Safer Culture Roadmap

A roadmap for your journey to creating an effective patient Safer Culture

Organizations can use this roadmap to guide individuals’ groups’, and leaders’ efforts to improve Safer Culture by understanding assessing, measuring, and improving all of the components required for an effective patient Safer Culture.

Safer Culture Roadmap overview

 

About the Project

An Emerging Roadmap for Patient Safer Culture

Strategies to Improve Perinatal Care

Medical errors are a leading cause of death
Every year more hospital patients die from medical errors than from car crashes, breast cancer, or AIDS. Medical errors have recently been estimated to be the third leading cause of death in the U.S. Since efforts to improve patient safety began in earnest in 2000, some areas of healthcare are safer, but errors and preventable patient harm remain far too frequent across all healthcare areas.

Perinatal safety is of particular concern
Although the majority of childbirths in the US result in healthy infants and mothers, serious adverse events are occurring at steadily increasing rates, resulting in devastating outcomes for infants, mothers and families. According to the Centers for Disease Control (CDC), there were 17.2 deaths per 100,000 live births in 2015, compared to 7.2 deaths per 100,000 live births in 1987.  Pregnancy-related complications result in increased days in the hospital and are about 50% as costly as uncomplicated births, accounting for $17.4 billion in annual US hospital costs. Some events are unavoidable or have increased risk due to pre-existing conditions; however, estimates suggest that 30% to 60% are preventable. Neonates are particularly vulnerable to medical errors. With reported rates as high as 74 neonate events per every 100 patients, 56% or those are considered preventable.

Improvement requires a “total systems approach” and “culture of safety”
The National Patient Safety Foundation concluded that a “total systems approach” is required to improve perinatal outcomes, and that leadership must establish a “culture of safety.”  Experts agree that improving patient safety will require a transformation of the culture of the healthcare industry.

The term patient Safer Culture refers to the values, norms, and beliefs about the role organization and employees play in ensuring positive patient health outcomes. A positive patient Safer Culture may be associated with fewer adverse events in hospitals.  Culture dictates healthcare leader and provider behavior and attitudes, and it sets the social rewards or punishments associated with specific actions.

Pre-existing frameworks have been incomplete and ineffective
Existing frameworks fail to distinguish factors that influence Safer Culture from Safer Culture itself, or the behaviors and health outcomes that result from a Safer Culture. These frameworks also fail to include all the known factors related to a safe culture. Given these limitations, efforts to improve Safer Culture have met with mixed results. For example, current improvement efforts begin with baseline measurements that use surveys of clinicians that only measure attitudes and perceptions — the safety climate. But Safer Culture assessment requires a more comprehensive assessment including not only the attitudes and perceptions (climate), but also the behavioral norms, values, and assumptions.

Introducing an evidence-based framework and complete set of tools
The healthcare community critically needs a comprehensive and evidence-based approach to improving and sustaining patient Safer Culture. That’s why the University of Texas Health Center, March of Dimes, and Moore Foundation have partnered to develop an evidence-based framework for building Safer Culture, and have created tools to help healthcare organizations measure and improve their cultures.  This framework and its accompanying tools provide a new roadmap for Safer Culture that can ultimately reduce preventable harms.

 

Why we focus on perinatal care

Tragedies such as preventable maternal deaths highlight the urgency for healthcare organizations to adopt cultures of care that promote safety for patients. Our Safer Culture framework is generalizable to all areas of healthcare, but our initial work centers on improving Safer Culture perinatal care because of recent research highlighting serious concerns about perinatal patient safety.

 

In the US between 2000 and 2014, the maternal death rate increased 26.6%, higher than most developed countries. With an average of 700 women dying every year from pregnancy- or childbirth-related causes, it is estimated that 60% are preventable.  In addition, infants suffer high rates of preventable harms in neonatal ICUs. National organizations such as ACOG, AAP, IHI and others are leading specific interventions to improve specific areas of perinatal safety, but for these interventions and others to reach their potential, organizations must improve their overall Safer Culture. Our intention is to provide a roadmap for health care systems, institutions, and providers that enables them to choose a route forward compatible with their existing goals. We also aim to help them sustain a culture that enables all contributors to enact perinatal safety best practices, improving outcomes for both mothers and babies.

Intended Audience

Who should use this roadmap?

Many types of healthcare professionals will find this roadmap helpful, especially leaders of patient safety and quality initiatives in healthcare organizations — or anyone responsible for developing initiatives affecting the culture of an entire organization. These could include:

  • Organizational leaders, quality improvement, or patient safety officers wanting to lead their organization to improve overall Safer Culture
  • National leaders wanting to promote maternal and infant health, such as policy makers, public health leaders, and regulators

As we refine and expand the roadmap, there will also be valuable content for clinicians or managers wanting to learn more about how to improve Safer Culture within their organization or unit; and researchers wanting to test, refine, and revise the framework and related tools to improve Safer Culture.

About Us

University of Texas Health Science Center Houston / Children’s Memorial Hermann Hospital Contributors

KuoJen Tsao, MD, Principle Investigator. Dr. Tsao is a Professor of Pediatric Surgery and Vice-chair of Quality and Safety in the Department of Pediatric Surgery at the University of Texas Health Science Center. He has served as the principal investigator and executive director for the March of Dimes perinatal safety center (MOD PCS). He is a pediatric surgeon trained in maternal-fetal surgery. Academically, he is a quality improvement and patient safety expert that has been the PI on several funded patient safety initiatives. Dr. Tsao has directly supervised the research and the training & comparative analytics cores. He’s been responsible for the developing and supervising the partnerships with healthcare organizations, educational institutions, and industry.

Eric J. Thomas, M.D., Sub-Investigator. Dr. Thomas is a Professor in the Department of Internal Medicine, Division of General Internal Medicine at the University of Texas Health Science Center. Dr. Thomas is the Director of the UT Houston-Memorial Hermann Center for Healthcare Quality and Safety and is Associate Dean for Healthcare Quality. Since 1992 he has conducted research on patient safety and his work was heavily cited in the Institute of Medicine’s landmark report on medical error. Dr. Thomas’ current research focuses on diagnostic errors, measuring safety culture, measuring and improving teamwork, and the use of health information technology to improve quality and safety. Dr. Thomas contributed his expertise and knowledge in safety culture and had direct involvement in the evolvement safety culture roadmap.

Madelene Ottosen, PhD, MSN, RN, Sub-Investigator. Dr. Ottosen is an assistant professor with the Cizik School of Nursing at UT Health and a faculty member with the UT Houston-Memorial Hermann Center for Healthcare Quality and Safety (CHQS). Her research interests lie in the exploration of organizational safety culture, the involvement of patients and family in patient safety and healthcare quality improvement and the use of qualitative and mixed methods research designs. She has developed patient and family focus groups at Children’s Memorial Hermann Hospital. Dr. Ottosen’s efforts on this project have primarily been in contributing her expertise and knowledge in safety culture, continued research in various areas of the safety culture roadmap and website.

Sue Lesser, PhD, MSN, RN-BC. Dr. Lesser is a Quality Improvement Specialist in the Department of Pediatric Surgery at UTHealth McGovern Medical School. Dr. Lesser has decades of experience as a clinical nurse. She has been licensed in four states, and has experience in academic and community hospitals, in urban and rural settings. Her passion has always been for mothers and babies. Her specialty focus is Maternal/ Child Nursing, Quality Improvement and Professional Development. Her experience includes NICU, LDRP and home health nursing. She taught Lamaze childbirth preparation classes for nineteen years. Dr. Lesser’s efforts has been devoted to the evolvement of the safety culture roadmap and website through her continued research. She has expertise in qualitative and patient-centered research.

Maryam Broussard, BS, MHA. Ms. Broussard is a Program Manager in the Department of Pediatric Surgery at UTHealth McGovern Medical School. She received her bachelor’s in science at the University of Houston followed by her Master’s in Healthcare Administration at the University of Houston-Clear Lake and is a certified clinical research professional. She has over 15 years of experience in healthcare in various roles including translational, human subjects, and clinical trial research as well as project management. Ms. Broussard has overseen the March of MOD PSC program and participated in various areas of research.

Nutan Hebballi, BDS, MPH. Ms. Hebballi is a Senior Research Associate in the department of Pediatric Surgery at UTHealth McGovern Medical School. Ms. Hebballi received her Master of Public Health in Epidemiology from The University of Texas School of Public Health, Houston and Bachelor of Dental Surgery from Rajiv Gandhi University of Health Sciences, Bangalore, India. She is a certified Project Management Professional and Six Sigma Green Belt. Ms. Hebballi has assisted in various areas of research for the MOD PSC roadmap and website development. Her research focuses on quality data acquisition.

Elisa Garcia, BSN, RN. Ms. Garcia is a Research nurse in the Department of Pediatric Surgery at UTHealth McGovern Medical School. Prior to nursing school, Ms. Garcia worked in Fetal Medicine research and in the Pediatric Surgery outpatient clinic. Ms. Garcia worked on several subprojects for the March of Dimes Perinatal Safety Center.

Kendra Folh, MSN, RN-OB, is a project manager in pediatric quality and safety at Children’s Memorial Hermann Hospital. She is an experienced registered nurse with a demonstrated history of working in the hospital & health care industry focusing on the obstetric population. Kendra has experience in project management focusing on clinical effectiveness, quality, and safety projects. She is a system lead project manager in clinical redesign of obstetric APR-DRG workstream, clinical effectiveness, and cost reduction. Ms. Folh is a member of various quality improvement communities and has been an asset in the collection and dissemination of key data.

Nana Ama E. Ankumah, MDAssistant Professor, Department of Obstetrics, Gynecology and Reproductive Services at the University of Texas Houston McGovern Medical School

Clara Ward, MDAssistant Professor, Department of Obstetrics, Gynecology and Reproductive Services at the University of Texas Houston McGovern Medical School

Susan Wootton, MDAssistant Professor, Department of Pediatrics at the University of Texas Houston McGovern Medical School

Mary Austin, MD, MPHAssistant Professor in both the Department of Pediatric Surgery at the University of Texas Houston McGovern Medical School and UT M.D. Anderson Cancer Center

Patti Heale, DNP, RNC-OBClinical Nurse Specialist, Children’s Memorial Hermann Hospital

Paige Del Castillo, BSN, RNC-OBDirector of Women’s Services, Children’s Memorial Hermann Hospital

 

Rice University / Safety Science Experts

Eduardo Salas, PhD
Professor and Chair at Rice University’s Department of Psychological Sciences

Tiffany M. Bisbey, MA
Graduate Researcher and Doctoral Student, Industrial and Organizational Psychology, Rice University

Molly Kilcullen, MA
Graduate Researcher and Doctoral Student, Industrial and Organizational Psychology, Rice University

 

Roadmap Project Expert Panel (Reviewers)

Suzanne McMurtry Baird, DNP, RNC-OB
Co-Owner and Nursing Director, Clinical Concepts in Obstetrics, LLC

Susie Distefano, MSN, RN
Chief Executive Officer, Children’s Memorial Hermann Hospital

Siobhan Dolan, MD, MPH
Professor and Vice Chair, Research Department of Obstetrics & Gynecology and Women’s Health Montefiore Medical Center / Albert Einstein College of Medicine

Donald Dudley, MD
The William T. Moore Professor and Director Division of Maternal-Fetal Medicine University of Virginia

Karen E. Harris, MD, MPH
Ob/Gyn Program Director HCA/UCF Consortium, Gainesville, Florida

Karen Kendrick, MSN, RN
Vice President, Clinical Initiatives Texas Hospital Association Foundation

David Lakey, MD
Vice Chancellor for Health Affairs and Chief Medical Officer the University of Texas System

Kathy Luther, MPM, RN
Director of Quality, UT McGovern Medical School Partners

Eugene Toy, MD
Professor of Obstetrics and Gynecology at the University of Texas Houston McGovern Medical School.

 

Leadership Advisory Council

Barbara Stoll, MD
Dean of the University of Texas Health Science Center Houston McGovern School of Medicine

Kevin Lally, MD
A.G. McNeese Chair in Pediatric Surgery, Richard Andrassy Distinguished Professor and Chairman of the Department of Pediatric Surgery and Interim Chairman of the Department of Pediatrics at the University of Texas Health Science Center

Sean Blackwell, MD
Professor and Chairman of the Department of Obstetrics and Gynecology and Reproductive Services at the University of Texas Health Science Center and director of the Larry C. Gilstrap, M.D., Center for Perinatal and Women’s Health Research at UTHealth McGovern Medical School

Amir Khan, MD
Professor at the University of Texas Health Science Center Houston McGovern School of Medicine and Medical Director of Children’s Memorial Hermann Hospital NICU, Respiratory Care, and Transport Team

Susie Distefano, MSN, RN
Chief Executive Officer, Children’s Memorial Hermann Hospital

 

Patient and Family Advisory Council

Paige D. Mellor
Pamela A. Merhan
Crystal Needham
John D. Needham
Chris Peterson
Jennifer Peterson
Susana M. Rosas

Funded by the Gordon and Betty Moore Foundation through the March of Dimes

Webinars

Click the link to view the recording.

August 20, 2020 – Safer Culture Roadmap: Strategies to Improve Perinatal Patient Safety

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