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27-29 March 2019 Glasgow SEC Centre, Scotland Conference Proceedings People Make Change

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27-29 March 2019 Glasgow SEC Centre, Scotland Conference Proceedings People Make Change 27-29 March 2019 Glasgow SEC Centre, Scotland Conference Proceedings People Make Change internationalforum.bmj.com @QualityForum #Quality2019 We have always believed that everyone should get involved in improving healthcare, and our mission at the International Forum on Quality and Safety in Healthcare has always been just to do that - make healthcare improvement simple, support effective innovation and provide practical ideas that can be implemented in the workplace. The Conference Proceedings contains work submitted to us via our Call for Posters for this year’s International Forum taking place in Glasgow on 27-29 March 2019. The work volunteered by abstract authors for inclusion in this booklet is a reflection and a celebration of what the global quality improvement community has achieved over the past few years. You will find many projects from teams in countries such as the UK, the Netherlands, Denmark, Saudi Arabia, Australia, Brazil and many more. Thank you to all those who have shared their work and have made it available in this digital format. We hope you enjoy this selection of abstracts and will join the International Forum improvement community to share your experiences, challenges, improvement successes and failures at our future events. Find out more about future International Forums at internationalforum.bmj.com. A management tool to improve patient safety culture in primary care, Aarhus Municipality Denmark Call for Posters - Building Capability and Leadership Ane Blom, Maya Damgaard Larsen, Nikoline Rytter City of Aarhus Denmark Background Aarhus Municipality works continuously with quality improvement in the elderly care e.g by developing a management tool to improve patient safety culture (PSC). PSC is considered fundamental for the delivery of safe care and can be described as an aggregation of individuals’ behavior, habits, norms, values and basic assumptions related to patient care. Literature shows that leadership frames the quality of the culture under which the staff practices safety. However, culture is a complex phenomenon. As a manager, a tool to identify PSC can be useful to get insight into the culture. Despite that primary care is the most rapidly growing segment of the healthcare sector, studies of PSC are mostly conducted in hospital settings resulting in a significant knowledge gap in primary care. However, this study shows how a Safety Attitude Questionnaire (SAQ), developed for hospital settings, can be tested and adjusted to primary care and used for identifying quality improvement activities. Methods The primary target group was managers and frontline staff in elder care. The intervention was a twostep process of 1) quantitative SAQ-DK questionnaire and 2) a qualitative follow-up concept. SAQ-DK questionnaire: 10 validated questions from the Danish translation of SAQ were selected (SAQ- DK). For each question explanatory texts were written, and pilot tested to ensure full understanding in an elder care setting. The questionnaire was distributed by e-mail to frontline staff and their managers in 7 nursing home units and 2 home care teams. Follow-up concept: is a three-step structured process with high level of staff involvement. This gives managers and staff a platform enabling dialogue about their culture and enabling how to prioritize improvement activities. The result is a driver diagram. Outcome Average response rate of the SAQ-DK was 87.11% Follow-up concept showed that 7 out of 9 units participated in a facilitated workshop and the improvement activities were structured in local driver diagrams. One manager from a nursing home expressed that “…the actual measurement gives me an insight into where we can benefit from development and improvement”. Qualitative assessment showed that the managers have taken lead and chosen dedicated staff members to implement the improvement activities according to the model of improvement. The units follow their improvement activities with local result and process indicators. A manager expresses that: “improvement activities and culture may be a fluffy size but with the SAQ we express what we can work with in the daily improvement work. It has improved both the workflows and the working environment, and at the same time it has meant that the elderly gets a better care". Conclusion Our results showed that using SAQ-DK in elder care can help initiate systematic quality improvement activities and contribute to enhance PSC. However, building a PSC needs a clear leadership focus. Leaders need to enable the staff to take ownership and allow quality improvement activities in their day-to-day practice. Perception of nursing work environment differentiated according to educational level Call for Posters - Building Capability and Leadership Annemarie (JBM) de Vos, Ellen Olsthoorn Amphia Hospital, Nursing Council, Breda, The Netherlands Brigitte (JM) de Brouwer Accuralis Zorgoptimalisatie, Geldrop, The Netherlands Background The increasing intensity of patient care requires that the nursing capacity and quality have to be increased. Moreover, in order to attract and retain academically trained nurses, creating a healthy and productive working environment is essential. Sufficient and skilled nurses, good relationships with doctors, autonomy, team leader support, control over professional practice, and patient-oriented care culture are positively associated with patient outcomes, such as pressure ulcers, infection, delirium, malnutrition, patient satisfaction and mortality. The appropriate deployment with regard to all CanMEDS roles and level of education do justice to competencies of both academically (hbo) and vocational trained (mbo-inservice) nurses, without over-demanding and under-utilization them. New nursing profiles in The Netherlands assign the management role, coordination and care improvements to academically trained nurses and the protocol-based individual patient care to vocational trained nurses. Thus far, it is not known what the perception is of the nursing staff in the Amphia Hospital on the characteristics of the work environment, such as autonomy, control over professional practice, and relations with doctors. In addition, insight into the differences and similarities between the various educational levels is lacking. The aim of this research is to obtain insight into the perception of hbo, inservice and mbo trained nurses regarding the work environment. The results will provide input for the implementation of the new nursing profiles in the Amphia Hospital in 2019. Methods The Dutch Essentials of Magnetism II was used to measure the work environment of nurses and to identify the strong aspects and the improvement options. This instrument measures eight characteristics of an attractive and productive work environment, which nurses consider important to deliver good quality care: (1) Working with skilled colleagues, (2) Good relations with doctors, (3) Autonomy, (4) Team leader support, (5) Control over professional practice, (6) Education opportunities, (7) Sufficient staff and (8) Patient-oriented care culture. In addition, the perception on the quality of patient care, the overall job satisfaction, and the professional job satisfaction were measured. Outcome Almost two third of all nursing professionals (ntotal=1349) in Amphia (61,8%; n=834) completed the questionnaire. The major part was inservice trained (40%), followed by mbo (28%), and hbo (28%). Hbo- nurses are most positive in comparison to mbo- and inservice nurses regarding seven of eight characteristics (Table 1). Yet, inservice nurses score higher than higher hbo-nurses on the characteristic 'Sufficient staff'. Mbo-nurses score lowest on six of the eight characteristics. Conclusion All nurses, regardless of educational level, indicate that they are satisfied with their work. Hbo- and inservice nurses, however, have a more positive perception on the work environment than mbo-nurses. This is due to the fact that mbo-nurses have a significantly more negative picture than the hbo- and inservice nurses on 'Team leader support', 'Control over professional practice', 'Sufficient staff', and the result variables 'Quality of patient care' and 'Professional job satisfaction'. In addition, hbo-nurses are significantly more positive about the professional competence of colleagues than mbo- and in-service nurses. These results imply that the improvement potential for hbo-, inservice and mbo-nurses lies in different areas. In order to ensure the correct application of all CanMEDS roles, implementation trajectories in the context of function differentiation should take into account the differentiated perception on the working environment, depending on the level of education. Optimising Strength and Resilience in Healthcare Staff Call for Posters - Building Capability and Leadership Anne-Marie Doyle, Anna Bootle, Elizabeth Haxby The Royal Brompton and Harefield NHS Foundation Trust, London, England Myra Hunter King’s College, London, England Background There is growing recognition of staff work-related stress and links between leadership, staff health & well-being, quality & safety, and organisational culture. The latest national staff survey (2018) showed 39.8% of staff were unwell as a result of work-related stress, the highest rate in 5 years. The aim of the research was to evaluate the efficacy & acceptability of a new group programme for staff entitled ‘Optimising Strength and Resilience’ designed to increase staff knowledge, skills and confidence managing stress/distress and to improve
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