Welcome to the Leadership for Safety Webinar Safety Attitude Questionnaire:

Unit-Level Results on Teamwork and Non-Punitive Response to Error

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Agenda for Today’s Webinar

• Unit-level COS results from San Francisco General Hospital, and UT Tyler

• Unit by unit COS data, resilience, and readiness for change

• Run chart “poster session”

• Next month’s focus: Just Culture – How to know whether to hold an individual to account for a safety mishap.

Who is on Today’s Call?

Leadership Summit staff

Guest speakers on today’s call

Kimberly Horton, DHA, MSN, FNP, RN, FACHE

San Francisco General Hospital and Trauma Center

Regional Medical Center at Memphis

Cook County Health & Hospitals System John H. Stroger, Jr. Hospital

Truman Medical Centers TMC- Hospital Hill TMC- Lakewood

Los Angeles County Department of Health Services

Harbor-UCLA Med CenterLAC+USC Healthcare NetworkRancho Los Amigos National Rehab. Center

Maricopa Medical Center

Univ. Medical Center of El Paso

UT-Health Science Center at Tyler

LSU-HCSD Interim Bogalusa

Contra Costa Regional Med. Center

Santa Clara Valley Health and Hospital System

Harris County Health System Ben Taub GeneralLBJ Hospital Quentin Mease

St. Luke’s Regional Medical Center

MetroHealth

Alameda County Medical Center

San Mateo Medical Center

St. Luke’s Meridian Medical Center

St. Luke’s Treasure Valley

Provident Hospital

Jim Reinertsen, MD

Jill Steinbruegge, MD, PhD

Bianca Perez, PhD

Arielle Gorstein

David Coultas, MD, FACP

Bart Hill, MD, MPA

Sue Currin, MS, RN

Alfred Connors, MD

Thomas Holton, MS, RN

University of Texas – TylerComparative Results By Unit

Teamwork Across Units  Unit 1 2012 Unit 1 2010 Difference

Unit 2 2012

Unit 2 2010 Difference Unit 3 2012 Unit 3 2010 Difference Unit 4 2012 Unit 4 2010 Difference Unit 5 2012 Unit 5 2010 Difference

1. Hospital units do not coordinate well with each other.

Database36 36   43 39 44 43   48 46   41 39  

Your Hospital 33 45 -12 33 55 -22 35 14 21 100 60 40 75 65 10

2. There is good cooperation among hospital units that need to work together.

Database48 46   57 53   58 56   63 60   55 54  

Your Hospital 33 55 -22 56 64 -8 50 43 7 80 80 0 75 52 23

3. It is often unpleasant to work with staff from other hospital units.

Database 50 49   63 62   61 60   64 64   56 55  Your

Hospital 58 45 13 75 73 2 47 53 -6 80 80 0 92 71 21

4. Hospital units work well together to provide the best care for patients.

Database 58 56   66 63   66 65   71 69   65 63  Your

Hospital 58 64 -6 63 36 27 57 47 10 100 100 0 92 62 30

Teamwork Within Units  Unit 1 2012 Unit 1 2010 Difference

Unit 2 2012

Unit 2 2010 Difference Unit 3 2012 Unit 3 2010 Difference Unit 4 2012 Unit 4 2010 Difference Unit 5 2012 Unit 5 2010 Difference

1. People support one another in this unit.

Database 84 84   89 89   85 84   92 92   83 83  Your

Hospital 92 73 19 100 100 0 82 81 1 100 100 0 100 78 22

2. When a lot of work needs to be done quickly, we work together as a team to get the work done.

Database 86 86   90 90   81 81   90 89   86 86  

Your Hospital

85 73 12 100 100 0 85 75 10 100 100 0 100 87 13

3. In this unit, people treat each other with respect.

Database 74 74   80 80   77 76   88 87   73 73  Your

Hospital 77 50 27 100 100 0 85 75 10 100 100 0 100 74 26

4. When one area in this unit gets really busy, others help out.

Database 67 67   77 77   64 62   77 75   65 65  Your

Hospital 69 36 33 67 67 0 52 56 -4 100 100 0 100 52 48

Nonpunitive Response to Error  Unit 1 2012 Unit 1 2010 Difference

Unit 2 2012

Unit 2 2010 Difference Unit 3 2012 Unit 3 2010 Difference Unit 4 2012 Unit 4 2010 Difference Unit 5 2012 Unit 5 2010 Difference

1. Staff feel like their mistakes are held against them.

Database 43 43   46 46   46 46   64 64   48 49  Your

Hospital 58 36 22 33 45 -12 38 25 13 80 100 -20 50 39 11

2. When an event is reported, it feels like the person is being written up, not the problem.

Database 38 38   43 41   44 42   62 61   46 46  Your

Hospital 62 36 26 33 27 6 45 6 39 40 60 -20 50 43 7

3. Staff worry that mistakes they make are kept in their personnel file.

Database 28 27   31 30   32 31   52 50   35 34  Your

Hospital 31 36 -5 25 18 7 15 6 9 80 20 60 42 48 -6

Unit by Unit COS data, Resilience, and Readiness for Change

7

9

From Bryan Sexton

Key Domain One: TeamworkDriven by Answers to Six Questions

1. Nurse input is well received in this clinical area.

2. In this clinical area, it is difficult to speak up if I perceive a problem with patient care.

3. Disagreements in this clinical area are resolved appropriately (i.e., not who is right, but what is best for the patient).

4. I have the support I need from other personnel to care for patients.

5. It is easy for personnel here to ask questions when there is something that they do not understand.

6. The physicians and nurses here work together as a well-coordinated team.

10

A poor teamwork score (less than 60% reporting positive teamwork)…

• Results from persistent interpersonal dysfunction on the unit

• Predicts operational outcomes e.g. staff turnover, delays, etc.

Needs a specific leadership response: If teamwork score is low, find out which of the questions is

dragging the score down and address that issue specifically

Key Domain Two: Safety ClimateDetermined by scores on seven questions:

1. I would feel safe being treated here as a patient.

2. Medical errors are handled appropriately in this clinical area.

3. I know the proper channels to direct questions regarding patient safety in this clinical area.

4. I receive appropriate feedback about my performance.

5. In this clinical area, it is difficult to discuss errors.

6. I am encouraged by my colleagues to report any patient safety concerns I may have.

7. The culture in this clinical area makes it easy to learn from the errors of others.

Poor safety climate scores (<60%)…• Predict poor clinical outcomes, and high staff injury

rates

• Result from perceived lack of commitment to safety by leadership

• Leadership response: demonstrate eagerness to learn about safety problems, and willingness to do something about them

Key Support Domain: Resilience (Burnout)Determined by scores on four questions:

1. I feel fatigued when I get up in the morning and a have to face another day on the job

2. I feel burned out from my work 3. I feel frustrated by my job 4. I feel I am working too hard on my job

Leadership Response:

For units with HIGH resilience, you can go ahead with a new initiative even if safety or teamwork scores are low (but you will need to address the

specifics of why these scores are low)

For units with low resilience AND low teamwork/safety climate scores, you must first deal with the burnout issues before you can hope to accomplish

ANY change initiative.

The MetroHealth System

Run charts for 2010, 2011, 2012 for VAP, CLBSI, and CAUTI

16

Catheter Related Bloodstream Infections (CLBSI), 2010 to 2012

0

10

20

30

40

50

60

Nu

mb

er o

f in

fect

ion

s

ICU 14 23 10

Non-ICU 40 28 25

2010 2011 2012

2.91*2.58*

1.86*

*infections per 1000 catheter days

17

Total Hospital Acquired Catheter Related Bloodstream Infections (ICU and non-ICU, 2010 to 2012)

2

0

4 4 4

14

4

1

8 8

4

1

5

3 3

5

2 2

8

7

5

3

6

2

4 4

3

9

1

6

1

2

1 1

3

0123456789

101112131415

Jan-10

Feb-10

Mar-10

Apr-10

May-10

Jun-10Jul-1

0

Aug-10

Sep-10

Oct-10

Nov-10

Dec-10Jan-11

Feb-11

Mar-11

Apr-11

May-11

Jun-11Jul-1

1

Aug-11

Sep-11

Oct-11

Nov-11

Dec-11Jan-12

Feb-12

Mar-12

Apr-12

May-12

Jun-12Jul-1

2

Aug-12

Sep-12

Oct-12

Nov-12

Dec-12

18

Ventilator Associated Pneumonia (VAP)2010 to 2012

0

10

20

30

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50

60

Nu

mb

er o

f in

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s

VAP 51 51 35

2010 2011 2012

4.81* 4.69*

4.14*

*pneumonias per 1000 ventilator days

Ventilator Associated Pneumonia2011 to 2012

4

1

2

5 5

7 7

5

4

7

3

1

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Jan-10

Feb-10

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0

Aug-10

Sep-10

Oct-10

Nov-10

Dec-10

Jan-11

Feb-11

Mar-11

Apr-11

May-11

Jun-11Jul-1

1

Aug-11

Sep-11

Oct-11

Nov-11

Dec-11

Jan-12

Feb-12

Mar-12

Apr-12

May-12

Jun-12Jul-1

2

Aug-12

Sep-12

Oct-12

Nov-12

Dec-12

Infe

ction

s/M

onth

19

20

Catheter Associated Urinary Tract Infection (CAUTI) 2010 to 2012

0

20

40

60

80

100

120

140

160

180

Nu

mb

er o

f In

fect

ion

s

CAUTI 167 119 76

2010 2011 2012

8.71*

4.12*

3.11*

*infections per 1000 catheter days

21

Catheter Associated Urinary Tract Infections (CAUTI)(ICU and non-ICU)

33

20

2726

23

29

31 31

36

24

28

23

19

7

13

11

6

10

8

16

4

7

10

76

10

16

7

34

8

5

34

9

0

5

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25

30

35

40

Jan-10

Feb-10

Mar-10

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0

Aug-10

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Dec-10Jan-11

Feb-11

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1

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Jun-12Jul-1

2

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Oct-12

Nov-12

Dec-12

Infe

ction

s/M

onth

Change in CAUTI definition

Total BSI, VAP, UTI 2011 to 2012

118

75

51

35

51

35

0

50

100

150

200

250

2011 2012

CAUTI CLBSI VAP

34% reduction 2011 to 2012

23

Total BSI, VAP and CAUTI 2011 to 2012

34

16

22

25

15

18

23

30

16

13

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1314

17

26

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7

16

12

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1213

0

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40Ja

n-11

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-11

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-11

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-11

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-11

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-11

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-11

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-11

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12

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-12

Mar

-12

Apr

-12

May

-12

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Jul-1

2

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-12

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-12

Oct

-12

Nov

-12

Total VAP, CLBSI, & CAUTI Linear (Total VAP, CLBSI, & CAUTI)

Next Month:Tuesday February 12th 8am PT/9am MT/10am CT/ 11am ET

Just Culture1. Have a brief conversation with the chief nurse, or the head of HR,

and ask the following questions: Did we initiate disciplinary action against any staff member (nurse, pharmacist,

physician, nursing assistant…) because of a safety mishap in the last year? If yes…by what method did we decide that this was a problem with the individual?

What is our method for determining individual culpability for safety mishaps? 2. Be prepared to discuss what you’ve learned about your

organization and how it decides when to hold people to account for their safety behaviors. Just Culture Algorithm, HR protocols, or other document

THANK YOU FOR JOINING US!

Monthly webinars are scheduled through March…Tell us if you’d like to continue!

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