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Measuring Healthcare Safety Culture Through Employee Voice

The physical and psychological safety of employees has become even more important as a result  of the pandemic, and an increasing number of organizations are placing greater emphasis on safety as a larger factor of well-being. Healthcare is no exception.

Recently, Anne Marie Benedicto, vice president of The Joint Commission Center for Transforming Healthcare, Brooke Eggleston, director of organizational development and culture at BJC Healthcare, Chellie Butel, director for patient safety and BJC Healthcare, and Lauren Beechly, director of healthcare client consulting at Perceptyx, took part in a webinar to discuss  safety culture in high-reliability healthcare organizations and how to measure it to ensure the best possible work environment for employees.

What is Safety Culture in High-Reliability Organizations?

High-reliability organizations are often in industries with a high-risk of causing harm or accidents, such as nuclear power, aviation, and healthcare. While these organizations are high-risk, they are also continuously working to create a safer environment and mitigate any chance of injury, harm, or accident. Emphasizing a safety culture in high-reliability organizations starts at the top but is prioritized at all levels throughout the organization. 

As Anne Marie Benedicto noted in the webinar, many healthcare organizations are on the path to high reliability, but none have achieved it yet. High reliability in healthcare is a three-pronged model. It requires leadership to be committed to ensuring zero harm. It requires a safety culture in which all staff are empowered to speak up if they see something go wrong or potentially dangerous. And lastly, there must be a robust process improvement system in place that takes a data-driven approach to complex problem solving. Without all three, a healthcare organization is not functioning at a high-reliability model, which is why so many organizations are prioritizing their safety culture and measuring it to ensure their employees, patients, and visitors get the best care in the best environment.  

The Joint Commission Center for Transforming Healthcare defines safety culture as “the sum of what an organization is and does in the pursuit of safety. It is the product of individual and group beliefs, values, attitudes, perceptions, competencies, and patterns of behavior that determine the organization’s commitment to quality and patient safety.” And as Benedicto mentioned, it starts with trust. To have a truly safe environment in which people feel empowered to speak up, you must have trust in leadership, trust in your colleagues, and trust that you will be listened to, respected, and your concerns acted upon. Organizations can monitor their safety culture through surveying employees, creating and enforcing a code of conduct, formalizing a feedback loop, and sharing and acting on results.

Understanding Safety Culture in Your Organization

While it’s important to understand your organization’s safety culture and the areas that may need improvement, the options for measuring organizational safety are limited. To get a well-rounded view of today’s healthcare employee experience, measurements need to include clinical and non-clinical staff, provide input for both manager- and employee-led priorities, and address physical as well as psychological safety and its impact on employee engagement and retention. It also needs to be done with processes and measures approved by the Joint Commission. 

BJC Healthcare looked at this challenge as an opportunity to change the way they listened to their employees. Eggleston explained that BJC, “transitioned from conducting large-format, traditional employee surveys every 12 to 18 months to adopt a pulse employee listening strategy.” This was done with the goal of increasing employee engagement and creating a positive work experience that would, in turn, result in a positive experience for patients.  

When implementing this new listening strategy, BJC focused on the user experience. Since they are in a high-stress, patient-focused industry where time is short, it was important to them that the survey solution be easy to use, quick yet comprehensive, and would not keep the employees away from their roles for too long. They decided to implement a 16-question or less survey that could be completed in five minutes, and be accessed from both a mobile device and a desktop computer. 

“We’re able to see the results in real-time if we choose to, and there’s also a crowdsourcing feature that pairs two different suggestions and allows caregivers across our organization to do pairwise voting and quickly prioritize the most popular responses,” Eggleston said. “So now, instead of a one-time survey, we have a cultural practice of listening to our team members.” 

After the initial survey, they are able to act on the feedback and check back in with employees to see how they are performing on those actions. Eggleston points out how this new methodology helps build the trust that is essential for building a strong culture of safety. 

“It moves us from compliance for managers, to a true culture of listening and acting, and transparency around those actions,” she said. 

Transforming to a High-Reliability Organization Through Listening to Employees

For BJC, understanding their safety culture by surveying their employees is key to achieving their goal of becoming a high-reliability organization.

Chellie Butel, director for patient safety and BJC Healthcare, discusses this is great detail in the webinar, but the big takeaways are that BJC needed a process for routinely listening to employees, it needed to be quick and accurate, and they needed to be able to access the results in real time. It was also important to use a tool that all employees, not just patient-first caregivers, could use and access. This included office staff and all employees across the healthcare system. BJC chose to partner with Perceptyx to develop their own safety culture survey.

They chose to focus on the concepts that were important to BJC as an organization, such as psychological safety, teamwork, continuous Improvement, and an overall safe care assessment question. Again, they wanted to keep it short (ending up with just 13 questions in total). They wanted it to include items from other surveys that presented opportunities. They also made sure the questions were worded in a way that made sense for both clinical and nonclinical staff. 

The results were successful. They beat their participation goal by 6% with more than 10,000 employees completing the survey in the two weeks it was open. BJC had an overall positivity score of 76%, which is the total percentage of positive responses across all the questions. With their open-ended, crowdsourced question, utilizing Dialogue from Perceptyx, they had more than 9,500 responses of suggested actions, and more than 66,0000 votes. 

An Innovation in Safety Culture Measurement for Healthcare

By looking at their own team and developing a thorough safety culture survey, BJC has created a new way to measure safety culture in healthcare. While they are the innovators, it is a method that can be replicated across other organizations, and it can help more healthcare systems get the information and employee feedback they need to achieve their goal of becoming a high-reliability organization. 

One of the most unique aspects of the BJC survey was the addition of the crowdsourcing question. The open-ended question allows employees to suggest solutions to key safety challenges while surfacing real issues that employees on the front line were struggling with.

“Crowdsourcing is a powerful method of listening when we’re looking for actionable data that co-creates solutions with our team members,” said Lauren Beechly of Perceptyx. … “It’s a gamified and engaging experience that prioritizes how to act based on the feedback from our front line.”

In addition to creating the survey, BJC and Perceptyx also needed to ensure that it was a validated solution to measuring safety culture. They did this by comparing survey results from the BJC survey to the AHRQ survey. Perceptyx found that the new survey is highly correlated with AHRQ, which tells us that this is an effective measuring tool. The data Perceptyx gathered also found that the new survey takes less than half of the time to complete as compared to AHRQ, saving 3,500 hours annually. Additionally, the BJC survey is 75% less likely to elicit a missing or “not applicable” response compared to AHRQ. Overall, Perceptyx found that the survey is valid, reliable, actionable, inclusive, and meaningful. 

This is just a snapshot of the great information shared in the webinar. To get the full view of the new survey methodology and how BJC benefited from it, watch the webinar on-demand.

For more information on how your healthcare organization can measure its safety culture with this innovative new survey, please reach out to our healthcare experts.

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