Staff survey on culture improves patient safety at LifePoint Health

In 2012, LifePoint Health got serious about creating a culture of safety among its workforce.

The year before, the Brentwood, Tenn.-based hospital chain was one of 26 providers selected by the CMS to reduce patient harm at their organization by 40% in three years as part of the Partnership for Patients Initiative.

LifePoint leaders recognized that a vital way to achieve that lofty goal was to ensure staff members were engaged in the effort.

“There's a clear body of evidence that shows if you want to prevent patients from being harmed you have to focus deeply on the people who care for those patients,” said Barbara Olson, vice president of clinical improvement and healthcare safety at LifePoint.

So, in order to understand how interested and attuned staff were to patient-safety issues, LifePoint decided to partner with Pascal Metrics, a quality measurement company, to create a survey. All LifePoint employees including physicians, environmental service staff and nurses, are asked to complete the survey every 18 months. Across 72 hospitals, the hospital chain has 43,000 employees. There is an 80% response rate.

The survey asks questions about teamwork, communication and motivation to solve issues. In 2014, LifePoint decided to combine the safety culture survey with its engagement survey to limit survey fatigue.

LifePoint is able to analyze the results by unit at each of its hospitals. Olson said each unit has its own unique culture and set of concerns to address.

Unit-level leaders, along with the hospitals' human resources department and social workers, hold meetings to discuss the findings and work toward solutions. All leaders have been trained on debriefing skills and listening tactics. “It was a skill we wanted to bring to each one of our hospital units and departments,” said Dr. Rusty Holman, LifePoint's chief medical officer.

The meetings can be emotionally “heavy,” Holman said. Staff are encouraged to bring up issues that may be uncomfortable or frustrating. The hope is vulnerabilities will be exposed so solutions can be found. Sometimes personal issues are brought up as well. Those conversations often resulted in staff being told about LifePoint's employee-assistance program.

Holman admitted that “a process like this makes an organization vulnerable.” By encouraging staff to come forward with grievances, the pressure is on for the organization to follow through with solutions or risk eroding trust with the staff. “The worst thing you can do is expose these things and never deal with them,” he said. Holman has noticed that staff who were quiet during the initial meetings have become more talkative and open as they see their concerns are taken seriously by administrators.

Hospital unit leaders are given the leeway and resources to be innovative on solutions plaguing their team.

The results from the surveys have spread beyond just department-based solutions. The senior leadership team has put in place systemwide changes as well. The leadership team noticed that a consistent problem brought up in the surveys was inadequate communication among clinical staff.

“There was a feeling that things that were solvable just got kind of stuck,” Olson said.

To address that, LifePoint implemented five evidence-based practices across all its hospitals: morning huddles, additional huddles when something doesn't seem right, debriefs at the end of every shift, senior leadership rounds on each unit, and learning boards on units to keep track of outstanding issues.

“This isn't going to solve everything, but at least you can get to a place where teams can routinely communicate and solve the easy things,” Olson said.

LifePoint has since seen the work culture improve. Staff members report they find it easier to learn from errors and they work better together as a team.

Overall, LifePoint's performance on the survey's teamwork and safety climate index rose 29% since 2012. The hospital chain also achieved a 62.5% reduction in patient-harm events from 2011 to 2017. The reduction involves various patient-safety measures like falls, infections and blood clots.

“It's remarkable what can be done when you have an entire organization focused on the same thing,” Holman said.