Muskie School of Public Service Tennessee Rural Hospital Patient Safety Demonstration Judy Tupper, MS, CHES Research Associate Presented at the Tennessee Hospital Association’s 14th Annual Small or Rural Hospital Conference Nashville, TN April 6, 2007
Institute for Health Policy Muskie School of Public Service GOAL To test the feasibility, cost, and impact of implementing a set of patient safety interventions with a sample of small rural hospitals.
Institute for Health Policy Muskie School of Public Service Demonstration Participants • Tennessee Hospital Association • Universities of Southern Maine (Lead), Minnesota, and North Dakota – Andy Coburn (PI) and Judy Tupper (Project Director), Maine Rural Health Research Center, University of Southern Maine – Ira Moscovice, Upper Midwest Rural Health Research Center, University of Minnesota – Jill Klingner, University of Minnesota – Mary Wakefield, Center for Rural Health, University of North Dakota • QSource (Tennessee QIO) • Eight Small Rural Tennessee Hospitals • Funder: BlueCross/BlueShield of Tennessee
Institute for Health Policy Muskie School of Public Service Activities of Project • Patient Safety Culture Survey • Record of survey process • Record of feedback to hospitals • Intervention prioritization process – Safety culture, ER protocols, PDA utilization • Intervention planning • Intervention collaborative with QIO – Monthly conference calls, quarterly gatherings – Structure, technical assistance, best practices • Repeat Safety Culture Assessment 3/06, and 12/06 • Evaluation of implementation process and initial results of interventions – (site visits, phone surveys) • Provide lessons learned for spread to other rural hospitals
Institute for Health Policy Muskie School of Public Service The Hospital Survey on Patient Safety Culture was distributed in 3/2005, 3/2006, and 12/2006, to staff at 8 participating hospitals in the Tennessee Rural Hospital Patient Safety Project. ~ 3 rounds of surveys averaged 74% response rate (AHRQ pilot 29%)* ~ 3 rounds of surveys averaged direct patient contact 76% (AHRQ pilot 84%)* * Benchmark data from AHRQ survey pilot of 1400 staff from 20 hospitals.
Institute for Health Policy Muskie School of Public Service Strengths •Supervisor/manager expectations and actions promoting safety •Organizational learning •Teamwork within hospital areas •Hospital management support Weaknesses •Non-punitive response to errors •Hospital handoffs and transitions
Institute for Health Policy Muskie School of Public Service AHRQ Culture Survey: Tennessee Hospitals Overall Perceptions of Safety 80% 69% a 67% a 56% 60% 56% 56% 56% 40% TN Hospitals AHRQ Benchmark 20% 0% March 2005 April 2006 December 2006 Survey Date a Significantly different from March 2005 survey Source: AHRQ Benchmark, Sorra JS, Nieva VF. Hospital Survey on Patient Safety Culture. (Prepared by Westat, under Contract No. 290-96- 0004). AHRQ Publication No. 04-0041. Rockville, MD: Agency for Healthcare Research and Quality. September 2004.
Institute for Health Policy Muskie School of Public Service AHRQ Culture Survey: Tennessee Hospitals Frequency of Events Reported 80% 69% a,b 63% a 60% 52% 52% 52% 51% 40% TN Hospitals AHRQ Benchmark 20% 0% March 2005 April 2006 December 2006 Survey Date a Significantly different from March 2005 survey b Significantly different from April 2006 survey Source: AHRQ Benchmark, Sorra JS, Nieva VF. Hospital Survey on Patient Safety Culture. (Prepared by Westat, under Contract No. 290-96- 0004). AHRQ Publication No. 04-0041. Rockville, MD: Agency for Healthcare Research and Quality. September 2004.
Institute for Health Policy Muskie School of Public Service AHRQ Culture Survey: Tennessee Hospitals Supervisor/Manager Expectations & Actions Promoting Patient Safety 100% 80% a,b 76% 72% 80% 71% 71% 71% 60% TN Hospitals AHRQ Benchmark 40% 20% 0% March 2005 April 2006 December 2006 Survey Date a Significantly different from March 2005 survey b Significantly different from April 2006 survey Source: AHRQ Benchmark, Sorra JS, Nieva VF. Hospital Survey on Patient Safety Culture. (Prepared by Westat, under Contract No. 290-96-0004). AHRQ Publication No. 04-0041. Rockville, MD: Agency for Healthcare Research and Quality. September 2004.
Institute for Health Policy Muskie School of Public Service AHRQ Culture Survey: Tennessee Hospitals Organizational Learning/Continuous Improvement 100% 77% 76% 74% 80% 71% 71% 71% 60% TN Hospitals AHRQ Benchmark 40% 20% 0% March 2005 April 2006 December 2006 Survey Date Source: AHRQ Benchmark, Sorra JS, Nieva VF. Hospital Survey on Patient Safety Culture. (Prepared by Westat, under Contract No. 290-96-0004). AHRQ Publication No. 04-0041. Rockville, MD: Agency for Healthcare Research and Quality. September 2004.
Institute for Health Policy Muskie School of Public Service AHRQ Culture Survey: Tennessee Hospitals Teamwork Within Areas 100% 83% a,b 79% a 74% 80% 74% 74% 60% 68% 40% TN Hospitals AHRQ Benchmark 20% 0% March 2005 April 2006 December 2006 Survey Date a Significantly different from March 2005 survey b Significantly different from April 2006 survey Source: AHRQ Benchmark, Sorra JS, Nieva VF. Hospital Survey on Patient Safety Culture. (Prepared by Westat, under Contract No. 290-96-0004). AHRQ Publication No. 04-0041. Rockville, MD: Agency for Healthcare Research and Quality. September 2004.
Institute for Health Policy Muskie School of Public Service AHRQ Culture Survey: Tennessee Hospitals Communication Openness 80% 67% a,b 61% 61% 60% 61% 60% a 50% 40% TN Hospitals AHRQ Benchmark 20% 0% March 2005 April 2006 December 2006 Survey Date a Significantly different from March 2005 survey b Significantly different from April 2006 survey Source: AHRQ Benchmark, Sorra JS, Nieva VF. Hospital Survey on Patient Safety Culture. (Prepared by Westat, under Contract No. 290-96-0004). AHRQ Publication No. 04-0041. Rockville, MD: Agency for Healthcare Research and Quality. September 2004.
Institute for Health Policy Muskie School of Public Service AHRQ Culture Survey: Tennessee Hospitals Feedback & Communication about Error 80% 68% a,b 63% a 53% 60% 52% 52% 52% 40% TN Hospitals AHRQ Benchmark 20% 0% March 2005 April 2006 December 2006 Survey Date a Significantly different from March 2005 survey b Significantly different from April 2006 survey Source: AHRQ Benchmark, Sorra JS, Nieva VF. Hospital Survey on Patient Safety Culture. (Prepared by Westat, under Contract No. 290-96- 0004). AHRQ Publication No. 04-0041. Rockville, MD: Agency for Healthcare Research and Quality. September 2004.
Institute for Health Policy Muskie School of Public Service AHRQ Culture Survey: Tennessee Hospitals Non-Punitive Response to Error 60% 50% a,b 43% 44% a 40% 43% 43% 35% TN Hospitals AHRQ Benchmark 20% 0% March 2005 April 2006 December 2006 Survey Date a Significantly different from March 2005 survey b Significantly different from April 2006 survey Source: AHRQ Benchmark, Sorra JS, Nieva VF. Hospital Survey on Patient Safety Culture. (Prepared by Westat, under Contract No. 290-96-0004). AHRQ Publication No. 04-0041. Rockville, MD: Agency for Healthcare Research and Quality. September 2004.
Institute for Health Policy Muskie School of Public Service AHRQ Culture Survey: Tennessee Hospitals Staffing 80% 54% a 60% 50% 52% a 50% 50% 40% 46% TN Hospitals AHRQ Benchmark 20% 0% March 2005 April 2006 December 2006 Survey Date a Significantly different from March 2005 survey Source: AHRQ Benchmark, Sorra JS, Nieva VF. Hospital Survey on Patient Safety Culture. (Prepared by Westat, under Contract No. 290-96-0004). AHRQ Publication No. 04-0041. Rockville, MD: Agency for Healthcare Research and Quality. September 2004.
Institute for Health Policy Muskie School of Public Service AHRQ Culture Survey: Tennessee Hospitals Hospital Management Support for Patient Safety 100% 78% a 78% a 80% 72% 60% 60% 60% 60% 40% TN Hospitals AHRQ Benchmark 20% 0% March 2005 April 2006 December 2006 Survey Date a Significantly different from March 2005 survey Source: AHRQ Benchmark, Sorra JS, Nieva VF. Hospital Survey on Patient Safety Culture. (Prepared by Westat, under Contract No. 2
Institute for Health Policy Muskie School of Public Service AHRQ Culture Survey: Tennessee Hospitals Teamwork Across Hospital Areas 80% 67% a 64% 60% 60% 53% 53% 53% 40% TN Hospitals AHRQ Benchmark 20% 0% March 2005 April 2006 December 2006 Survey Date a Significantly different from March 2005 survey Source: AHRQ Benchmark, Sorra JS, Nieva VF. Hospital Survey on Patient Safety Culture. (Prepared by Westat, under Contract No. 290-96- 0004). AHRQ Publication No. 04-0041. Rockville, MD: Agency for Healthcare Research and Quality. September 2004.
Institute for Health Policy Muskie School of Public Service AHRQ Culture Survey: Tennessee Hospitals Hospital Handoffs & Transitions 60% 52% 49% 48% 48% 48% 48% 40% 20% TN Hospitals AHRQ Benchmark 0% March 2005 April 2006 December 2006 Survey Date Source: AHRQ Benchmark, Sorra JS, Nieva VF. Hospital Survey on Patient Safety Culture. (Prepared by Westat, under Contract No. 290-96- 0004). AHRQ Publication No. 04-0041. Rockville, MD: Agency for Healthcare Research and Quality. September 2004.
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