March 13, 2017
At the 2016 Annual Meeting of the Massachusetts Medical Society (MMS) the below resolution was unanimously passed by the House of Delegates
That the MMS encourage the use of culture of safety (COS) surveys by physicians in their medical offices and where applicable in ambulatory surgical centers where they work.
The Culture of Safety (COS) survey has been widely adopted by hospitals and repeatedly validated. See Agency for Healthcare Research and Quality (AHRQ) website. Now the natural extension is to move it to the medical office and ambulatory surgical center setting . There is no cost for the survey and the AHRQ offers tailored surveys for each of these settings. COS surveys enhance communication, team work and transparency. By promoting feedback within the healthcare team areas of weaknesses within a practice setting and service delivery can be identified. The use of these surveys is crucial for the efficient operation of high reliability organizations across industries.
Once the survey tool is distributed and filled out , caregivers can check their results against a benchmark national database maintained by the AHRQ and then use the measures to identify opportunities for improvement. I personally suggest also surveying your patients with a simple tool to insure that you are fulfilling their needs and to further identify possible weaknesses in the service delivery which can be improved. The adoption of the survey tool inherently indicates a willingness to critically evaluate your service delivery and improve the practice. The success of the surveys may be the self selection of clinicians committed to excellence and continuous improvement.
When embarking on a COS survey clinicians and staff need to be aware of the tools available to correct deficiencies identified in the process. These tools could include performing system analysis with Lean Six Sigma, Kaizen, the model for improvement( used by the IHI with free training modules online) and performing root cause analysis and some familiarity with plan /do /study /act cycles. Frequently, there are significant gaps in knowledge in the theory, methodology and tools used in process improvement by many. Fortunately easy steps can be adopted to ameliorate the situation.
The work and theories of Deming are not part of the routine training of physicians, administrators and most healthcare team members. Furthermore the techniques of process improvement are not part of the experience of most staff. For there to be a culture of safety, the lexicon and tools of process improvement must be understood by all those at the table. Regardless of the descriptor presented, Lean, Six Sigma, Kaizen or the Model for Improvement, the team must speak the same language and understand the methods.
I believe a champion of the system analysis tools should be chosen who can educate and orient the team to the tools and their use. The champion can then educate senior management and remaining staff as well as onboard new hires. Understanding and using system analytic tools is crucial for developing and maintaining a culture of safety. Creating a comprehensive tool kit covering the basic elements for process improvement using the chosen methodology of the organization is very helpful. Lastly and just as important is to be sure to update the skill set so that the newest, best practices in process improvement are communicated to the key members of the team. Having a dedicated person responsible for updating the senior mamangement and new hires creates accountability. The essential element of new member training and maintenance of knowledge will ensure that a culture of safety will thrive.
2500 years ago Socrates said the life unexamined is not worth living. COS surveys allow caregivers to be self critical and seek opportunities to improve. Adopting COS surveys shows your staff and your patients a commitment to excellence.
Copyright Nicolas Argy, MD, JD 2017