Creating a culture of safety demands more than performing time outs and signing surgical sites. It requires raising staff awareness about protecting patients, identifying strengths and areas of needed culture improvement, and measuring how new initiatives improve patient safety. The Agency for Healthcare Research and Quality has done the heavy lifting for you by creating the Ambulatory Surgery Center Survey on Patient Safety Culture (see “Take the ASC Survey on Patient Safety Culture”).

The 30-question survey asks staff to check 1 of 5 boxes — which gauge their feedback from “never” to “always” — next to a variety of safety-related questions, such as how comfortable they feel speaking up when patients are in jeopardy and how well surgeons communicate with other team members in the OR to how near-misses and mistakes are handled to the level of support management puts behind safety initiatives. I’ve asked my staff and surgeons to complete the survey annually for the past 4 years. The survey (osmag.net/RXb8dS) has proved to be an invaluable tool because we dive into the results instead of simply reading over the responses.

1 Assign and discuss

Creating and maintaining a culture of safety requires setting aside time to communicate with your staff and surgeons about what a safe culture is and what it looks like in practice. Permitting staff and surgeons to complete the survey during work time emphasizes that you support its use and value their feedback. Administer the survey to specific departments — pre-op, the OR, post-op — and present staff with the results in department-specific three-ring binders. Have each staff member initial the binders to ensure they have read through the findings. After everyone has read through the binders, schedule a staff meeting to discuss the survey results. Review the responses to the survey’s open-ended questions and allow staff to clarify their remarks, add perspective or expound on their insights. Reassure staff that all comments made in the survey are confidential, even to leadership. These comments are taken very seriously, and we encourage staff to provide additional feedback during the meeting. You’ll learn a lot about how staff view your facility’s safety culture during those conversations.

2Take action

This is perhaps the most important step in your efforts to change your facility’s culture of safety. The survey is a worthless tool and a fruitless exercise if you don’t seriously consider the results and develop action steps based on your staff’s feedback. Focus on their top 3 areas of concern and potential improvement. It’s essential to show your staff that you hear their concerns and are taking specific action steps to address them. You will likely lose their trust and buy-in if you don’t follow through on implementing suggested changes necessary to further enhance the culture of safety.

3Involve the surgeons

While the survey is intended for staff to fill out, a lack of surgeon involvement is often the missing ingredient in facilities that struggle to develop policies that improve patient safety. Including surgeons in the survey will help to determine where improvements in surgeon-staff communication can be made. Are surgical team members asked to discuss the overall surgery plan just before procedures begin? Do surgeons ask for input from the staff throughout a case?

It’s helpful to partner with a surgeon who your staff likes and respects to emphasize the importance of the survey to her peers and assist in implementing the changes they request. Having a physician-champion is key for improving patient safety. For example, one of our surgeons asked what he could personally do to improve the culture of safety in his OR. I challenged him to address the team before each case like this: “I need you, so I can do my best work. I give you permission to speak up if at any time you see something you’re concerned about or something we need to address, because our goal is to provide the best possible patient care.” Imagine the impact that surgeon can have on the team’s safety mindset by beginning each case with that important and inspiring message.

Empowered or engaged?

There’s a slight, but important, difference between staff who are empowered to protect patients and those who are engaged in doing so. When staff are empowered, they take responsibility for providing a safe environment for their patients and fellow caregivers. They are charged with making change happen. Engaged employees, on the other hand, have an emotional commitment to improving patient safety. They truly believe in their role as a patient advocate and are fully invested in making sure the team performs surgery as safely as possible. Surveying your staff will clue you in as to whether your facility is filled with empowered employees or engaged caregivers. OSM