#SuperSHIFTER Gail Blackmore is the Senior Director of Quality Improvement and Safety with Nova Scotia Health Authority (NSHA). NSHA has adopted the Patient Safety Culture Bundle for CEOs and Senior Leaders to develop a positive patient safety and quality culture strategy and is implementing a dashboard to monitor their culture of quality and patient safety.

Why did Nova Scotia Health Authority choose the Patient Safety Culture Bundle to support its patient safety and quality improvement work?

Our patient safety and culture strategy framework is modeled from the Canadian Patient Safety Institute's Patient Safety Culture Bundle for CEOs and Senior Leaders (Bundle). The Bundle is a good match for us. It provides clarity and direction to healthcare leaders on the components involved in providing safe, reliable and effective care. The vital practices that are embedded into the Bundle are evidence-based and this is important from our perspective. We are committed to fostering existing practices and identify and implement new approaches, and the Bundle presents a way to do that.

The Bundle has three key elements – Enabling, Enacting and Learning – and actions to focus on in each of the elements that cover the key concepts of patient safety. There are also additional resources available, if you want to learn more about the key concepts. The Bundle is very comprehensive. It really acknowledges that there are multiple inputs and complexity in a safety culture for healthcare.

Can you provide examples of how the Bundle has helped to better align your work?

Since the activities noted in the Bundle are based on best practices and are found to have a positive impact on improving patient safety culture, it facilitated alignment of internal activities to focus our actions. Examples include patient stories, which are now being used across the organization to begin team meetings, start a discussion on quality and safety, and refocus the work on the experience of the patient and family.

Through the Bundle, we have also been able to do a deeper dive into just culture and expand the use of safety huddles and leadership safety rounds. A partnership with NHS Scotland/Education for Scotland to pilot safety culture discussion cards for healthcare teams, educators and leaders was highlighted at the 2019 Institute for Healthcare Improvement (IHI) National Forum on Quality Improvement in Health Care through a poster presentation by Erin Beaton, a Quality Director in our team. Safety Huddles were confirmed as an organizational priority to create system-wide and patient-specific changes and to support teamwork. An established working group continues to augment NSHA resources and processes to support Safety Huddles and evaluate their effectiveness. Reinforcing the goal of improving patient safety culture, Leadership Safety Rounds were additionally noted as an organizational priority initiative. The expansion of this practice has demonstrated Leadership commitment to building a culture of safety.

The role of our patient and family advisors (PFAs) has also evolved – we have created a focused system to recruit and retain advisors, and to nurture meaningful engagement. PFAs are now an integral part of the decision-making working group for disclosure. They participate fully in this process, bring the patient and family perspective and are an equal voting member to determine recommendations from the working group. Patients and families are also involved in prospective reviews, as full members of the system-wide Failure Mode and Effects Analysis (FMEA) review team, with leaders, physicians and staff. This work in patient engagement is recognized as leading practices with the Health Standards Organization (HSO).

Can you tell us about the dashboard you have developed to monitor and evaluate your quality and patient safety culture?

The quality improvement and safety team and the performance and analytics team collaborated to develop the dashboard concept. The intention was to bring data from various sources together in a single location and provide NSHA with a user friendly, simple, yet comprehensive visual on important patient safety culture information that can be used to examine and understand performance at the organizational and zone levels.  

An Excel spreadsheet outlines the three Bundle elements and their associated evidence-based practices, along with selected indicators and the most current data. Aligned indicators were chosen from existing HSO and Accreditation Canada surveys, such as the patient safety culture, workplace and governance survey tools. A question from the Canadian Patient Experiences survey, an in-patient survey provided by the Canadian Institute for Health Information (CIHI), was selected to track patient engagement. Where existing Accreditation survey questions could not be aligned, we looked to internal processes and data already being collected to identify measurable indicators for each element of the Bundle. Examples include data reported within the organization's Safety Improvement and Management System (SIMS) and from monitoring patient and family advisor engagement on quality improvement and safety teams.

The number of indicators per key concept was kept to a minimum, however in certain cases we did find it useful to map more than one question to a concept because it allowed a greater depth of information for those really complex areas, like just culture as an example. With the data organized in a visual way, it's a lot easier to analyze and translate data for action. To further ease analyzing a large amount of data points, colour-code formulas have been built in, similar to the red, yellow, green flag color scheme used in the accreditation surveys. The color coded flags provide a good visual of where we are doing well and where the opportunities for improvement are as it quickly brings important information together in a comprehensive way.

We are still in early days of using the dashboard and the Bundle to look at our actions. We continue to seek opportunities to learn more from each other within our health system, through evidence-based tools like the Bundle, and by continuing to spread best practices. It takes perseverance, but we can do more together from that perspective.

Can others replicate this evaluation process?

Yes. The Bundle can be used to align and develop organizational frameworks. The dashboard indicators were chosen from existing HSO and accreditation tools wherever possible, so that is quite transferrable to other organizations. Indicators that did not map to an existing survey or tool were aligned to organizational priorities, and others would be able to do that as well.

To learn more about the dashboard, contact Gail.Blackmore@nshealth.ca.