St. Jude Relies on AHRQ's Hospital Survey on Patient Safety Culture

St. Jude Children's Research Hospital, an institution focused on pediatric cancer and other catastrophic diseases, treats nearly 8,000 patients annually and has used AHRQ's "Hospital Survey on Patient Safety Culture" since 2009 to understand and improve the hospital's culture, identify areas ripe for quality improvement, and collect data on its own research projects.

"The Hospital Survey on Patient Safety Culture Survey is a trusted tool that is used by over 1,000 hospitals and has been validated in many contexts and cultures," says James M. Hoffman, PharmD, the Medication Outcomes and Safety Officer at St. Jude. "We believe the entire process of promoting the survey—participating, discussing, and sharing the results of the survey and then using the results to prioritize improvement efforts—helps us improve patient care."

AHRQ's tool helps hospitals assess their patient safety culture, track changes, and evaluate the impact of patient safety interventions. "Because we have used the survey several times to date, we are developing a rich dataset to track our patient safety culture over time, which is valuable," notes Hoffman. "We really view the survey as a key input into what we can do better."

At St. Jude, survey results are reported across the hospital, including to its Board of Governors. St. Jude promotes and distributes the survey every 2 years and has done so three times to date. Survey response rates have ranged from 46 percent to 54 percent among about 1,000 eligible participants. Of St. Jude's approximately 4,000 employees, the survey is sent only to patient care employees.

"The survey process has really become woven into the fabric of how we assess and improve patient safety at St. Jude," says Hoffman. "It helps keep us focused on patient safety at all times. At other times it validates what we were already working on to improve, and it also gives us new insights on opportunities we may not have realized existed."

For example, survey results in 2009 about feedback and communication of errors prompted St. Jude to put into place a variety of methods to improve communication about events, including new summaries from the hospital's voluntary event reporting system that lead to more discussion about specific events. "Managers are talking to staff about events and near misses, and the ways we can improve," says Hoffman. "It's not about blaming them that an error occurred."

That change and others led to a sharp increase—from 59 percent in 2009 to 76 percent in 2011—of employees positively responding about the hospital's feedback and communication regarding events. The hospital also compiles quarterly summaries of entered event reports, which are discussed at a variety of meetings. Distributed information includes trending data for frequency of total submitted reports, types of events (e.g., medication variances, device failures), severity of harm, contributing factors, clinical services, and staff positions.

St. Jude also modified its customized electronic event reporting system to improve its patient safety culture. Specifically, a text box was added for event reporters to provide their own suggestions to improve aspects of the patient care delivery system that contributed to the event. St. Jude also streamlined the interface with a goal of making the time to enter an event report of 2 minutes or less.

The survey also measures the effectiveness of handoffs and transitions, and St. Jude's scores on this dimension validated a recent quality improvement project in this area, which led to seven changes in how handoffs are performed at St. Jude. The project significantly reduced the number of cases of poor handoff communication among physicians.

St. Jude recently used administration of the AHRQ survey to conduct a study on the "second victim" phenomenon in health care—the personal and professional anguish health care workers can experience after their involvement with unanticipated patient harm. The pediatric research hospital has also used AHRQ's survey in guiding its implementation of a "just culture" for patient safety. Just culture balances nonpunitive response to errors with elements of fair and just accountability.

When hospital officials needed a validated instrument to assess staff's experience with second victim phenomena, "St. Jude's routine use of the Patient Safety Survey once again served as an excellent platform to conduct research," says Hoffman. In 2013, the hospital collected validation data on a measure of second victim experiences and support resources. In 2011, a similar strategy was used to validate a survey designed to measure the hospital's just culture, which was recently published in the Journal of Patient Safety.

Officials saw that "certain dimensions of the survey are very relevant to a just culture," notes Hoffman. These dimensions include nonpunitive response to error, communication openness, hospital management support for patient safety, and feedback and communication about errors. "The results from the just culture components of the survey helped initiate the formation of a work group that is striving to implement a just culture throughout the entire institution. As a research effort, we have developed and validated a tool to specifically measure just culture in hospitals, and the patient safety survey was a key reference as we developed this survey," he adds.

"We can never be complacent," concludes Hoffman. The AHRQ Hospital Survey on Patient Safety Culture  "keeps us driven and forward looking, and as a research institution we're data driven," says Hoffman. "The survey is an essential patient safety technique for any hospital."

For more information on St. Jude, visit: http://www.stjude.org/about.