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2015 Safety Culture Survey shows value of HRO training

The 2015 Patient Safety Culture Survey results are in, and show that high reliability organization training is working.

A total of 7,534 YNHH employees took the 2015 survey, 18 percent more than the last survey in 2013. Part of a coordinated Yale New Haven Health System initiative, the survey included statements about employees' work areas/units and the hospital in general. Employees were asked how much they agree with statements such as "We are actively doing things to improve patient safety" and "We have enough staff to handle the workload."

"Now that we have gone through HRO training and are adding programs to sustain these principles, future surveys will show if we progress in meeting and exceeding our benchmarks," said Ellen Macone, patient safety coordinator, Quality Improvement Support Services.

Results showed that YNHH improved in six domains: non-punitive response to error; openness and communication; staffing; feedback and communication about error; supervisor/manager expectations and actions promoting safety; and teamwork within hospital units.

Non-punitive response to error improved by 11 percent since the last survey. Openness and communication increased after declining in 2008 and 2013; and staffing, a significant issue in 2013, improved this year.

Implementation of the daily morning safety report likely accounted for most of the increase in the top two domains, said Thomas Balcezak, MD, chief medical officer.

"It's incredibly important to have a good system to detect, analyze and report back to staff what we're hearing, and how we're working on issues and trying to improve the organization," he said. "Communicating to all the employees and medical staff members is a challenge. The fact that we're improving is a testament to all our hard work. We can only get better at communication, which is a foundation of safety."

Other domains, including hospital handoffs and transitions, teamwork across the hospital, management support for patient safety, frequency of event reporting and overall perceptions of safety, showed modest declines since 2013. Handoffs showed the largest decline, which Dr. Balcezak attributes to the fact that there are more handoffs and transitions happening than ever before.

"Handoffs reflect how we communicate with one another across disciplines, units and areas of the institution," he said. "We're going to work on that and break it down."

With the survey results, the hospital can take next steps to sustain the HRO safety behaviors, including continued HRO training for current and new employees, hospital leaders rounding, safety stories and Great Catch awards and morning safety report. In addition, the hospital will train approximately 400 HRO safety coaches, and Human Resources will implement an accountability program.

Research has shown that improving safety culture survey results correlates with better clinical outcomes, Dr. Balcezak said.

"Survey results show that our high reliability work is taking root and continuing to grow, and will inform our work going forward," he said. "There are some encouraging things in these results. We still have a lot of room to improve, but this strengthens our resolve to continue on the path we've already begun."

"For the past two years, Yale New Haven Health System has focused on improving safety in our hospitals and physician offices," said Alan Kliger, MD, senior vice president and chief quality officer, YNHHS. "A key component has been training all 20,000 system employees in the HRO behaviors they are now using in their daily activities. The survey shows us how well every health system employee understands the importance of creating a safety culture that protects our patients, and we will use the results to continue our journey toward high reliability."