Novak Adam
Michigan Health and Hospital Association Keystone Center, Okemos, MI.
J Healthc Risk Manag. 2019 Jul;39(1):19-27. doi: 10.1002/jhrm.21360. Epub 2019 Apr 12.
Fostering a culture that empowers staff to speak up when concerned about the quality or safety of patient care is both an ethically and economically responsible endeavor. The Michigan Health & Hospital Association (MHA) Keystone Center has implemented the Speak-Up! Award program that acknowledges frontline health care staff for voicing their concerns and making care safer. The objective of this effort was to advance patient safety in Keystone Center member organizations through widespread, measurable culture improvement. After extensive data collection and analysis, there was a discernable improvement in culture survey results across a 2-year period coinciding with the launch and sustainment of the award program. Furthermore, in an effort to demonstrate the power of speaking up among staff, the Keystone Center applied a cost-savings framework to the types of harm avoided. Results from the cost-savings analysis suggest that each instance of speaking up by staff saves patients, families, and health care organizations an average of more than $13,000.
Keystone Center Speak-Up! Award nominations were submitted through an electronic form that collects open, closed, and Likert-type question responses, producing a data array on type and severity of harm prevented, as well as the difficulty and magnitude of the decision to speak up. All data were then coded by harm type and subsequently applied to a tailored version of the cost-savings estimation framework used in the Great Lakes Partnership for Patients Hospital Improvement and Innovation Network. Safety culture was measured through the use of a survey instrument called the Safety, Communication, Operational Reliability, and Engagement (SCORE) instrument.
The Keystone Center Speak-Up! Award program received 416 nominations across the 2-year study period, of which 62% (n = 258) were coded as a specific harm type. Adverse drug events (n = 153), imaging errors (n = 42), and specimen errors (n = 27) were the most common harm types prevented by speaking up. After applying the cost-savings framework to these data, it is estimated that for every instance of speaking up, approximately $13,000 in total expenses were avoided, which is in line with the findings from a report on the economic impact of medical errors sponsored by the Society of Actuaries. Furthermore, culture survey results improved by 6% between 2015 and 2017, coinciding with the Keystone Center Speak-Up! Award program.
The Keystone Center Speak-Up! Award has proven to be a valuable tool in recognizing staff awareness and willingness to raise concerns about quality and safety in health care. Data analysis from this program presents evidence that fostering a psychologically safe culture of speaking up yields fiscal and humanistic returns, both of which are crucial to sustainable, meaningful progress in safety and quality. However, further research is required to adequately gauge the degree to which safety culture improvement is proportional to cost savings.
营造一种让员工在担心患者护理质量或安全时能够直言不讳的文化，是一项兼具道德和经济责任的努力。密歇根医疗与医院协会（MHA）基石中心实施了“直言不讳！”奖励计划，该计划表彰一线医护人员表达他们的担忧并使护理更安全。这项工作的目标是通过广泛的、可衡量的文化改进，在基石中心成员组织中推进患者安全。经过广泛的数据收集和分析，在与该奖励计划的启动和持续实施相吻合的两年时间里，文化调查结果有了明显改善。此外，为了证明员工直言不讳的力量，基石中心将成本节约框架应用于避免的伤害类型。成本节约分析结果表明，员工每次直言不讳平均为患者、家属和医疗组织节省超过13,000美元。
基石中心“直言不讳！”奖励提名通过电子表格提交，该表格收集开放式、封闭式和李克特式问题的答案，生成关于所预防伤害的类型和严重程度以及直言不讳决定的难度和重要性的数据数组。然后所有数据按伤害类型进行编码，并随后应用于大湖患者医院改进与创新网络使用的成本节约估计框架的定制版本。安全文化通过一种名为安全、沟通、运营可靠性和参与度（SCORE）工具的调查工具进行衡量。
在为期两年的研究期间，基石中心“直言不讳！”奖励计划共收到416项提名，其中62%（n = 258）被编码为特定伤害类型。药物不良事件（n = 153）、影像错误（n = 42）和标本错误（n = 27）是通过直言不讳预防的最常见伤害类型。将成本节约框架应用于这些数据后估计，每次直言不讳可避免约13,000美元的总费用，这与精算师协会赞助的一份关于医疗错误经济影响的报告结果一致。此外，2015年至2017年期间，文化调查结果提高了6%，这与基石中心“直言不讳！”奖励计划相吻合。
基石中心“直言不讳！”奖励已被证明是一种有价值的工具，可用于认可员工对医疗保健质量和安全提出担忧的意识和意愿。该计划的数据分析表明，营造一种心理上安全的直言不讳文化会产生财务和人文回报，这两者对于安全和质量的可持续、有意义的进展都至关重要。然而，需要进一步研究以充分衡量安全文化改进与成本节约成正比的程度。
