Launching a Culture of Patient Safety
Many organizations are now determining how best to evaluate their current culture for patient safety. Effective completion of a patient safety culture survey will highlight aspects of your culture that may be supporting or inhibiting your organization’s efforts to prevent harm to patients. Included below are general tips related to planning and launching a culture of patient safety.
1. Ensure that the executive team openly supports conducting the survey, as well as the specific survey selected, and the survey process plan (see below). Staff and physicians will need to know that the organization’s leaders support the survey and are interested in the results; leaders will need to clearly communicate that the intent of the survey is to enhance patient safety. Leaders will also determine a budget and resources available to conduct this survey; these allocations will have a direct impact on decisions outlined in the tips that follow.
2. Assign an “owner” of the survey project. Consider selecting a person with demonstrated project management skills. Conducting this assessment will require project planning, timelines, communication to all staff, operational skills, analytical acumen, and the ability to connect directly with leaders and managers. The project manager should also establish a project team with diverse representation from the organization to assist with all survey plans and logistics.
3. Select a survey instrument that works best for your organization. Review the scope of the survey to confirm that it covers the topics you are interested in (e.g., teamwork, leadership support, event reporting), and that it will allow for stratification of results by work units and type of staff (questions regarding these strata will need to be in the survey). Also confirm the reliability of the instrument (will you believe the results?) and whether comparative information is available, should you desire it. Methods for and estimated costs of conducting the survey should also be clearly understood, as well as the estimated time it will take for an individual to complete the survey. Staff will not respond as well to a survey that is too long.
4. Decide who will be targeted to complete the survey. Some organizations limit the survey to clinical staff who work directly with patients. Other organizations choose to open the survey up to all staff, purposely intending to communicate the importance of patient safety to everyone. Whichever staff groups are targeted, you will also need to consider whether to invite only a sample of those staff or simply invite all targeted staff to complete the survey. It is often easier to invite everyone, rather than determine and operationalize a valid sampling scheme. Cost is an important point to consider, however, particularly if using a hard-copy, manual data-entry approach to survey completion and analysis.
5. Select the survey method that will work best for your organization. Some organizations prefer to use a manual process, where staff fill out a paper copy of the questionnaire. Others utilize their intranet to facilitate electronic completion of the survey instrument; in this case, access to computer workstations is required for staff requested to complete the survey. Finally, some organizations allow staff to complete the survey either on paper or electronically. Important to your decision will be the cost, staff comfort with anonymity, and expected resources for analysis (i.e., are there resources for key-entering surveys completed on paper?).
6. Define a timeline for completing the survey. Be very specific about the time it will take to prepare for and launch the survey, the duration the survey will be “open” for staff completion (number of days or weeks) and the exact dates (start and end dates). In addition, plan the estimated timeline for analysis and reporting (i.e., the post-survey communication of results and next steps).
7. Determine the plan for analyzing completed surveys and for identifying next steps. Be certain all completed surveys are included in the database before analyzing results. Identify stratification of results of interest to your organization, such as work units or departments, medical staff, nurses, pharmacists. Outline the plan for presenting results; usually the executive team sees the results first, with subsequent confirmation of how to share results with other managers and frontline staff. The leadership team will also select priority areas for further study, if necessary, and improvement actions.
8. Develop a communications plan and campaign for promoting completion of the survey. It will be very important to launch the campaign for this assessment survey in advance of the actual start date of the survey process. This time is necessary to build the staff’s awareness of the intent of the survey, and increase their interest in completing it once launched. The communication plan may be best orchestrated by your organization’s “communications department.” It should include the purpose of the assessment; intended use of results; assurance of aggregate review (not an individual’s response); survey methods that will be used; how staff can access the survey (electronically or hard copy); dates of survey activity; estimated time for an individual to complete the questionnaire; time period for analysis; and general plans for sharing results. Staff should also be given the name and number of a project team member who has been selected to serve in the role of responding to requests for more information or clarification about the survey activity.
9. Launch the survey! With all pre-survey elements of tips 1-8 completed, you can feel reasonably prepared to launch the survey. Remember to communicate throughout the actually survey period, urging completion of the survey. Consider providing frontline managers with daily reports of the organization’s aggregate response in an effort to have them also encourage their staff to complete the survey. Celebrate successful response rates along the way, and certainly upon completion of the survey period.
10. Honor your intent to share results with staff and to take steps toward enhancing patient safety. As with any input sought from staff, they will want to know the results and intended next steps—did leaders really mean it when they said the purpose was to enhance patient safety? Highlight the strengths of the organization and admit the shortcomings. Seek additional input from staff when necessary or when volunteered. While preparing for, launching and conducting the survey may have seemed to have consumed significant time and energy, the challenging part starts now—taking action to make your organization’s culture one that is committed to patient safety, supportive of staff reporting and communication about actual and potential errors, and demonstrative of leaders’ intent to act on identified risks.
For additional assistance with completing a survey of your organization’s culture, email us at DNadzam@jcrinc.com.