Using SCORE Safety Culture Survey in the Emergency Department at Derriford Hospital

Dr Annette Rickard, Consultant in Emergency Medicine at Derriford Hospital, Plymouth shares her experiences of the SCORE Safety Culture Survey from the South West Academic Health Science Network the and how this has been used within the emergency department team.
“About three years ago the College of Emergency Medicine set up the requirement for Safety Leads for each Emergency Department, and I became the safety lead at Derriford Hospital. I first heard about the Safety Culture Survey via the South West AHSN (SW AHSN) in 2015. I was keen to find out more about what safety means in Emergency Medicine, so set up a meeting to brainstorm what was important to the team here: What is safety culture? Why is it important? What does safety mean in this department? My anaesthetic colleague, Matt Hill (who also works with the SW Academic Health Science Network), introduced me to the SCORE Safety Culture Survey. He had just started using it for his team and as we thought it sounded like a good tool, we met and worked out logistics. There are about 250 people in our department, with a wide range of roles:  porters, doctors, receptionists, nurses etc. There is also a real flux in staff, as we have many junior doctors in training rotating through our ED, nurses who change roles and military staff attached to the department. We wanted to work out how best to capture the views of as many people as possible, in order to make the results meaningful.
We first ran the SCORE Safety in July 2015 and asked everyone in the department to fill it in. We pre-warned staff members and managed to get champions across the tiers – communicating why we were doing the survey; encouraging people ad hoc and getting nurse champions to encourage peers to complete it.  We also created a few screensavers explaining what safety culture was.
We were actually really pleased with our response rate, as around 60% of people completed the survey. The results were sent off for analysis and then Allan Frankel of IHI talked us through the analysis and the results and put perspective on it. He was able to explain about safety culture and how the SCORE survey tool explores what level of safety culture you have reached within your own organisation – not about comparing with other departments or areas. Once we had received the results we wanted to know more about individuals’ responses. Matt Hill and I, together with Jilly Ball, a senior nurse safety culture champion, and Amelia, a quality improvement professional from IHI, arranged about 20 or 30 sessions between the end of October 2015 and the Christmas break to feedback to small groups using the radar diagrams and free text. Together we were able to explore some of the themes coming up. We were able to feedback to mixed groups of tiers of nurses and doctors and a couple of big groups, for example – doctors in training and all of the consultants, which were quite targeted, specific group sessions.
One of the key messages that came out of the survey was a really simple thing to fix. It was highlighted that there was an element of poor communication within the department and this was something that we could fix really quickly and easily, simply by improving the way people speak to each other and getting people to think about the way they were speaking to each other.
A bigger theme emerged, which was burnout and the causes of burnout and unhappiness –  with the main culprits being lack of staffing, overcrowding and lack of space. The service line lead took this up with Trust and went to the Board with our Safety Culture evidence and this was presented to the Safety and Quality commission also. They were really receptive to this. We also identified areas for improvement – such as the allocation of time – how long do nurses need to write up rotas in a timely fashion? The answer is considerably more than they were getting.
We also tweaked areas that we currently work on.  Up until the survey, we had already run twice yearly safety days, which in the past focussed on where things had gone wrong and learning from it. Since the SCORE survey, however, we have now introduced to the Safety Days a QI slot, where Matt and Amelia have come in to talk about Improvement methodology in mixed groups. For some people, key areas of dissatisfaction were the nursing rota, for others printer problems or the interface between wards and work has started on this by our own staff groups who feel passionately about the problem.
In these times where Trusts are feeling the pinch and staff may be a bit demoralised, this positive work is going on in the background and helps strengthen cohesion within our department and build team morale.
We are now looking at re-running the survey in November to get a real measurement of what we have achieved and how things have improved and I hope to share details of this when we have received them.

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