For many Indiana hospitals, patient safety remains a top priority year after year. However, creating a hospital culture conducive to maximizing patient safety takes time, effort and consistent monitoring. For many Indiana hospitals, the first step to creating cultural shifts in regard to patient safety begins with a simple survey.
Since 2007, IHA has offered the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Culture Survey free to all IHA members. Administered through Survey Monkey, IHA collects the responses and analyzes each organization’s culture as it relates to patient safety.
Survey participants are asked questions regarding their specific work area, the frequency of reported “events” (any type of error, accident, etc., regardless of whether it results in patient harm) and organization-wide communications following events. Ultimately, the AHRQ survey enables hospital leaders to gain insight into the perceptions of employees and physicians related to the culture of patient safety within each hospital.
Currently, 50 Indiana hospitals conduct the survey each year. In 2015, two hospitals experienced above average participation rates: Indiana University Health Blackford Hospital in Hartford City (100 percent) and St. Mary Medical Center in Hobart (89 percent).
While their institutions couldn’t be any more different (Blackford is a 15-bed, 55,000-square-foot campus serving the local community; and St. Mary Medical Center is a 195-bed operation with more than 500 physicians on staff ), there was plenty of overlap between their strategies—and their outcomes.
“Our high response rate really boiled down to full-fledged support from administration, our management teams, as well as multi-channeled communication,” says Lisa Leckrone, director of quality and risk management for St. Mary Medical Center.
Lisa and her team developed a plan with the quality staff and nursing quality teams and presented it to their CEO and CNO, who fully supported the initiative and established a goal of a hospital-wide, 75 percent response rate. If the goal was met, the administration would hold a celebration.
Similarly, IU Health Blackford CEO Steven West was involved early in the process. “He wanted to know everyone’s perceptions, from housekeepers to dietitians to the clinical staff,” says Robin Cook, performance improvement coordinator at IU Health Blackford. “That way, if a housekeeper walks by a room and sees a patient get up that shouldn’t get up, they know to wait with that patient until a nurse can assist.”
Lisa and her team at St. Mary communicated their plan and the administration’s response rate goals at monthly management team meetings. At these gatherings, they also provided management teams with the tools they needed to make participation easy—and enticing—for their employees.
One such tool was a Culture of Patient Safety Survey packet, which contained a list of each manager’s employees, as well as raffle tickets and candy bars. “When an employee completed the survey, they received a treat and a raffle ticket for a drawing of a gift card,” Leckrone says. “We also communicated updates of our response rate three days a week, along with the names of weekly raffle winners.”
“Easy access to the survey was key,” says Leckrone. Her team set up computer terminals in the cafeteria where hospital personnel who didn’t use computers as part of their daily job function could easily take the survey. In addition, they placed the survey link on the facility Intranet home page and embedded the link in hospital-wide email communications. Finally, their team hung Uncle Sam-themed “We Want You…to Support Patient Safety” posters throughout the facility to help raise awareness.
While Robin Cook and her team at Blackford utilized email and posters to get the word out, because of the size of their hospital, leaders were able to walk around and speak with everyone about the initiative. “We didn’t want employees to view it as another chore to be done,” Cook says. “It’s more of a privilege; we’re inviting you to tell us what’s going on, and we value your input.”
Both IU Health Blackford and St. Mary Medical Center were able to use the survey findings to inform the creation of new initiatives.
“Although we scored positively in many areas, one area that we found we needed to improve was communication openness about patient safety,” Cook notes. “Even though we’re small, we still don’t reach everyone all the time. So we’ve been intentional about figuring out more effective ways to communicate with everyone.”
St. Mary created a Culture of Patient Safety Task Force to address two key areas fundamental to patient safety: effective communication and cooperation among hospital units working together, and improving handoffs and transitions when transferring patients from one unit to another.
“Raffles and candy bars are great incentives, but at the core of almost every employee in health care—both clinical and non-clinical—is the desire to help or improve the lives of others,” Leckrone says. “We respected that by reporting the survey results and creating action plans based on those results.”
Their diligence in promoting the Culture of Patient Safety Survey has enabled IU Health Blackford and St. Mary Medical Center to take the two most important—and oftentimes most difficult—steps to shifting their culture: creating institution-wide awareness and participation. One day, their patients will surely thank them.