"Efforts to Achieve a Culture of Safety in the Veterans Health Administration"
Using survey data to evaluate progress and consider areas for improvement in the VA Edward J. Dunn, MD, MPH William B. Weeks, MD, MBA Scott McKnight, PhD VA National Center for Patient Safety National Center for Patient Safety • Established in 1998 • Developed models for systems based problem solving in the VHA – RCA – HFMEA – PS Manager in every VA health system • Provides educational resources, reporting system for adverse events & close calls, programs for improving patient safety in HS – SPOT reporting system – web based by Sept. 2007 – Alerts & Advisories – Med Team Training Program – PS Curriculum workshops – Falls Toolkit - prevent harm from falls – PS Assessment Tool – assess PS environment – Directives: ECS; Prevention of Retained FB in Surgery; Airway management in code events; Recall of defective med devices; Reducing fire hazards when O2 is present – PS Improvement Corps (partner w/ AHRQ) – Newsletters: TIPS; Briefings & Debriefings; Frontlines – PS Fellowship • One goal is to achieve a culture of safety within VA Culture of safety • To assess the culture of safety within VA, NCPS has conducted two national surveys • Survey developed by NCPS – some dimensions overlap with ARHQ patient safety culture survey – 2000 – distributed through patient safety managers at facilities. N=6153 • 120 items, 9 dimensions (factors) – 2005 – distributed through website with email reminders. N=42561 • 77 items, 14 dimensions (factors) – Ability to identify job categories of respondents (physician, nurse, allied health professional, administrator) Improving perceptions and resources 5 2000 2005 4 3 2 1 0 All VA All VA All VA Physicians Physicians Physicians Nurses Nurses Nurses Overall perception of patient Shame Education and training safety resources Challenges in communication, perceived safety, job satisfaction 5 2000 2005 4 3 2 1 0 All VA All VA All VA Physicians Physicians Physicians Nurses Nurses Nurses (NS) (NS) Communication Comparisons to others Job satisfaction Benchmarked strengths and weaknesses 100% 80% 60% 40% 20% 0% All VA All VA All VA All VA Nurses Nurses Nurses Nurses Physicians Physicians Physicians Physicians Organizational Feedback about Teamwork across Teamwork within learning error units units Summary Strengths – Improvement in perception of patient safety – Improvement in PS education/training resources – Organizational learning/QI – Feedback about adverse events/close calls Weaknesses – Decline in communication (more among nurses) – Decline in job satisfaction (especially among nurses) – Relative weakness in teamwork, within and across units (compared to AHRQ benchmarks) Plan • Medical team training rollout (2007-2009) – Uses crew resource management applied to health care to enhance communication – Targets surgical services and critical care – Early evidence demonstrates improvement in • Communication • Job satisfaction • Nurse participation/empowerment • Teamwork • Surgical performance measures – Program Evaluation will measure effect on • Risk adjusted surgical outcomes • Surgical and critical care performance measures • Surgical staff job satisfaction