[No SPF Record] [IMPROVEDX] Culture

Rory Jaffe rjaffe at CHPSO.ORG
Mon Jun 11 21:32:40 UTC 2018


The surveys are reasonably sophisticated and don’t ask just straight “safety” questions, though the overall purpose of the survey is clear.

To see the SCORE survey, look at the survey starting on page 12 of this pdf: http://www.dukepatientsafetycenter.com/doc/SCORE_Techincal_Report_5.22.17.pdf

For the AHRQ culture survey (the AHRQ survey is a bit old and showing its age), see https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patientsafetyculture/hospital/userguide/hospital-survey-items.pdf


From: Tom Benzoni <benzonit at gmail.com>
Sent: Monday, June 11, 2018 1:42 PM
To: Society to Improve Diagnosis in Medicine <IMPROVEDX at list.improvediagnosis.org>; Rory Jaffe <rjaffe at chpso.org>
Subject: Re: [IMPROVEDX] [No SPF Record] [IMPROVEDX] Culture

I wonder if the data is useful; I'm recalling Ioannidis' work; see PubMed notations inter-located with citations.

I have worked in organizations that were extremely unsafe; so unsafe the employees dared not say they were unsafe. I think indirect measurements are going to be more useful.

Separate questions, takes solely from my observations (ER):

"Are you encouraged to pick up new patients until the end of your shift?"

"Are you told it is OK to turn over/hand off patients?"

"Are you an "exempt" employee?"

"As an exempt employee, do you have a regular schedule (an assigned begin/end time and date)?"

"Do you "go off the clock" (cease to be paid) at the end of your assigned time?"

"Are you expected to finish work after you are "off the clock?"

I assume the members of this group understand what the underlying question is to each of the above.
Hint: you can see parallels into the burnout issue here.
This brings the questions full circle to errors; increasing burnout increases errors.

tom




On Mon, Jun 11, 2018 at 1:32 PM Rory Jaffe <rjaffe at chpso.org<mailto:rjaffe at chpso.org>> wrote:
Here’s a few references on the relationship between culture and outcomes. Note this is a random selection and not a review of the literature.

Farup PG. Are measurements of patient safety culture and adverse events valid and reliable? Results from a cross sectional study. BMC Health Serv Res. 2015;15:186. doi:10.1186/s12913-015-0852-x.

Result: "There was an inverse association between the patient safety culture and adverse events. Until the criterion validity of the tools for measuring patient safety culture and tracking of adverse events have been further evaluated, measurement of patient safety culture could not be used as a proxy for the "true" safety." (PubMed)
"

Fan CJ, Pawlik TM, Daniels T, et al. Association of Safety Culture with Surgical Site Infection Outcomes. J Am Coll Surg. 2016;222(2):122-128. doi:10.1016/j.jamcollsurg.2015.11.008.

Result: Safety culture may decrease surgical site infections (12 indicators, "7 hospitals...with a mean survey response rate of 43%. The SSI rates ranged from 0% to 30%, and surgical unit safety culture scores ranged from 16 to 92 on a scale of 0 to 100."


Huang DT, Clermont G, Kong L, et al. Intensive care unit safety culture and outcomes: a US multicenter study. Int J Qual Health Care. 2010;22(3):151-161. doi:10.1093/intqhc/mzq017.
Mismatched reference; analysis on first article cited.

Results: (pasted from PubMed) We achieved a 47.9% response (2103 of 4373 ICU personnel). Culture scores were mostly low to moderate and varied across ICUs (range: 13-88, percent-positive scores). After adjustment for patient, hospital and ICU characteristics, for every 10% decrease in ICU perceptions of management percent-positive score, the odds ratio for hospital mortality was 1.24 (95% CI: 1.07-1.44; P = 0.005). For every 10% decrease in ICU safety climate percent-positive score, LOS increased 15% (95% CI: 1-30%; P = 0.03). Sensitivity analyses for non-response bias consistently associated safety climate with outcome, but also yielded some counterintuitive results."


Mardon RE, Khanna K, Sorra J, Dyer N, Famolaro T. Exploring relationships between hospital patient safety culture and adverse events. J Patient Saf. 2010;6(4):226-232. doi:10.1097/PTS.0b013e3181fd1a00.

Result pasted from PubMed: "Nearly all of the relationships tested were in the expected direction (negative), and 7 (47%) of the 15 relationships were statistically significant. All significant relationships were of moderate size, with standardized regression coefficients ranging from -0.15 to -0.41, indicating that hospitals with a more positive patient safety culture scores had lower rates of in-hospital complications or adverse events as measured by PSIs."


Chang Y, Mark B. Effects of learning climate and registered nurse staffing on medication errors. Nurs Res. 2011;60(1):32-39. doi:10.1097/NNR.0b013e3181ff73cc.

Result pasted from PubMed: "A significant negative relationship was found between learning climate and medication errors. It also moderated the relationship between nurse mix and medication errors: When learning climate was negative, having more registered nurses was associated with fewer medication errors. However, no relationship was found between nurse mix and medication errors at either positive or average levels of learning climate. Learning climate did not moderate the relationship between work dynamics and medication errors."


Weaver SJ, Lubomksi LH, Wilson RF, Pfoh ER, Martinez KA, Dy SM. Promoting a culture of safety as a patient safety strategy: a systematic review. Ann Intern Med. 2013;158(5 Pt 2):369-374. doi:10.7326/0003-4819-158-5-201303051-00002.

Snips from Discussion, para3: "...clear limitations must be considered. Only studies in acute care settings using established survey measures were included. ...qualitative studies of safety culture...were outside the scope of this review. ...results may not generalize beyond inpatient settings. Relevant studies may also have been inadvertently excluded despite extensive searches. Publication bias and selective reporting of positive findings also may limit conclusions... ...traditional criteria for evaluating the effectiveness of clinical interventions for individual patients are not well-suited to assessing the effectiveness of quasi-experimental study designs conducted at the unit level of analysis. This may have introduced systematic bias...



Rory


From: ROBERT M BELL <0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG<mailto:0000000296e45ec4-dmarc-request at LIST.IMPROVEDIAGNOSIS.ORG>>
Sent: Saturday, June 09, 2018 3:51 PM
To: IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG<mailto:IMPROVEDX at LIST.IMPROVEDIAGNOSIS.ORG>
Subject: [No SPF Record] [IMPROVEDX] Culture

Dear all,

Over the years I have often thought that a Good Culture in a hospital, medical facility reduced errors.

I did a google search and there are significant posts suggesting that a  good culture reduces errors. However, I have no idea what is the scientific evidence for this.

I assumed it was accurate and came up with my own list, gathered from many sources, of words/phrases of what kind of hospital, if given the chance, I would like to work in and/or be a patient.

excellent standards, compassion,
flexibility, compromise, transparency,
courtesy, kindness, fairness, time-related goals,
conflict resolution procedures, encourages creativity,
good feedback mechanisms, defined mission and goals,
defined strategy, team concepts, good communications,
collaboration, compromise, embracing diversity.

And one would ask, how meaningful are these, and what others should be added or removed?

These are not ranked is any order and begs the question should they be?  What are the most important to prevent error.

There seem to be barriers to introducing the right culture into a hospital and this article discusses that.

https://www.fiercehealthcare.com/hospitals/hospital-impact-8-cultural-barriers-to-achieving-high-reliability-healthcare<https://urldefense.proofpoint.com/v2/url?u=https-3A__www.fiercehealthcare.com_hospitals_hospital-2Dimpact-2D8-2Dcultural-2Dbarriers-2Dto-2Dachieving-2Dhigh-2Dreliability-2Dhealthcare&d=DwMFAg&c=hx0HUg_nG-xRkKlwWZeJFCbvzzw0Ym5DwdL_1FKbReI&r=ykcs2wU25yxj5BckI49bSg&m=3-ovTI9oH9-1frmaUjjmP1WRMfm7j-oludtaCuOs7mU&s=adh1lnz3o7l3o0vMW7SyRPYlikIxPs3M38-JjDiotns&e=>

Are these culture barriers meaningful? And what can anything be done about the obstacles to make it easier for hospitals?

While we are waiting to find good ways to prevent diagnostic errors (and errors in general) could we support moving to good cultures for all in medical facilities.

Would that help in any way?

One fantasizes of reducing the error rate by 1 - 5%

Or is this being done successfully already?

Rob Bell, M.D.



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