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Microsoft PowerPoint - Developing a safety culture in Healthcare R ...
Developing a Safety Culture in Healthcare Rhona Flin, Industrial Psychology Research Centre Patient Safety Research Group VMIA, Melbourne, September 2009 Welcome to the Industrial Psychology Research Centre. The centre specialises in the application of psychology to high reliability workplaces. The group has worked with the oil industry since 1986, and regularly engage in consultancy projects. We are currently working with the offshore oil industry, civil aviation, nuclear power generation, surgery, emergency services, conventional power generation and transportation. Interests of the centre include: •Accident analysis •Incident command •Occupational stress •Emergency decision making •Crew Resource Management •Measuring and managing safety culture/climate •Human factors aspects of safety management and emergency response Clients include: Agip, AKER Offshore (Norway), AMEC, Amerada Hess, AMOCO, British Energy, BHP, BP, Brown & Root, Chevron, Civil Aviation Authority, Coflexip Stena Offshore, Conoco Phillips, Defence Evaluation and Research Agency (DERA), EC (DGTREN), First Group, Halliburton, Health & Safety Executive, KBR, Kerr McGee, National Power, NHS, Powergen, Royal College of Surgeons, Salamis SGB, Schlumberger, SCPMDE, Shell, Talisman, Texaco, Total Fina Elf, Transocean Sedco Forex, UBS Warburg & UK Nuclear Imc. 1 Safety Culture FAQs • What is it? • Why is it important? • How does it influence safety outcomes? • How do you diagnose (measure) it? • How do you treat (enhance) it? What is safety culture? Term introduced following Chernobyl accident in nuclear industry (1986) • The necessary framework that prioritises safety within the organisation which is the responsibility of the management hierarchy • The attitude of staff at all levels in responding to and benefiting from the framework 2 Zohar, 1980 ‘Safety Climate’ “The perceptions of policies and procedures which specify the priority given to safety” (Zohar & Luria, 2005) Why is culture important? • Culture (national, professional and organizational) influences human behaviour • Culture therefore impacts on work behaviour, management practices and thus can effect the performance of organizations 3 Safety culture and behaviour • Worksites with more positive safety culture show lower accident rates • Workers who perceive their supervisors/ managers to be more committed to safety engage in more safety-related behaviours and fewer risk taking behaviours • Motivational mechanism linking culture to behaviour – expectations/ rewards linked to behaviour of managers/ supervisors (Zohar, 2002) ( Landy & Conte 2006) The Bristol Royal Infirmary Inquiry • BBC News November 1999 • Money came first, baby inquiry told • Stephen Bolsin blew the whistle at Bristol • The Bristol heart scandal whistleblower has told a public inquiry that managers ignored him because they thought they might lose government cash. • Consultant anaesthetist Dr Stephen Bolsin said that senior staff wanted to maintain the hospital's designation as a specialist children's heart facility. • He told the inquiry: "The analogy that was used was of a train where occasional passengers were falling off, and the train had to keep moving in order to attract funding. • "That was one of my concerns about the subjugation of patient safety by reasons of funding and continued activity in high risk areas." • Former Bristol Royal Infirmary chief executive Dr John Roylance, later struck off by the General Medical Council, was "dismissive" of his attempts to bring the high death rates to his attention, he said. • And surgeon James Wisheart, who was also banned from practising, was angry that he had discussed the unit's performance with other doctors. 4 Kennedy (2006) NHS England “Safety still struggling to be on the agenda. Strong leadership needed.” Surgical safety culture (Flin et al, 2006) CONSULTANT TRAINEE SURGEONS SURGEONS agree agree Pre-list briefing is important 37% 51% for safety Junior members should 90% 77% question decisions made by senior OR members Encouraged to report 41% 44% incidents I observe In favour of postoperative 44% 72% debriefing 5 Surgeons’ view of their Trust’s commitment to safety • “If I were to fail in the following areas which would concern my NHS Trust most?” (% surgeons ranking as first): Patient safety 42% Reduce waiting lists 27% Saving costs 15% Trust’s reputation 16% i.e. 58% of surgeons think their NHS Trust is primarily concerned with something other than patient safety 138 consultant surgeons in Scotland (Flin, Yule, Paterson-Brown & Maran, The Surgeon, 2006) Organisational factors associated with a safety culture (HSE, 1999) • Senior management commitment • Management style • Visible management • Good communication between all levels of employee [management action] • A balance of health and safety and production goals [management prioritisation] 6 Organisational factors associated with a safety culture (HSE, 1999) “Senior Management Commitment - crucial to a positive health and safety culture. It is best indicated by the proportion of resources (time, money, people) and support allocated to health and safety management and by the status given to health and safety” (p 46). Nuclear Industry: Safety Culture ‘On a personal basis, managers at the most senior level demonstrate their commitment by their attention to regular review of the processes that bear on nuclear safety, by taking direct interest in the more significant questions of nuclear safety or product quality as they arise, and by frequent citation of the importance of safety and quality in communications to staff.’ (International Atomic Energy Authority, 1997) 7 SAFETY CLIMATE Company MOTIVATION UNSAFE BEHAVIOURS Management Commitment to PATIENT Safety Errors- loss of SA, poor INJURY Expectations regarding decision making etc reward Not taking precautions Department/ Rule Breaking Supervisor Leadership Risk Taking Unit Style WORKER Not speaking up INJURY Supervisor Not reporting incidents/ Commitment to Peer Pressure near misses Safety, Work Pressure, Communication, Safety System Flin (2004) Proposed Model of Safety Climate and Injury Outcomes Based on Zohar (2003); Neal & Griffin (2004) Why Attempt to Measure? • Diagnosis – level of safety, characteristics of prevailing culture • Identify problems/ problem areas • Establish baseline • Track changes • Evaluate interventions • Benchmark @ local, national, international 8 Offshore oil platforms: benchmarking safety culture 4.50 Satisfaction with safety 4.30 measures 4.10 3.90 Perceived management 3.70 commitment to safety 3.50 3.30 Willingness to report incidents 3.10 2.90 Perceived 2.70 supervisor 2.50 competence B/99 C/99 D/99 E/99 F/99 G/99 H/99 K/99 L/99 Safety culture questionnaires 9 Psychometric criteria • Construct validity – Content validity (inc theoretical basis) – Internal structure – Criterion validity • Reliability – Stability over time • For analysis – attention to levels & within group homogeneity • Flin, Burns, Mearns, Yule & Robertson (2007, QSHC) Review of 12 hospital safety culture measures shows limited psychometric analysis. Hospital Survey on Patient Safety Culture (AHRQ, USA) Consists of 42 items measuring 12 dimensions plus 2 single items ‘Unit-level dimensions of safety culture’ • Organizational learning – Continuous improvement • Teamwork within units • Non-punitive response to error • Staffing • Supervisor/ manager expectation and actions promoting safety • Communication openness • Feedback and communication about error ‘Hospital-level dimensions of safety culture’ • Hospital management support for patient safety • Teamwork across hospital units • Hospital handoffs [handovers] and transitions ‘Outcomes’ • Overall perceptions of safety • Frequency of event reporting • Patient safety grade (of the hospital unit) • Number of events reported 10 Patient Safety Climate in Scottish Hospitals Cakil Sarac Supervisors: Rhona Flin, Kathryn Mearns School of Psychology This work is funded by Scottish Patient Safety Alliance (2007-2011) Scottish Patient Safety Programme NHSScotland is the first health service in the world to adopt a national approach to improving patient safety. Outcome Aims: Reduce healthcare associated infections Reduce adverse surgical incidents Reduce adverse drug events Improve the organizational and leadership culture on safety 11 Adverse events in one Scottish acute hospital Williams, Olsen, Crichton, Flin, et al. (2008). Detection of adverse events in a Scottish hospital using a consensus-based methodology. Scottish Medical Journal,53, 426-30. • The estimated cost of adverse events in terms of bed days was £69,189 Scotland wide would cost £297 million per annum Sample: The proposed sample for the first stage is all clinical staff at one acute hospital per Scottish NHS Board Organisations by Region Ayrshire & Arran Borders Dumfries & Galloway Fife Forth Valley Grampian Greater Glasgow & Clyde Highland Lothian Lanarkshire Orkney Shetland Tayside Western Isles 12 HSOPSC (Hospital Survey on Patient Safety Culture): standardized instrument which was developed by the Agency for Healthcare Research and Quality (AHRQ) to assess hospital staff opinions about patient safety issues, medical error, and event reporting. • Covers wide range of safety climate dimensions • Provides a more comprehensive report on scale development and psychometric properties than the other questionnaires (Flin et al, 2006) • Designed both for clinical and non-clinical staff • Has been widely used which allows benchmark data Author Country Sample size Factor Analysis AHRQ, 2007 USA 1437 (21 hospitals) CFA and EFA Olsen, 2008 Norway 1919 clinical and non CFA clinical staff Pfeiffer, et al., (2008) Switzerland 2989 clinical and non CFA and EFA clinical staff across 61 services (1 hospital) Smiths, et al., 2007 Netherlands 583 clinical and non EFA clinical staff across 23 units (8 hospitals) Waterson, et al., 2008 England 1461 clinical and non CFA and EFA clinical staff (3 hospitals) Sarac, C. & Lajunen, T., Turkey 240 clinical staff (10 CFA 2007 hospitals) Studies using HSOPSC 13 Customisation for Scotland • in order to customise the instrument for Scottish healthcare system, a number of interviews were conducted with healthcare staff • demographic questions, job codes and incident reporting items had to be adapted for Scotland. • incorporate the NHS Staff Survey (Aston Business School, 2007) job descriptions and also to add the incident reporting items to the original instrument to avoid this confusion. Safety Behaviour: Healthcare staffs’ safe behaviours were assessed by self report items based on Neal and Griffin’s (2000) safety compliance and safety participation items. Proposed model: Safety Climate Worker Behaviours Worker Injuries Self-report HSOPSC Supervisor/ manager expectation and actions Safety Compliance promoting safety Safety Participation Patient Outcomes Self-report Teamwork within units Non-punitive response to error Hospital management support for patient safety 14 Procedure • The procedure for administration of the questionnaires was determined in conjunction with each participating Board or hospital. • Paper questionnaires / but web-based version were made available • Administration February – September 2009. • A confidential summary report prepared for each participating hospital. • Pilot study was based in one of the smaller hospitals Culture – Behaviour Path? Safety Worker Manager Motivation/ Worker Unsafe behaviour Culture competence Behaviour Or Safe? Peer behaviour 15 Further information Further information • email@example.com • www.abdn.ac.uk/iprc lists of projects and papers and reports www.resilience-engineering.org 16
"Microsoft PowerPoint - Developing a safety culture in Healthcare R "