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A tool developed by ÂÜÀòÊÓƵprovided both a benchmark and a measure of progress for a major quality improvement initiative at Evanston Northwestern Healthcare (ENH). The tool—the Hospital Survey on Patient Safety Culture—was used in the labor and delivery units at ENH's three-hospital system based in Evanston, Illinois.

The ÂÜÀòÊÓƵsurvey allows hospitals, nursing homes, and ambulatory medical offices to assess their current patient safety cultures. It also helps providers track changes in patient safety over time and evaluate the impact of patient safety interventions. In addition, the survey allows hospitals and hospital units to compare their performance in creating a culture of patient safety to other organizations of similar size.

Ian Grable, MD, MPH, Director of the Center for Maternal and Fetal Health, expected that staff at the hospital system would rate the hospital's patient safety culture highly. It's typical, he notes, for staff members "to think we're doing everything right." A similar perception of patient safety existed at Beth Israel Deaconess Medical Center in Boston, he recalled, where Grable practiced before arriving at ENH.

After the results of the survey of ENH staff were tallied, however, specific areas such as staff perception of safety, teamwork, and communication emerged as areas for improvement. Results were "clearly not an issue of patient safety," according to Grable. But they did raise issues of staff perceptions of safety that the hospital began to address in October 2006, using a team training program.

Courses in teamwork were given to staff in labor and delivery units over a two-week period at two of ENH's hospitals. All staff involved in the patient care process—including physicians, nurses, technicians, and administrative staff—underwent the training.

Six months after completion of the teamwork training course, ENH staff took the ÂÜÀòÊÓƵsurvey again. In every single category, staff reported "significant improvement" compared to their responses to the first survey, Grable says. "We were tremendously impressed by the improvements" noted in each category, he continues. "We felt that overall safety was improved."

In the short term, Grable advises hospitals to do two things to sustain recent improvements in patient safety. The first is to share the results of surveys or data on adverse outcomes within a department. "Show staff the areas where they have been successful or need improvements so that everyone knows what has been accomplished. That is really important."

Teamwork training is based on training programs used in the aviation industry since the late 1970s to improve the safety of flight crews. Research conducted by the National Aeronautics and Space Administration has identified human error, often spurred by lapses in communication or teamwork, as the cause of the majority of aviation accidents. Teamwork training programs emphasize the role of human factors in high-stress situations and typically use teamwork, simulation, group debriefings, and performance measurement of staff.