Patient Safety in Small Rural Hospitals

ENGINEERING A CULTURE OF SAFETY
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AHRQ Hospital Survey on Patient Safety Culture (HSOPSC) Resources

AHRQ HSOPSC on AHRQ Website

AHRQ HSOPSC - Adapted for Critical Access Hospitals

Premier Inc. Excel Tool - Modified for use with the Critical Access Hospital adaptation of the HSOPSC

Presentations on Interpreting the AHRQ HSOPSC in Critical Access Hospitals

Administration

AHRQ HSOPSC Administration Service - Offered by the Nebraska Center for Rural Health at UNMC

By engaging the Nebraska Center to conduct this survey, small rural hospitals obtain the following:

an unbiased measurement of employee attitudes regarding patient safety,

assurance of employee anonymity as employees use a postage paid envelope to mail surveys to the Nebraska Center for data entry and analysis,

ability to benchmark findings with hospitals of similar size,

consulting assistance for strategic planning to respond to strengths and weaknesses identified in the survey,

electronic copies of all reports and graphics to communicate findings to medical staff, employees, and the board of directors.

Click here for more information

Interpretation

The Culture of Safety in 24 Critical Access Hospitals:
Lessons Learned from the AHRQ Hospital Survey on Patient Safety Culture

Benchmark tool for survey results in Critical Access Hospitals

Benchmark tool for number of events reported - How mindful is your staff of safety?

Understanding Assessment Results from the AHRQ Hospital Survey on Patient Safety Culture
2007 - 2008 MN Rural Patient Safety Culture Workshop #1, November 15, 2007

Understanding Reassessment Results from the AHRQ Hospital Survey on Patient Safety Culture
A WebEx for QIOs from the Rural HIQIOSC, November 1, 2007

Action Planning Tools - By Survey Dimension

FREQUENCY OF EVENTS REPORTED
Frontline workers will freely report errors and near misses when organizational practices exist to support a *Reporting Culture* and they believe that … · management will support and reward reporting and that discipline occurs based on risk-taking (Marx)--organizational practices support a *Just Culture. · authority patterns will relax when safety information is exchanged because those with authority respect the knowledge of front-line workers—organizational practices support a Flexible Culture. · the organization will analyze reported information and then implement appropriate change—organizational practices support a Learning Culture*. Practices that directly support a reporting culture include systematic data collection, Safety Briefings, and Leadership Walkrounds. However, practices that support Just, Flexible, and Learning Cultures also support a Reporting culture as workers see that reporting errors results in changes in processes of care.

MANAGER ACTIONS PROMOTING SAFETY
Managers demonstrate their support for patient safety by ensuring that reporting of events results in learning within their shift, department or unit. Practices that demonstrate a manager’s support for patient safety include team leadership skills and conducting Safety Briefings that ensure reporting and identification of patient safety risks and hazards within the context of daily work processes.

ORGANIZATIONAL LEARNING
Learning organizations consider reported errors as opportunities to improve unless there is evidence of intent to increase risk such as repeated violation of policy/procedure. These organizations continually “close the loop” with front-line staff by providing feedback about the effect of organizational changes implemented as a result of learning activities such as Safety Briefings, WalkRounds, and aggregate and individual RCA. Organizational learning from errors does not occur when the primary response to an error is to educate/train the individual who reported the error. This focus on individual retraining exacerbates the perception of a punitive environment.

TEAMWORK WITHIN DEPARTMENTS
Much of healthcare occurs in small groups such as nursing units, interdisciplinary teams, operating rooms, and intensive care units. However, members of these groups are trained as separate disciplines in separate educational programs and receive little formal team training. Teams are made up of two or more people who have specific roles, perform interdependent tasks, and share a common goal. To achieve this common goal, effective teams have specific characteristics: team leadership, mutual support by providing backup behavior, mutual performance monitoring, effective communication, adaptability to changing conditions, shared mental models of roles and tasks, mutual trust, and a team orientation that values team goals over individual goals. Building these characteristics is the goal of the TeamSTEPPS program.

COMMUNICATION OPENNESS
Communication is the lifeline of teamwork and effective management of changing workloads. Effective communication must take place between individuals, departments, and organizations. There are five standards for effective communication: (1) complete—all relevant information is communicated, (2) clear—communication is plainly understood, (3) brief—communication is concise, (4) timely, and (5) closed loop—the receiver verifies receiving the information. Senior leaders should implement structured communication strategies such as SBAR and CUS (the “two challenges rule”). These strategies are included in the TeamSTEPPS program from the Department of Defense.

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