Mercy Health Uses AHRQ's Patient Safety Culture Survey and TeamSTEPPS® to Enhance Care

Mercy Health, one of the largest nonprofit health systems in the United States, has used AHRQ's Hospital Survey on Patient Safety Culture and team training tools since 2005 to identify and monitor areas where it can improve patient safety. Mercy also uses the AHRQ resources to gain critical insights into opportunities to enhance safety culture efforts.

The Hospital Survey on Patient Safety Culture is a tool hospitals can use to assess their patient safety culture, track changes in patient safety over time, and evaluate the impact of patient safety interventions. Using the survey to monitor its performance, Mercy Health saw steady system-wide improvement in its overall safety score, from 58 percent in 2005 to 61.5 percent in 2011. Mercy Health's goal is achieving AHRQ's "overall perception of patient safety" average of 65 percent—a benchmark based on the average score of AHRQ survey respondents.

When using the survey in 2013, however, Mercy Health saw its trajectory toward achieving this goal fall slightly, to 61 percent. The dip came during a year in which Mercy Health centralized operations throughout its organization. The intensity of that system-wide effort led to a slight drop in its goal of creating and sustaining a culture of safety. At that point, the survey became more than a monitoring tool.

"Our CEO said we took our eye off the ball," says Jana Deen, R.N., J.D., vice president and patient safety officer for Mercy Health. To recalibrate Mercy Health's quality and safety initiatives, "We used the Hospital Survey on Patient Safety Culture as a wakeup call," says Ms. Deen, and the 2013 results became a clear reminder to refocus on patient safety.

Though Mercy Health's safety score suffered a bit, not all of its hospitals saw a decline. Of the 22 Mercy Health hospitals in which the 2013 AHRQ survey was conducted, 12 saw improvements—some significantly. These include St. Joseph Health Center in Warren, Ohio, which saw its safety score increase by 10.4 percent, as well as Mercy Health – Fairfield Hospital in Ohio, which had an overall safety score increase of 8.5 percent.

Of the remaining facilities, scores declined or remained the same compared with 2011 survey results. Overall, the biggest areas of improvement included the survey domains "frequency of events reported," "feedback and communications about error," and "teamwork within units." The largest declines were seen in "management support for patient safety," "organizational learning-continuous improvement," and "staffing."

"The survey has always been a central component of our patient safety program," Ms. Deen says. In recent years, the survey findings have helped Mercy Health revamp its patient safety event reporting system, develop event management guidelines, and decrease reportable events.

This year, Mercy Health reinstituted "Patient Safety WalkRounds" to give frontline staff the chance to discuss patient safety concerns with senior leadership. Mercy also replaced patient beds to reduce incidents of pressure ulcers and to promote patient and staff safety.

Since 2009, findings from AHRQ's survey have helped guide several other patient safety and quality activities at Mercy Health, including the following:

• Implementing SAFECARE, an event reporting system that dramatically reduced the amount of time required to enter an event or near-miss.
• Partnering with the Institute for Healthcare Improvement's "Safety Across the System" in an effort to replicate patient safety improvements seen in hospitals in the United Kingdom.
• Increasing the number of certified safety professionals through "Safety Enhanced by Certified Professionals" training, resulting in 36 individuals, representing all Mercy Health regions, passing a rigorous examination.
• Implementing the "Minimal Lift Program," which is designed to reduce injuries resulting from repositioning and moving patients, in the southwest Ohio region. The program demonstrated a 49 percent annual reduction in acute care patient handling incident reports, a 74 percent reduction in acute care restricted work days, and a 30 percent reduction in acute care lost time days.
• Implementing "Just Culture Principles," which include creating an open and just environment, learning from adverse events, implementing safe systems, and instituting safe behavioral choices.

In addition to the survey, Mercy Health has also implemented TeamSTEPPS® across several facilities. TeamSTEPPS, developed by AHRQ in collaboration with the Department of Defense, is an evidence-based system aimed at optimizing patient outcomes and promoting a culture of team-driven care. The program establishes interdisciplinary team training systems to serve as the foundation for a patient safety strategy.

"When TeamSTEPPS, combined with the survey, was used systemwide in 17 obstetrics departments in Kentucky, we saw lots of success," Ms. Deen says. For example, Mercy saw a significant decline in claims (and dollars spent) in obstetrics events, she notes. After TeamSTEPPS was implemented in all Mercy Health obstetrics departments, 7 of 12 survey domains improved.

TeamSTEPPS was also a key component of a toolkit Mercy Health developed to address disruptive clinician behavior. The toolkit helps senior leadership establish and enforce standards of professional conduct. Individual facilities within Mercy Health customize the toolkit's contents and develop an action plan for implementing its various components. More information on this toolkit is available at http://www.innovations.ahrq.gov/content.aspx?id=2698.

To read more about TeamSTEPPS, visit: http://www.ahrq.gov/professionals/education/curriculum-tools/teamstepps/index.html.

To learn more about the AHRQ's patient safety surveys, go to: http://www.ahrq.gov/professionals/quality-patient-safety/patientsafetyculture/index.html