# Presentation: 709614

## Indian River Memorial Hospital

- Barbara Horne, VP/Chief Nursing Officer
- 335-bed not-for-profit community hospital in Vero Beach, Florida* *
- Early adopter of survey
- Decided to conduct a patient safety survey
- Establish a baseline measurement
- Perceived mistrust in past; was it dissipating?

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## Decision to Use AHRQ Survey

- Learned of AHRQ survey at workshop  *  *
- Research-based
- Easily administered
- Support available during administration and evaluation
- Can be used across the organization
- After discussion with developers at Westat, removed 4 staffing questions
- Concerned about setting up an unrealistic expectation that staffing patterns would be changed based on results of the survey

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## Survey Sample

- 1,200 to 1400 employees depending on the time of year including seasonal and per diem staff.  We average about 1000 paid FTEs per pay period.
- Initial discussion about including non-clinical staff, but decided they should participate
- Non-clinical staff spend time in care delivery areas, make observations, see results of care delivered, or talk with patients after discharge
- Offer a different perspective in regard to culture
- Wanted across-the-board assessment to be able to compare clinical versus non-clinical responses

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## Data Collection Procedure

- IS guru developed a web-based version of the survey and placed it on our intranet. Meal ticket incentive
- A certificate could be printed upon completion of the web survey
- Survey promotion activities
- Letter sent to employees homes before survey from the CEO
- Notice on pay checks
- Posters and e-mails sent out
- Follow-up letter midway through time period
- 6-week data collection time period
- Due to hurricanes, extended the field period!

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## Survey Response

- 619 surveys completed; greater than 50% response rate largely due to incentive of meal ticket attached to completion
- 75% of respondents were clinical staff
- More manager support and encouragement may have improved our response rate, but we did much better than we anticipated

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## Survey Results

- Hospital technical staff developed a survey results reporting tool in Excel
- Bar charts, 5-point Likert scales condensed into just three points (negative, neutral, positive)
- Can display results in aggregate, by department, length of service or by job classification
- Distributed survey results electronically through the Excel tool
- We provided initial input for Premier’s Customized Excel tool which is similar to what we developed

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## Sharing Survey Results

- Results shared with all directors and managers
- Has been distributed house wide through Department Directors and Managers.
- Surprised and pleased with the extent of participation
- Encouraged overall with the results (less negative than anticipated)
- Concerned that pockets of staff may perceive there to be a risk of retribution for bringing safety issues to light

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## Action Planning/Follow-up

- VP/CNO had one-on-one conversations with managers in areas of concern; plan to do further follow-up
- Currently developing individual goal-based incentive pay program
- For managers, would like one goal to address issues raised in survey as appropriate
- Leadership Academy of the Advisory Board Company in Washington, DC presented a module on patient safety to our midlevel managers specifically using our survey results.
- Communication between departments needs to be a focus of manager

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## PACU/Surgical Unit Tool	

- Patient name/_brief_ history
- Surgical Procedure
- Surgeon/Anesthesiologist
- Type of anesthesia
- IV Fluids
- Estimated Blood Loss
- Pain Score
- Last pain med given
- Discharge Order check marked?
- Last Vital Signs
- Length of stay as Phase I PACU patient
- Other essential information to know?

## Lessons Learned & Future Plans

- Needed 3 hospital staff who worked together on the survey project
- All were detail-oriented, good at follow through
- Next time, plan to improve survey results follow-up
- Give staff access to results more quickly
- Initiate action plans more quickly
- Definitely plan to redo the survey after 1 year, hopefully in the fall
- Not during the peak of hurricane season!

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