How a new approach to employee surveys is helping BJC HealthCare encourage a 'speak-up' culture and improve safety — 5 learnings

Maintaining a strong safety culture is an important goal for healthcare organizations, but the listening methods most commonly used to gain insights on where organizations fall short, and how they can improve, isn´t very effective.

During a February Becker's Hospital Review webinar sponsored by Perceptyx and moderated by Lauren Beechly, Ph.D., director of healthcare customer consulting at Perceptyx, three experts on safety culture discussed a new approach to employee surveys that elevates the employee voice and enables leaders to make swift, inclusive and meaningful improvements. Panelists included:

  • Anne Marie Benedicto, vice president, The Joint Commission Center for Transforming Healthcare
  • Chellie Butel, system director for patient safety, St. Louis-based BJC HealthCare
  • Brooke Eggleston, director of learning and development, BJC HealthCare

Five learnings:

  1. Safety culture is a key component of high reliability organizations. In healthcare, a high reliability organization — or HRO — is one that maintains consistently high levels of safety and quality across all services and settings, with zero harm events of any kind. "Transformation to high reliability is possibly the greatest change management challenge that any healthcare organization team will undertake," Ms. Benedicto said.

Such transformation depends on the adoption of three interrelated domains of change: leadership, robust process improvement and safety culture. Safety culture is a core element in industries that operate in high hazard domains, such as nuclear power, commercial airlines and healthcare. Its hallmark is that everyone — from the C-suite to the front line — speaks up when they see something that will or might go wrong, without fear of retribution.

  1. Intimidating behaviors threaten the performance of healthcare teams and undermine a culture of safety. Behaviors such as intimidating language, gossip and bullying can lead to burnout, disengagement and turnover. A culture that tolerates such behaviors and punishes those who report them erodes trust, hinders collaboration and prevents learning from errors.
  1. Employee surveys can measure and help to improve safety culture, but they often have flaws. Traditionally, surveys assessing safety culture are conducted infrequently, take too long to act on, are too top-down driven and focus only on clinicians' views. More frequent surveys that include all staff and whose results are used to quickly act on feedback are a better alternative. "It moves us from a compliance [culture] into a true culture of listening and acting and transparency," Ms. Eggleston said.
  1. More flexible and employee surveys focus on a few key domains and are fast to complete. For BJC HealthCare, those key domains included psychological safety, teamwork and continuous improvement. These domains served as the organizing principle for the 13-questions survey, which took an average of just five minutes to complete and garnered nearly 11,000 responses.

BJC's survey also included an open-ended, more subjective question that asked respondents, “What is one action your leader and/or team can take to make it more safe to speak up? "There were such great, well-thought-out responses on that subjective piece that we really encourage folks to look at," Ms. Butel said.

  1. Crowdsourced insights help organizations co-create solutions on issues that matter most. Traditional employee surveys that include an open-ended question often end there. The Perceptyx solution goes one step further by presenting responses provided to those open-ended questions in pairs, and asking respondents to prioritize those actions by voting. "It creates a gamified experience and a great channel for listening to team members that co-creates and helps prioritize how to act, based on feedback from the front line," Dr. Beechly said.

Employee surveys that involve all staff in generating solutions to safety issues, and that clearly demonstrate how that feedback drives improvements, can foster an environment of psychological safety that encourages speaking up. For organizations that aspire to high reliability, nurturing this level of trust paves the way for attaining HRO status.

To view an on-demand recording of the live presentation, click here.

To register for upcoming Becker’s webinars, click here.

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