New blog post from Jo Pendray, Improvement Lead – Patient Safety
Jo Pendray blogs about her experiences at the Patient First Conference
Given the opportunity to speak at a national conference about the work of the Patient Safety Collaborative on our SCORE Safety Culture Survey for the first time, it was with some trepidation that I said “yes, I would love to!” The Patient First conference was to be held at the Excel conference centre in London on 22 & 23 November – a venue so large that it hosts several national conferences simultaneously….
There were a couple of factors that I found reassuring – firstly that I would have an experienced and expert co-presenter in Dr Matt Hill (Consultant Anaesthetist & Regional Patient Safety Lead) and secondly that I was comfortable with the subject matter, having been involved in the safety culture work since March this year.
We were due to speak on day two of the conference and I was there for day one, making the most of seeing other speakers and meeting people on the Patient Safety Collaborative stand. So…..the day of the presentation dawned. Matt opened and talked through “Vulnerable System Syndrome”, the seven steps to patient safety, key messages from the Frances enquiry, the Berwick Report, and our perception of “What is a safety culture?” Watching him was like a masterclass in calm, measured, interesting delivery…..no pressure! When my turn came, though, everything fell into place, the preparation kicked in and sharing what we had learned became the focus. Looking out at the dimly lit audience it was hard to tell how we were being received aside from the nods I could see and people taking photos of the slides, which was heartening. I started by talking through the detail of the SCORE Safety Culture Survey and drilled down into the detail. The analysis groups the questions in the survey into a series of domains – the first domain is the Learning Environment, which assesses the ability of the work setting to reflect on itself and how effective its’ work practices are, looking at both its’ strengths and the opportunities for improvement and learning. The second domain is local leadership which examines the perception of opportunities to interact with local leaders and whether individuals and teams feel that they receive appropriate levels and types of feedback about their performance, which is another hallmark of a learning culture – so, is feedback seen as a useful tool and is it used for driving improvement? Feedback in a learning culture is given to both individuals and teams and can be from a variety of sources, so for example, from patients, managers, peers and external bodies. This domain also enables us to look at whether a team celebrates success – is good feedback displayed for all to see, for example, so that we can maximise the positive benefit for the morale and performance of the team?
The next domains are related to Burnout, one which relates to the individual’s perception of their team members’ burnout and one which relates to the individual’s perception of their own burnout. These domains essentially assess perceptions of emotional exhaustion, so where scores are high we would need to look at what it is that affects the work setting in an emotionally unhealthy way. This may be as simple as the language which is commonly used in the workplace, so when people are very busy and this is aired in a negative way – don’t know how to get through the day etc, this inevitably has an impact on each individual’s perception of their colleagues’ burnout and what we usually find is that the perception of others’ burnout is higher than the perception of our own burnout because we feel more in control of our own situation than of others.
The teamwork domain assesses the effectiveness of communication in the workplace and the impact this can have on patient safety. This includes whether there are issues between those working in different disciplines and if people find that they have to deal with difficult colleagues on a regular basis, as this can affect the team’s ability to operate effectively. Communication issues often arise in the health system because of the structural issues people have to negotiate and find a way through. Teams with a healthy and safe culture are those who maximise the efficacy of teamwork by starting with shared goals and communicating frequently, clearly and positively. Briefings and debriefings are tools which can be used to highlight actions needed and to reflect on what went well as well as what can be improved.
With the safety climate domain, there is a powerful question about whether people would feel safe to be treated in their work setting as a patient. The domain also assesses perceptions of shared values and the psychological safety present in the team when raising, discussing and learning from errors. This reflects whether there is an open, just culture which assesses what has happened in the system when there is an error or adverse incident, rather than looking to blame an individual. These are indicators, alongside suggestions about quality being acted upon, relating back to whether the team has a learning culture.
The final domain is the Work Life Balance domain which allows insight into whether at the extremes, a culture of taking breaks, leaving on time etc is in place or if an expectation has developed for people to work through breaks and work extra hours as the norm and how this may affect people outside of work. It is also useful for examining any frustrations with technology and thinking about how this can be addressed
I then worked through example results and where we go with the results. This part of the process is key to understanding and unpicking the reasons for the results…we debrief the staff, going through the survey analysis with them in order to build up an understanding of the way they answered, this includes asking them to give examples of where things go well and where they have ideas for improvement so we can really get into the granularity of the results and decide how to take things forward.
After debriefing, the team goes through a period of improvement, working on the areas they have identified to work on, and after an interval of 9 – 12 months we survey again to see how and if the results have changed. We are just at the point of re-surveying the first teams who took part in the survey in the South West, so really interested to see what the results of the second surveys will show.
Matt went on to explain the importance of leadership and the approaches to this which contribute to creating a safe culture. We had lots of questions at the end of the presentation, followed by more specific one to one contacts after the formal Q&A session was over. The immediate feedback was positive and overall it was a great opportunity.
On a personal note, the female readers will understand the ongoing debate I had with myself about the appropriate footwear for the occasion – I decided to risk a possible Bridget Jones moment and go for the high green suede heels and I can confirm that they definitely helped!