Presentation Authors: Janelle Fox*, Ines Stromberg, Todd Sterling, Erik Grossgold, Rustin Walters, Portsmouth, VA
Introduction: Contemporary data from a 2013 study (James) estimates serious health care related harm in 210,000 patients annually. A minority (1%) of these injuries are due to negligent care, whereas the majority of errors and patient safety concerns are attributed to poor processes. As there is no roadmap for Urology clinics to follow to improve patient safety and reduce medical error, the Naval Medical Center Portsmouth Urology clinic wished to determine if our &[Prime]culture of safety&[Prime] improved over a 12-month period following 18 quality improvement/patient safety (QIPS) projects.
Methods: All levels of the 34 full-time clinical staff were physically and electronically given the Johns Hopkins Armstrong Institute Safety Culture Survey at three time points during FY2018 for voluntary, anonymous completion (baseline, 6 and 12 months). During this time period, performance improvement projects were robust including: nurse-led 4DX projects, physician-led complication trending, and medical-assistant led clinic-wide initiatives. Survey results were summarized and statistical calculations completed in SPSS (version 25).
Results: Survey response rates improved as follows over time in three groups (baseline, month 6, month 12): 17.6% (6/34), 29.4% (10/34), and 44.1% (15/34 staff). The degree of understanding about a &[Prime]culture of safety&[Prime] did not significantly change over time for response groups (mean ± standard deviation): 3.167 Â± 1.169 vs. 3.750 Â± 0.707 vs. 3.400 Â± 0.828 (F(2,26)= 0.097, p= 0.908, one-way ANOVA). In addition, there was no difference between survey groups&[prime] Manchester patient safety framework scores over time (χ2(12)= 15.00, p= 0.24). Over the survey period, there was a transition in perception of things done well from individual (Professionalism, Interpersonal communication skills) to systems/process-based competencies (Practice-based learning and improvement, Systems-based practice). The implementation of clinic-wide Team STEPPS and clinic safety champions were cited the biggest facilitators of patient safety, with the most commonly cited barriers of staff turnover and communication.
Conclusions: No improvement was seen in our clinic&[prime]s understanding of the &[Prime]culture of safety&[Prime] or its patient safety framework score with repeated QIPS projects. While safety culture surveys can help a surgical clinic identify what is important to its staff to focus QIPS efforts, this study more importantly highlights that projects alone are insufficient to improve staff perception of a safety culture. Correlation of staff perception with patient outcomes is more challenging to track but is the goal of future clinic studies.