do not coordinate well with each other.
  • It is often unpleasant to work with staff from other hospital units.
Management support for patient safety:
  • Hospital management provides a work climate that promotes patient safety.
  • The actions of hospital management show that patient safety is a top priority.
  • Hospital management seems interested in patient safety only after an adverse event happens.

In an effort to better understand culture of patient safety data and to ultimately connect it to other EMHS data sets and initiatives, a crosswalk of data was completed at the facility and department/unit levels. The literature shows that there are many correlations between various measures of patient safety culture, quality, and patient satisfaction. The survey data was compared to Partnership for Patients patient harm data, employee engagement data, patient experience hospital data, and to the five principles and stages of maturity in high reliability organizations. With a clearer picture of their priorities, member organizations next developed action plans or incorporated patient safety culture composites into existing action plans. Understanding how interconnect our work is key for safety improvements.
Tyson Thornton, PharmD, MBA, BCPS, and senior director of therapeutic and support services at Sebasticook Valley Health (SVH) shares his experience about how this team approach to resolving issues of patient safety results in real, sustainable change:
In January, a multidisciplinary team of frontline staff and leaders at SVH met to find a way to reduce readmissions for patients with ambulatory care sensitive conditions, conditions that can be prevented and managed outside of the hospital. After considerable work, we identified the largest areas of opportunity and two key issues surfaced: we needed to standardize staff education around care treatment and address polypharmacy, an issue in which patients are prescribed multiple drugs to treat a single ailment or condition. 

As a result of this exercise, two work teams have convened to begin standardizing education of congestive heart failure and chronic obstructive pulmonary disease treatment across all care locations. We also developed hard-wired mechanisms to refer polypharmacy patients, in all care settings, to the inpatient pharmacist staff as well as to pharmacy resources, which are currently embedded in all SVH primary care locations. 

The Patient Safety and Clinical Performance System Team is partnering with other system Leadership 2020 groups to lead the efforts around patient safety event reporting. The system team’s goal is to increase event/error reporting and use that data to learn and prevent any future patient harm. There are a number of strategies in place to meet this goal, including defining close calls and near misses, identifying methods for reporting events by unit and utilizing meaningful reports to learn and improve, and support the development and education of a root cause analysis squared (RCA2) and tracer education programs. Future Pathways articles will present our member organizations successful actions using the Culture of Patient Safety Data and event reporting data at the individual department/unit level to identify, trend, and prioritize areas of opportunity to prevent harm to our patients. Additionally, we will share how our members use RCA2 and tracers to improve systems and processes that could potentially lead to patient harm.
About the authors:
Tina Scott is the system director of clinical performance and lead system coordinator for the Partnership for Patients (PfP) engagement. Emily Burdin is the system director of patient safety and data coordinator for PfP HEN 2.0 engagement.